EVALUATION INNOVATING FOR CHILD HEALTH: AN EVALUATION OF AN INTEGRATED CARE GROUP MODEL IN RWANDA September 2015 This publication was produced at the request of the United States Agency for International Development. It was prepared independently by Anbrasi Edward, Johns Hopkins University, with contributions from Melene Kabadege, Deborah Dortzbach, Carmen Umutoni, Rhona Murungi, Rachel Hower, and Allison Flynn, World Relief Rwanda ICSP Final Evaluation Report September 2015 Page 2 of 997 Photo Credit: Emily Hunn, University of British Columbia. Mothers practice responsive feeding their children with thick porridge at a Nutrition Week session INNOVATING FOR CHILD HEALTH—AN EVALUATION OF AN INTEGRATED CARE GROUP MODEL IN RWANDA EFFECTIVENESS OF AN INTEGRATED CARE GROUP MODEL AND OPERATIONS RESEARCH ON NUTRITION WEEKS TO IMPROVE HEALTH AND NUTRITIONAL STATUS OF CHILDREN IN NYAMAGABE DISTRICT, RWANDA September 15, 2015 AID-OAA-A-11-00056 DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. Rwanda ICSP Final Evaluation Report September 2015 Page 2 of 997 CONTENTS Contents.................................................................................................................................................................................................... 2 Acronyms.................................................................................................................................................................................................. 3 Evaluation Purpose and Evaluation Questions................................................................................................................................. 9 Evaluation Purpose ......................................................................................................................................................................... 9 Evaluation Questions..................................................................................................................................................................... 9 Project Background ..............................................................................................................................................................................11 Findings, Conclusions, and Recommendations..............................................................................................................................20 Findings............................................................................................................................................................................................20 Conclusions....................................................................................................................................................................................29 Recommendations........................................................................................................................................................................30 References......................................................................................................................................................................................33 Annexes...................................................................................................................................................................................................34 Annex 1. List of Publications and Presentations Related to the Project .................................................... 34 Annex 2. Work Plan Table .................................................................................................................................... 35 Annex 3. Rapid CATCH Table ............................................................................................................................. 39 Annex 4. Final Knowledge, Practices and Coverage Report ........................................................................ 43 Annex 5. Community Health Worker Training Matrix............................................................................... 350 Annex 6. Evaluation Scope of Work ................................................................................................................ 351 Annex 7. Evaluation Methods and Limitations .............................................................................................. 363 Annex 8. Data Collection Instruments............................................................................................................ 367 Annex 9. Sources of Information ...................................................................................................................... 434 Annex 10. Disclosure of Any Conflicts of Interest....................................................................................... 436 Annex 11. Statement of Differences ................................................................................................................ 441 Annex 12. Evaluation Team Members, Roles, and Their Titles................................................................. 442 Annex 13. Final Operations Research Report............................................................................................... 443 Annex 14. Stakeholder Debrief PowerPoint Presentation ......................................................................... 823 Annex 15. Project Data Form............................................................................................................................ 834 Annex 16. Year 3 (MTE) KPC Report............................................................................................................. 857 Annex 17. Optional Annexes............................................................................................................................. 987 Annex 18. Qualitative Data Findings............................................................................................................... 991 Annex 19. Summary Of Project Activities......................................................................................................996 Rwanda ICSP Final Evaluation Report September 2015 Page 3 of 997 ACRONYMS BCC Behavior Change Communication CBNP Community Based Nutrition Program CG Care Group CHW Community Health Worker CSP Child Survival Program CSHGP Child Survival Health Grants Program DIP Detailed Implementation Plan FGD Focus Group Discussions FY Fiscal Year EOP End of Project GMP Growth Monitoring and Promotion ICSP Innovation Child Survival Project ICG Integrated Care Group IYCF Infant and Young Child Feeding KII Key Informant Interview KPC Knowledge Practice Coverage LOE Level of Effort MCSP Maternal and Child Survival Project MNCH Maternal Newborn and Child Health MOH Ministry of Health NGO Non Governmental Organization NW Nutrition Weeks OR Operations Research PBF Performance Based Financing SOW Scope of Work UBC University of British Columbia USAID U.S. Agency for International Development VNC Village Nutrition Committee WR World Relief September 2015 Innovating For Child Health—An Evaluation of an Integrated Care Group Model in Rwanda, Executive Summary This project was funded by the U.S. Agency for International Development through the Child Survival and Health Grants Program. September, 2015 Evaluation, Purpose, and Evaluation Questions The purpose of the World Relief (WR) final evaluation was to make strategic contributions to advance the health system strengthening goal of the Rwandan Ministry of Health. The findings provide key recommendations to achieve sustained improvements in child survival and equitable health outcomes, through innovative, integrated community-oriented and people￾centered health care systems.1 The mixed methods evaluation provides quantitative findings from key performance indicators and evidence of project investments and success from a multi-stakeholder assessment. The primary audience for the findings is the district and national Ministry of Health, the Global Health Initiatives and other development agencies. A brief synopsis of the evaluation themes are listed below: 1. Describe the achievement of Project Goals and Objectives as illustrated in the Detailed Implementation Plan (DIP), project strategies, outputs and outcomes. 2. Examine key factors that contributed to the outcomes, and project management mechanisms that were effective and challenges in program execution. 3. Specify sustainability factors and implications for scale up of program strategies and interventions. 4. Determine effectiveness of the Integrated Care Groups (ICG) in achieving health outcomes. 5. Describe outcomes of operations research on Nutrition Week (NW) interventions and integration into existing Community Based Nutrition Program Strategy Nyamagabe ICSP Evaluation Team Key Findings: • Significant improvements resulting from Nutrition Week interventions on key nutrition and health indicators • Evidence of successful integration of the Care Group model in the existing community based and health system architecture • Improved male participation resulting from community engagement FINAL EVALUATION EXECUTIVE SUMMARY September 2015 Project Background The goal of the Tangiraneza “Start Well” Innovation Child Survival Project (ICSP) was to reduce morbidity, mortality, and improve nutritional status of children under five and pregnant women in Nyamagabe District, Southern Province, Rwanda. The project’s objective was to improve capacity of Ministry of Health (MOH) staff and Community Health Workers (CHWs) to implement high impact maternal, newborn and child health interventions at the community level. Strategies were designed to support the MOH implementation of community health interventions with the following level of effort (LOE): nutrition (40%), maternal newborn care (35%), diarrhea (15%) and pneumonia (10%). Project Intermediate Results : 1. Improve geographic access to and demand for high-quality maternal, newborn and child health (MNCH) services. 2. Improve coordination and impact of community health activities. 3. Develop Nutrition Weeks (NW) Innovation and conduct Operations Research to test effectiveness. WR Rwanda (WRR) was one of the Care Group (CG) model pioneers during the first WRR CSP from 2001 – 2006 in Kibogora, eventually scaling up in other districts in modified form. As government CHW cadres were established with specific roles, the Integrated CG (ICG) was innovated in Nyamagabe. ICGs include three CHWs, the head of the village, a religious leader, three village leaders in charge of social affairs, information and community development, the women’s leader, and a representative of the hygiene club. ICGs were established in the entire Nyamagabe District, both Kaduha and Kigeme hospital zones, to implement maternal, newborn, and child health interventions. All training materials were developed with the Nutrition Technical Working Group (NTWG) and the district health team and aligned with the community-based nutrition program (CBNP) and global and national standards and priorities. Aside from training, ICSP staff met regularly with the ICGs to review progress, address challenges and institute problem solving measures. Home visits and community meetings were conducted monthly by the ICG team to reinforce the Behavior Change Communication (BCC) messages, improve facility-based service utilization— especially growth monitoring and promotion (GMP)—and promote kitchen gardens. In collaboration with the University of British Columbia (UBC) and the MOH, the project conducted an Operations Research study to test the Nutrition Weeks (NW) innovation. NW was implemented in Kaduha with Kigeme as the comparison. The NW concept uses a supportive group education technique based on the Positive Deviance/ Hearth Nutrition strategy, but targets all children in the first 1,000 days of life, not just malnourished children. Nutrition Weeks cycles are conducted by the Village Nutrition Committees (VNC), comprised of CHWs and village leaders. Evaluation Questions, Design, Methods, and Limitations The project employed both empirically designed quantitative methods using the cluster sampling for annual knowledge, practice and coverage (KPC) household surveys and qualitative research methods using focus group discussions and key informant interviews. The OR study used a quasi-experimental design using standard statistical measures for sample estimations, based on outcome measures with adequate power. The hospital zone with the worst health indicators at baseline was selected for the intervention site. Instruments were designed with stakeholders, translated and field tested. IRB approvals were obtained annually from the Rwanda National Ethics Committee to ensure compliance to all ethical considerations for human subjects research. The KPC surveys were limited by cluster sampling which may be biased towards wealthier households because poorer residents at the periphery of the community may not be selected. In addition, a design effect must be applied to the analysis in order to account for within-cluster homogeneity. Inherent bias due to the purposive selection and subjective responses from qualitative research are known, though information obtained from stakeholder perspectives on the program makes valuable contributions to compliment and triangulate information from quantitative findings. September 2015 Findings and Conclusions Results from the mixed methods evaluation showed that a majority of the child health targets were achieved. Households with soap at the place of handwashing increased from around 40% in both areas to 85% in Kaduha and 77% in Kigeme; point-of-use water treatment increased from 50% to 79% in Kaduha and from 56% to 67% in Kigeme. Infants visited by an appropriately trained health worker within 2 days of birth increased from less than 50% to 97% in Kaduha and 99% in Kigeme; mothers reporting four or more antenatal care (ANC) visits increased from about 47% to about 60% in both areas; those accessing care in the first trimester and skilled birth attendance also increased. Care seeking for pneumonia increased from baselines around 45% to 63% in Kaduha and 66% in Kigeme. Results from the OR study are impressive and have enormous policy implications for Rwanda’s nutrition agenda. A statistically higher proportion of children 6-23 months achieved a Minimum Acceptable Diet1 (MAD) when exposed to the Nutrition Week intervention, compared to those not exposed [a linear probability model (LPM) found that compared to not being exposed to Nutrition Weeks, the probability of achieving the MAD was 23% greater when a child was exposed to Nutrition Weeks (p<0.001). Results for Minimum Dietary Diversity2 and Responsive Feeding3 were similarly statistically significant. Minimum Meal Frequency4 increased to over 60% from baseline levels less than 10% in both intervention and comparison areas. Age appropriate introduction of complementary foods5 also increased. Complementing the standard MOH CBNP strategies of large group health education and cooking demonstrations during growth monitoring and promotion (GMP) sessions, Nutrition Weeks provided hands on practice and group support to improve feeding practices of children under 2 years. Qualitative findings highlighted the potential financial and management constraints of sustaining the Nutrition Weeks strategy, as it requires intensive efforts initially to establish the community structures for enhancing food availability and feeding practices. Despite the stated limitations for scale up requiring strategic engagement and oversight of both district health teams and communities, the study indicates the effectiveness of both the ICG and Nutrition Weeks innovation tested in this project. As Rwanda launches strategic innovations to enhance service delivery architecture, the findings offer key complementary mechanisms for achieving a people-centered health care model. Project results were shared with the Rwanda MOH, but it is not clear whether Nutrition Weeks will be added to the CBNP. Nutrition Weeks and Care Groups were included in a 2015 USAID Rwanda Mission RFA for eight districts. Nutrition Weeks has been adapted for use in WR programming in Indonesia and Malawi. The creative engagement of communities, through ICGs, offers unique solutions to the global workforce crises and a viable prototype for adaptation in other health care contexts. With the international efforts for reducing poverty, the alleviation of child malnutrition continues to remain a high priority. The Nutrition Week innovation offers a unique forum for creating community accountability and ownership and joint governance by communities and districts to inspire local solutions. The Tangiraneza in Nyamagabe District, Rwanda, is supported by the American people through the United States Agency for International Development (USAID) through its Child Survival and Health Grants Program. The Tangiraneza Project is managed by World Relief under Cooperative Agreement No. AID-OAA-A-11- 00056. The views expressed in this material do not necessarily reflect the views of USAID or the United States Government. For more information about Tangiraneza, visit: https://icsprwanda.wordpress.com/ 1 BF children 6-23 months who had at least the minimum dietary diversity and minimum meal frequency during previous day. Non-BF children who received at least 2 milk feedings and had at least the min. dietary diversity not including milk feeds and the min. meal frequency during previous day 2 Proportion of children 6-23m who consume at least 4 of the following food groups the previous day: Grains, roots and tubers; Legumes and nuts; Dairy products(milk,yogurt,cheese); Flesh foods(meat,fish,poultry& liver/organ meats); Eggs; Vit-A rich fruits & vegetables; Other fruits & vegetables 3 Percent of Caregivers who assist child when eating (of children who consume soft, semi-solid or solid foods). 4 Proportion of BF and non-BF children 6-23 m who receive solid, semi-solid, or soft foods the minimum number of times or more the previous day. For BF children, the minimum number of times varies with age (2 times if 6-8 mos.; 3 times if 9-23 mos.). For non-BF children, the number of times does not vary by age (4 times for all non-BF children 6-23 mos.) Dairy products only count toward the numerator for the non-BF children. 5 Proportion of infants 6–8 months of age who receive solid, semi-solid or soft foods. Rwanda ICSP Final Evaluation Report September 2015 Page 9 of 997 EVALUATION PURPOSE AND EVALUATION QUESTIONS EVALUATION PURPOSE The purpose of the final evaluation is to contribute to the global priority for cost effective, innovative strategies to improve child health in disadvantaged communities. More importantly it complements and addresses the health system strengthening goals of the Rwanda MOH for achieving sustained improvements in child survival and health outcomes in vulnerable populations through community￾oriented programs and systems. The USAID CSHGP cooperative agreements are structured to demonstrate the evidence of strategic interventions through outcome measures. Findings from the performance evaluation are shared with a wide community of development stakeholders, including policy and program entities in the national and sub-national sectors in the government of Rwanda, multilateral and bilateral donors, including the USAID Mission, NGOs operating in the health sector, the CORE Group consortium of US-based NGOs and other global initiatives. The evaluation was designed to integrate learning opportunities for all project stakeholders. Project accomplishments and strategic feedback on project value and performance from participants at all levels was obtained. These included mothers and caregivers, other community members and opinion leaders, health workers, health system administrators, local partners, other organizations, and donors. Independent evaluations are rigorously designed to provide unbiased inferences of project performance and help determine the effectiveness of the strategies employed, accounting for all project investments and other contextual factors. The project has been conducting both quantitative and qualitative assessments since the project inception in both intervention and comparison sites. Performance was documented through key nutrition and health indicators annually, along with qualitative assessments to inform program implementation. Though the ICSP project team had already completed the final KPC, the evaluation team leader led the final qualitative evaluation using IRB-approved focus group and key informant interview guides. Draft documents of the KPC report [Annex IV], and operations research study [Annex XIII], were shared with the lead evaluator prior to the field visit. The evaluator was approved by USAID. The final evaluation scope of work [Annex VI] was modified several times, to accommodate recent changes in the USAID evaluation criteria. The evaluator reviewed existing project data and reports prior to conducting the qualitative evaluation with key stakeholders to determine project effectiveness and challenges and provide strategic recommendations for follow up and integration into national priorities. EVALUATION QUESTIONS 1. To what extent did the project accomplish and/or contribute to the results (goals/objectives) stated in the Detailed Implementation Plan (DIP)? • What is the quality of evidence for project results? How were results achieved? If the project improved coverage of high-impact interventions simultaneously, what types of integration enabled this? Specifically, refer to project strategies and approaches and construct a logic model describing inputs, process/activities, outputs, and outcomes. Describe the extent to which the project was implemented as planned, any changes to the planned implementation, and why those changes were made. Rwanda ICSP Final Evaluation Report September 2015 Page 10 of 997 2. What were the key strategies and factors, including management issues, that contributed to what worked or did not work? • What were the contextual factors (such as socioeconomic factors, gender, demographic factors, environmental characteristics, baseline health conditions, health services characteristics, and so forth) that affected implementation and outcomes? What capacities were built, and how? Were gender considerations adequately incorporated into the project, either at the design phase or midway through the project? If so, how? Are there any specific gender-related outcomes? Are there any unintended consequences (positive and negative) related to gender? 3. Which elements of the project have been or are likely to be sustained or expanded (e.g., through institutionalization or policies)? • Analyze the elements of scaling-up and types of scaling-up that have occurred or could likely occur (dissemination and advocacy, organizational process, costs and/resource mobilization, monitoring and evaluation using the ExpandNet resource for reference).* Additional Questions: 1. How effective are Integrated Care Groups in helping achieve changes in maternal and child health outcomes in their communities? Should ICGs be replicated? What modifications would increase their effectiveness? a. Are the members of the ICGs doing what is expected of them, including home visits? (Even the different local leaders?) If not, is a different profile of member needed, or possibly differentiation made between different types of members and their expected duties? (Perhaps some are included because of their influence in other realms and others are included because they will actually be the boots on the ground? Are all households reached?) The MOH is looking for ways that heavily burdened CHWs can leverage the energy of others in the community (not just anyone, but “existing structures” – which the ICGs do). Learning from this has the potential to influence the work that MCSP is currently planning in Rwanda as well. 2. Did Nutrition Weeks add value to the MOH Community Based Nutrition Protocol (CBNP), and if so, what were the key elements that made them work? a. Were there significant improvements in nutrition outcomes among the households exposed to ICGs alone compared to the households exposed to ICGs and Nutrition Weeks? If so, what are they? b. Did Nutrition Weeks improve functioning of the CBNP? If so, how? Considering all Ministry priorities, is there a cost benefit to Nutrition Weeks? c. Which parts of the Nutrition Weeks curriculum are most effective? Are there certain parts that have greater impact than others? d. Is nutrition information reinforced differently by ICGs in Kaduha compared to Kigeme (since Kaduha has the Nutrition Weeks experience)? If so, how? * http://expandnet.net/PDFs/ExpandNet-WHO%20Nine%20Step%20Guide%20published.pdf Rwanda ICSP Final Evaluation Report September 2015 Page 11 of 997 PROJECT BACKGROUND RWANDA HEALTH SYSTEM OVERVIEW In the past two decades Rwanda has made dramatic improvements in revamping its health infrastructure to deliver high quality health care, resulting in a doubling of life expectancy, 80% reduction in deaths due to Human Immunodeficiency Virus (HIV), tuberculosis (TB) and malaria, and lowering maternal mortality by 60%. Health expenditure per capita is $56 for a population of 11 million people [2,3]. Aside from the enormous investments in equipping hospitals and health centers, Rwanda falls far below the minimum level recommended by the World Health Organization (WHO) of 2.3 providers per 1000 population at 0.83. However, 45,000 CHWs offer basic empirical diagnosis and treatment services, in addition to general health promotion. They have been instrumental in the control of infectious diseases and the reduction of costs. Efforts to successfully enhance service delivery include: 1) universal health coverage through the mutelle de santé preventing catastrophic spending by impoverished households at the lowest wealth quintile through subsidies, and 2) effectively addressing equity and quality of care through the performance-based financing system. However, even with the fastest annual reduction in child mortality in the world, Rwanda still faces challenges of sustaining these gains and addressing the disease burden due to pneumonia and diarrhea. Pneumonia accounts for 18% of under five deaths and diarrhea accounts for 8% [4]. Though Rwanda has demonstrated significant progress towards the Millennium Development Goals, the unfinished agenda for malnutrition and safe water remain. Almost 34% of children under five are anemic [5] and 30% of households do not have access to an improved water source [6]. Chronic childhood malnutrition also remains high at 44.2% for stunting, based on data from 2010. CARE GROUP MODEL IN RWANDA The Care Group (CG) model is a successful evidence-based community innovation strategy [7-10]. Rwanda was one of the early pioneers to experiment with the CG model when WR introduced it in 2001, through its USAID Child Survival Program in the former Kibogora health district, eventually scaling up to other districts [Fig 1]. The model has been adapted in over 60 health and nutrition programs by 27 NGOs, in 23 countries [11]. Figure 1. Scale up of Modifications of the CG Model in Rwanda Rwanda ICSP Final Evaluation Report September 2015 Page 12 of 997 Figure 3. Integrated CG Model The model employs an innovative, cost-effective, community-based strategy for universal coverage of health and nutrition education interventions through volunteers selected and managed by communities. Based on the success evidenced in other settings and previous projects in Rwanda, both the Kabeho Mwana project and this project adapted the model in response to MOH requests to support its CHWs and to work exclusively with existing human resources in the community. Each iteration of the model took into consideration what was then current as well as corresponding project goals and objectives. In this project, the CG model was innovated to integrate the existing health system community architecture, by training the MOH staff at the district level, CHWs, and local leaders (Fig 2). The project established 536 Integrated Care Groups (ICG)†, one in each village of Nyamagabe District. Ten members comprised the ICG in each village. Three of the members were MOH CHWs. Two of the CHWs known as Binomes, one male and one female, were trained in child health. One CHW was trained in maternal health and known as the animatrice de santé maternelle (ASM). Additional members included community representatives most closely associated with behavior change. These are the Social Affairs In-Charge at village level, the elected village leader (usually male), the village Information and Training In-Charge, the village Community Development Leader, the Women's Group Leader, a member of the Village Hygiene Club, and a religious leader (Fig 3). The ICG members met together monthly to receive training on health promotion messages and to support each other. Each CG member is allocated a certain number of households for the BCC home visit and follow up. Their functions also include the collection of vital events data and reporting to the district MOH (Fig 4). Capacity building and supervisory oversight is provided by the district team health and social affairs staff, WR project team and community entities (Fig 5). Data are collected every month by the ICG members, compiled at cell level and shared with the facility in charge. This is used for the CHW cooperatives for the Performance Based Financing (PBF). The data are integrated with the Health Management Information System (HMIS) and sent to the district hospitals. Some data are also collected by rapid SMS through CHW mobile phones. The facility and hospital data are password protected and the WR project teamobtain the information from the district. The project monitoring and evaluation officer maintains the database and synthesizes the information for supervision, problem solving and generation of reports. † The project used the term “Modified Care Group” (MCG) in earlier documents but “Integrated Care Group” better describes the innovation. Figure 2. Strategic Stakeholder Engagement Rwanda ICSP Final Evaluation Report September 2015 Page 13 of 997 Figure 5. Supervisory and Technical Oversight of Health Interventions PROJECT AND OR DESIGN The overall strategy of the Tangiraneza Innovation CSP was to train MOH staff, CHWs and local leaders in ICGs for interventions in nutrition, maternal and newborn care (MNC), diarrhea and pneumonia. As described above, ICG members allocated all the households of pregnant women and children under two years in their villages amongst themselves for home visits and community meetings for BCC. Although CHWs retained their specialized MOH roles, uniting them into an ICG helped them work together, and, with the additional ICG members, they were able to more effectively mobilize the community to adopt key family health practices. The CSP supported MOH policy for vital events data collection: ASM CHWs reported births and pregnancies and Binomes reported under-five deaths. Other ICG members supported them by collecting the data during home visits. The core interventions in the project’s technical approach were: Nutrition (40% LOE, with Operations Research surrounding an innovation for community-based nutrition education called Nutrition Weeks methodology), Maternal and Newborn Care (35%), prevention and treatment of Diarrhea (15%) and prevention and treatment of pneumonia (10%). The overall project goal, strategic objectives, and intermediate results are displayed in Table 1. Table 1. Project Results Framework Project Goal: To reduce morbidity, mortality and undernutrition of children under five and pregnant women in Nyamagabe District of Rwanda. Strategic Objective: Improve capacity of MOH staff and CHWs to implement high impact maternal, newborn and child health interventions at the community level. IR 1. Improved geographic access to and demand for high-quality MNCH services IR 2. Improved coordination and impact of community health activities IR 3. Develop Nutrition Weeks Innovation and conduct OR to test effectiveness Activities: Activities: Activities: 1) Build capacity of Community Health Supervisor and Hygienists from all 16 Health Centers as TOT trainers who will train CG in all CSP interventions. 2) Train Cell-Coordinators and Cell Social Affairs in-charges to supervise integrated CG 1) CHWs, religious leaders and community representatives meet monthly in integrated CG to: • Make action plans based on data reported by CHWs; 1) Conduct Operations Research comparing standard CBNP activities vs. CBNP plus ‘Nutrition Weeks’ intervention. Evaluate impact with regard Figure 4. Integrating Community Information in District Statistics Rwanda ICSP Final Evaluation Report September 2015 Page 14 of 997 comprised of CHWs, village and religious leaders. (3-10 integrated CGs per cell) 3) Train leaders of integrated CG to train their peers in BCC for all interventions: Nutrition, MNC, Diarrhea and Pneumonia. The Social Affairs in-charge at the cell level will train CHWs for Nutrition Weeks, and support the CHW Coordinator in BCC/ community mobilization. 4) Train Kaduha area CBN Village Committees with the ‘Nutrition Weeks’ innovation. 5) Train 536 maternal health CHWs (ASM) in MNC package. • Cross-train in BCC for key family practices based on barrier analysis and BCC strategy; • Coordinate regular home visits • Improve referral to appropriate CHW and/or health facility. 2) Build capacity of Sector and Cell level In-Charge of Social Affairs to support BCC. 3) Mobilize churches to assist vulnerable households with kitchen gardens & tippy taps. to cost and feasibility for scale-up. 2) Participate in Nutrition Technical Working Group; solicit input and share findings. 3) Improve CHWs records and reporting system for nutrition. The project prioritized nutrition as one of the key interventions for the operations research, as high levels of stunting were reported in Nyamagabe district compared to the already high levels reported nationally (53.5% vs 44%) [12]. In Rwanda, stunting is not restricted to the poorest households, as 26% of the richest households are also stunted. The annual cost of under nutrition is estimated at 503.6 billion Rwandan Francs. As the prevalence of stunting peaks at 18-24 months, the project targeted pregnant women and children between 0-23 months to align with the goal of UNICEF’s 1000 day intervention strategy from conception to 23 months [13]. To align with the national policies for eliminating malnutrition, strategies for addressing under nutrition include the Community Based Nutrition Program (CBNP), which focuses on growth monitoring and promotion. However, as in other global experience, the ‘promotion’ component is weak with few cooking demonstrations primarily due to lack of protocols and district support [14]. CHW training varied greatly and there was little evidence on stunting impact. Based on the learning and the success evidenced from the integration of the positive deviance Hearth model (PD/Hearth) in previous projects in Rwanda, WR designed an innovative approach for preventing malnutrition using strategic interventions focusing on nutrition education messages, cooking and feeding practice, counseling and follow up home visits, building on the distinctive characteristics of the CBNP and PD/Hearth strategy, while ensuring close supervision. This intervention approach, termed as ‘Nutrition Weeks’ was implemented only in Kaduha Hospital catchment area, and was tested through an Operations Research Study designed as a quasi-experimental two-arm study with the existing national CBNP program serving as the comparison. In Kigeme Hospital catchment area, the project supported the CBNP by strengthening GMP sessions through CHW training, provision of materials for cooking demonstrations and nutrition education delivered by ICGs. The Nutrition Weeks strategy targets all households with pregnant women and mothers of children under two years for prevention of malnutrition, unlike the PD/Hearth strategy, which targets only malnourished children and their caregivers for community-based recuperation. The Nutrition Weeks strategy also involves fathers and alternate caregivers in some activities. Standard research procedures and informed consent were obtained from all participants, following the IRB protocols. Community meetings were held prior to each cycle and leaders and community members received information on the interventions. Both hospital zones, Kaduha and Kigeme, received the standard CBNP interventions, but Kaduha was purposively allocated to receive the Nutrition Weeks interventions as it had the poorest nutrition indicators. Population characteristics for each hospital zone are described in Table 2. Rwanda ICSP Final Evaluation Report September 2015 Page 15 of 997 Table 2. Population Profile for Nyamagabe District by Hospital Catchment Area Kaduha Kigeme District Total Population 161,743 168,767 330,510 WRA 15-49y 54,531 56,900 111,431 Children 0- 59m 20,218 21,096 41,314 0-11m 4,044 4,219 8,263 12-23m 4,044 4,219 8,263 24-59m 12,132 12,657 24,789 Source: Nyamagabe District Statistics 2011 Aside from addressing the prevention of undernutrition, the Nutrition Weeks strategy differs from the CBNP in many dimensions. In the CBNP strategy, the CHWs are expected to create their own educational messages from their MOH nutrition curriculum materials, have too much information in the curriculum, are not knowledgeable about the nutritive value of foods, and address caregivers of all under five children. Nutrition Weeks focus on key infant and child feeding practices (IYCF), foster participation of mothers and fathers in the cooking demonstrations addressing barriers to adopting behaviors, and, more importantly, phase the educational messages with a step by step implementation guide for CHWs. Nutrition Weeks eventually empower communities as its members begin to build self efficacy in acquiring the food commodities, preparation of foods, and joint problem solving. The project worked with nutrition experts to review current evidence and also performed rigorous formative research and market surveys to construct the key messages and practices (Box 1). Households with pregnant women or children under two were invited to attend a two hour participatory group education session every day for one week, three times per year, each group consisting of 10-12 participants. At the conclusion of the week, participants also received a poster as a reminder for meal frequencies, food variety, and other nutritional messages. The activities were led by the CHWs with support from the VNC, which included the village leader. This team was responsible for the follow up of these participants. Other community mobilization strategies were designed to engage leaders, including pastors, other community groups etc. Though the cooking ingredients for NWs were purchased by the project during the initial phases, the responsibility was eventually assigned to the community. Some Nutrition Weeks participants (about 17%) formed community associations to produce or purchase the ingredients, though this was not an intended project strategy. This included kitchen gardens and raising small animals for sale or consumption. The comprehensive project strategy had to be executed similar to a symphony orchestra to ensure equity and authentic participation by all concerned stakeholders. The strategy included: ICG, health promotion and education on IYCF, GMP, screening and referral of children, Nutrition Weeks, promotion of kitchen gardens, fruit trees, and small animal rearing, community oversight and supervision with active linkages and information system strengthening with the district team. Capacity building occurred at all levels of the system (Table 3). Partnerships were created with various organizations working in the district but the key partner was the district health team, hospitals and health centers. Box 1. Nutrition Week Content Key Messages • Prepare thicker porridge with palm oil + three different kinds of flour • Give animal foods if possible • Improve feeding frequency Key Practices • Making and Eating Thicker Porridge • Eating Fat and Animal-Based Foods • Increasing Frequency of Meals • Eating a Variety of Foods • Improving Hygiene Practices • Infant Stimulation and Feeding • Increasing food intake for pregnant women • Increasing rest for pregnant women Rwanda ICSP Final Evaluation Report September 2015 Page 16 of 997 Table 3. Stakeholder Capacity Building Strategies PARTNERSHIPS/COLLABORATION USAID Washington and Mission and the MCSP project have been engaged closely since the project inception, supporting the design of the KPC instruments, assistance with programming of the software for tablet data collection, OR guidelines, inclusion of key staff in workshops and webinars, and support from the Evidence Project on developing OR reports and communicating research findings to policy audience. Feedback on final evaluation documents, advocacy and invitation to the theory of change workshop were also critical supportive activities. A site visit by the 3-member USAID Mission team was especially appreciated by the WR staff and the partners. The project partnered with Dr. Judy McLean, University of British Columbia, as Principal Investigator (PI), and her students, to implement the OR. Dr. Fidele Ngabo, former Director of Maternal and Child Health Unit of the Rwanda MOH, was the other PI of the OR study. The Rwanda MOH Nutrition Technical Working Group was closely engaged in the program design and in submission of the research protocols to the national ethics committee. PROJECT IMPLEMENTATION All project activities have been conducted according to the workplan described in the DIP and are summarized in Annex II. However, the MOH requested refresher training on verbal autopsy and death audits, and support to the health centers for follow up on CBNP, hence these were added to the workplan. All educational materials, evaluation tools and instruments used in the project were either validated previously or were reviewed and endorsed by the MOH, IRB and OR researchers. Reports were submitted monthly, quarterly, or annually to various internal and external project stakeholders. Monitoring of the program activities was routinely performed through various quantitative and qualitative reporting mechanisms, including attendance in meetings, trainings, feedback loops for improving Nutrition Weeks based on experiences, behavior change, and barriers. For example, incorporating three types of flour in weaning food was not feasible for mothers, so the message was changed to one flour (whichever was available); men’s attendance in meeting and Nutrition Weeks was low, as they did not perceive the value; and community leaders were mobilized to encourage participation. Tables 4 describes the sequencing of the OR interventions. Project Stakeholders Project Capacity Building Strategies National MOH (2012, 2013) Mebendazole supplies Hospital Staff (CHS, Nutrition supervisor, M&E, data manager, Hygienist supervisor) Health Center (In charges of CHW, Hygiene, data mangers, nutritionist) Master Trainer and TOT – Jointly with MOH Technical: MNCH package, iCCM, Nutrition including IYCF, GMP, Nutrition Weeks (Kaduha) Care Group Leader Training, Principles of Adult Education, Community Mobilization Methods, Community based information systems, BCC Workshop for SMS reporting – mhealth, Data Analysis CHWs Supplies, Storage Cupboard, Mother counseling cards, posters, educational materials, weighing scale (Unicef), record sheets, vessels for cooking demonstrations Care Group Joint Supervision support and Home visits Incentives; Hoe, basins for hygiene, small animals; pig, goats Community and associations (Hygiene Club, Women’s Council, Social Affairs in Charge, Community In Charge, Development in charge, Communication in charge Recipe for nutrition week participants Mothers association for animal husbandry (for households with children who were malnourished at project midterm) Training of VNC for animal rearing Rwanda ICSP Final Evaluation Report September 2015 Page 17 of 997 Table 4. Sequencing of OR Interventions Phase Objective Product Desk review of DHS, publications on nutrition from Rwanda Design of Instruments and analysis plan for qualitative data collection, and determine BCC messages OR evaluation instruments and analysis plan Market Survey Determine availability and cost of local food and related supplies for cooking demonstration Market survey report, and nutritive values Positive deviance inquiry using semi structured interviews and observations in the community Identify mothers with a well-nourished 6-23m child from a low SES and feeding practices Development of positive deviance tool and process based on standard approaches to Positive deviance Development of CHW training materials for Nutrition week, pilot testing, and knowledge evaluation instruments Standardize training materials and knowledge evaluation questions. Pilot testing with 30 CHWs Training materials designed, pretested and pre-post tests conducted with CHWs Interviews with mothers from Nutrition Weeks To refine activities based on mothers feedback Finalized activity plans Baseline survey design Design of instruments Conduct and analyze KPC results Implement Nutrition Weeks interventions thrice yearly Training and support to CHW to conduct Nutrition Weeks BCC Models Design Annual KPC Conduct evaluations Analyze data and report findings, address gaps in performance EVALUATION METHODS AND LIMITATIONS Mixed methods evaluation designs are increasingly popular in both clinical and management research. In this approach, quantitative outcome data is complemented by qualitative research contributions that provide in-depth understanding of contextual and other factors affecting the success or failure of the interventions. Valuable insights are made in understanding program performance and the value of the interventions provided by strategic stakeholders. Hence, in compliance with the USAID evaluation policy, the project team designed a mixed methods evaluation which systematically integrated the standard Knowledge Practice Coverage (KPC) survey and qualitative research. The KPC surveys were conducted annually using the KPC 2000+ modules, tailored to match project interventions and integrated with the 2008 Rapid Catch indicators. In addition, the indicator for Minimum Acceptable Diet (MAD) was modified to follow more current international standards. However, the annual survey measured only a subset of highest priority indicators relevant to main project activities, while the other indicators were measured only at baseline and final. The final KPC survey was performed by the WR project staff and health center staff and results shared prior to the evaluator’s visit. Focus Group Discussion (FGD) and Key Informant Interview (KII) guides were designed based on project interventions and type of stakeholder with engagement by the WR staff and the final evaluator and were submitted to the Rwanda National Ethics Committee (IRB) for review and approval [Annex VIII]. The study design was enhanced through KPC surveys performed annually using cluster sampling unlike other projects which monitor progress through the Lot Quality Assurance Sampling (LQAS) scheme. A truly randomized designed of communities would have provided an even more effective model for examining the effectiveness of the Nutrition Week interventions. Rwanda ICSP Final Evaluation Report September 2015 Page 18 of 997 Together with the Principal Investigators, the project designed a quasi-experimental operations research study to test the effectiveness of the Nutrition Weeks strategy using standard statistical measures for determining sample size with adequate power. The design was based on selected outcome measures: proportion of infants and young children 6-23m receiving minimum acceptable diet based on WHO standards (Minimum Acceptable Diet), number of food groups consumed for a 24h period (Minimum Dietary Diversity), minimum meal frequency, timely introduction of complementary food, and proportion of children 6-23m actively fed by caregivers. The evaluation instruments were jointly designed with the stakeholders and translated and field tested prior to the evaluation. IRB approvals were obtained annually from the Rwanda National Ethics Committee to ensure compliance to all ethical considerations for human subjects research. Both the Kaduha and Kigeme hospital zones received the standard CBNP interventions; however, the hospital zone with the comparatively most poor health indicators at baseline (Kaduha) was selected for the Nutrition Weeks intervention. KPC surveys were conducted in each zone annually, using a sample of 360 in each zone at baseline and final and a sample of 300 in each zone in the monitoring years. The larger samples at baseline and final were to ensure an adequate sample of children 0-5 months needed for certain indicators. The surveys used 30-cluster sampling to provide a sample expected to have the precision of a random sample half as large. Even with cluster sampling the principles of randomness continue to be applicable. However, every individual in the community may not have the chance of being selected if sampling proceeds in a randomly determined direction from a central starting point and includes the next cluster of households. It is likely that residents at the periphery of the community, who could belong to the poorest wealth quintile, may not be selected if this method is employed. Inherent bias due to the purposive selection and subjective responses from qualitative research, non-random selection of participants are known. However, qualitative findings from stakeholder perspectives on program effectiveness make valuable contributions to compliment and triangulate information obtained from quantitative findings. A brief summary of evaluation methods and sample for each stakeholder is provided in Table 5. The final evaluation team for the qualitative assessments was comprised of project stakeholders, including representatives from the MOH district team, Kaduha and Kigeme hospitals, a representative from the pastor’s committee, USAID Maternal and Child Survival Program, Concern Worldwide, University of Rwanda, Anglican Church in Rwanda (EAR), African Christian Church Community (CESA) and Catholic Relief Services (CRS) aside from the WR team. A thirty-six member team participated in the final evaluation and teams were assigned to perform assessments in both hospital zones. The field evaluation schedule is illustrated in Annex XVIII. The evaluator conducted a three-day training on principles and methods of qualitative assessments, field survey and quality control procedures. Table 1. Sample Frame for KPC and Final Qualitative Evaluation KPC Evaluation – Caretakers of Children Under 2 years Sample Size Baseline and Final Evaluation 720 (2 30X12 Cluster surveys) Year2, and 3 600 (2 30X10 Cluster Surveys) Final Qualitative Evaluation Stakeholders Kigeme Kaduha Total Participants Nutrition Weeks participants - Mothers (FGD) - 3 30 Nutrition Weeks participants - Fathers (FGD) - 3 29 Nutrition Weeks non-participants – Fathers (FGD) - 3 30 Fathers (FGD) 2 3 48 Mothers (FGD) 2 3 49 ICG (FGD) 2 3 47 (25F, 22M) Village Nutrition Committee (FGD) - 3 13 (7F, 6M) Sector and Cell leaders (FGD) 2 3 42 (13F, 29M) Religious leaders (FGD) 2 3 48 (7F, 41M) Head of Health Center (KII) 2 3 5 (2F, 3M) Rwanda ICSP Final Evaluation Report September 2015 Page 19 of 997 Health Center Staff (FGD) 2 3 29 (17F, 12M) Hospital Teams (Director, nutritionist, CHS) (FGD) 1 1 5 (1F, 4M) DHMT/Vice Mayor, District Health officer 2 (1M, 1F) The measurement instruments focused on multi-stakeholder perspectives and value of the project interventions, potential and challenges to scale up and sustainability, other health care environment factors, and lessons learned for continuing project interventions. Site visits were conducted by the evaluation teams to the hospitals, health facilities and communities to perform FGD and KII, with Integrated Care Groups, leaders, village nutrition committees, participants and nonparticipants of interventions. There were no major impediments to the field implementation schedules and all selected sites were visited. It is also important to note that the Rwandan government had decided to conduct the national nutrition survey during this period and other key stakeholders who had indicated interest in participating in the evaluation were engaged in the planning and execution of the survey. Since the final evaluation was planned in advance, the team solicited the support and permission from the Ministry of Health to conduct the ICSP final evaluation and ensured that there would be no disruption to the ongoing national evaluation. Means or percentages with confidence intervals were generated for the descriptive analysis and linear probability models. P-values were calculated for select nutrition indicators. Clustering was not accounted for, and sample size estimates were not generated for all 40 indicators. In addition, p-values were not generated for all indicators, but 95% confidence intervals were provided using a design effect of two to account for homogeneity between clusters. The KPC report (Annex IV) provides detailed information about the sampling strategy and selection of households and participants, indicating full compliance to standard procedures. There were no major issues with data quality in the collection, analysis and reporting for data, as WRR has extensive experience in conducting these surveys since 2001 and WR HQ prior to 2001 using an earlier version of the KPC. The project team employed a mixed methods strategy from inception to evaluation to inform program interventions, activities, and health education interventions. The methods strategy successfully leveraged the technical and research expertise of both country-level and international experts. The information from the qualitative findings was especially successful in contextualizing the Nutrition Week intervention strategies and messages for improving nutrient intake, and in engaging men in the health, nutrition, and well-being of their children. All the data used in this report were generated from primary data collection in this project. Although anecdotal information was obtained from the district mayor’s office, hospitals and health centers on service utilization and referrals, the survey teams refrained from disrupting the activities of the ongoing nutrition surveys and did not examine district or health records. Additional supportive supervision and mentoring measures were instituted to facilitate the activities in communities and cells that experienced greater challenges due to remote locations or inability to acquire ingredients for the cooking demonstrations. Income generating schemes through kitchen gardens and rearing small animals were developed to support community solidarity, ownership and long term sustainability and to address some of the community specific bottlenecks in project implementation. Rwanda ICSP Final Evaluation Report September 2015 Page 20 of 997 FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS FINDINGS Evidence from the final KPC report, OR Report, and qualitative evaluation findings indicate that both the ICG model and the innovation of the Nutrition Weeks intervention resulted in successful capacity building and health outcomes in both Kaduha and Kigeme. The improvements were higher in the Nutrition Weeks intervention areas especially for nutrition indicators and significantly higher for three of the five selected to measure effectiveness of the OR strategy. One-third of those selected for the KPC survey were in extreme poverty and about two-thirds were classified as poor. Over 80% reported mutuelle (health insurance) membership with 90% in possession of a health insurance card. This was a remarkable finding, as the hospital director and staff reported anecdotal evidence of increasing registration in the insurance schemes due to the effective mobilization of the ICG. The two hospital zones were comparable in terms of population characteristics (tested with chi-squared and t-tests). Table 6. Summary of Inputs, Activities, and Outputs that Contributed to Key Outcomes Project Objective 1: Improved geographic access to and demand for high-quality MNCH services Project Inputs Activities Outputs Outcomes MOH partners Trainers Training Materials TOT and Supervision CHE cell coordinators, cell social affairs in charge, to support 3-10 ICG each 536 Maternal Health CHWs in animatrice de santé maternelle ASM Package Refresher training on iCCM for 1072 CHWs 3 day Master training for facility staff, and 2 day training of CHW in charge – assist health center staff to supervise and support CHWs Train Kaduha CBN Village Committees on Nutrition Weeks interventions Trained Community health supervisors and Hygienists in 16 health centers Established 536 ICG Trained 5114 ICG members Trained 1608 CHWs Increased percentage of children breastfed within 1h of birth, increased introduction of weaning foods, and responsive feeding. Increased percentage of mothers reporting 4+ ANC visits, ANC in 1st Trimester, increased skilled birth attendance Increased percentage of households reporting effective water treatment, soap at handwashing stations, safe feces disposal and toilets in good condition Project Objective 2: Improved coordination and impact of community health activities Project Inputs Activities Outputs Outcomes Community stakeholders CHWs CG Members BCC materials CHWs, religious leaders and community representatives meet monthly in ICG to create action plans based on data reported by CHWs, Cross-train in BCC for key family practices based on barrier analysis and BCC strategy, Coordinate regular Action Plans for follow up Improved Referrals Kitchen Gardens Increased number of households reporting CHW visits, ICG member visits Home visit tool Increased participation in Nutrition Weeks, increased male participation in Nutrition Weeks. Improved referrals (reported by hospital staff) Increased number of Rwanda ICSP Final Evaluation Report September 2015 Page 21 of 997 Figure 7. Minimum Dietary Diversity Figure 6. Minimum Acceptable Diet home visits Improve referral to appropriate CHW and/or health facility. Build capacity of Sector and Cell level In-Charge of Social Affairs to support BCC. Mobilize churches to assist vulnerable households with kitchen gardens & tippy taps. households reporting CHW visits, ICG member and church member visits Increased number of households reporting improved behaviors around nutrition, hygiene, newborn care and pneumonia Churches mobilized to assist vulnerable families with kitchen gardens, tippy taps and small livestock CHW associations formed in 17% of cells for economic support of Nutrition Week activities Project Objective 3: Develop Nutrition Weeks Innovation and conduct OR to test effectiveness Project Inputs Activities Outputs Outcomes Training Materials Nutrition Weeks training Curriculum development Cooking demonstration equipment Design OR study on Nutrition Weeks Participate in Nutrition Technical Working Group; solicit input and share findings. Improve CHWs records and reporting system for nutrition Communities, reporting Kitchen gardens, rearing of small animals, use of produce from kitchen garden for health care or food Customized Nutrition Weeks curriculum Exit Interview tool Increased percentage of children in Kaduha reporting minimal meal frequency, minimum dietary diversity, minimum acceptable diet, consumption of iron rich foods. Decreased prevalence of underweight, wasting and stunting A majority of the indicators targeted by the project exceeded the targets set for the end of project. The most impressive improvements were in nutrition. The intervention area saw a statistically significant improvement in Minimum Acceptable Diet among infants and young children 6- 23 months as compared to the comparison area. Following a four year intervention period (three years for the Nutrition Weeks activities), a linear probability model (LPM) found that compared to not being exposed to Nutrition Weeks, the probability of achieving the MAD was 23% greater when a child was exposed to Nutrition Weeks (p<0.001) (Fig. 6). Likewise, Minimum Dietary Diversity (MDD) more than doubled in the intervention area from baseline to endline, but decreased in the comparison area. An LPM found that compared to not being exposed to Nutrition Weeks, the probability of achieving the MDD was 30% greater when a child was exposed to Nutrition Weeks (p<0.001) (Fig. 7). Minimum meal frequency increased from 7% to 69% in the intervention area and 7% to 66% in the comparison sites, and while these increases were statistically significant, the percent change between the zones was not (Fig. 8). Improvements were evident in age-appropriate introduction of semi solid foods, with no statistically significant differences between Rwanda ICSP Final Evaluation Report September 2015 Page 22 of 997 intervention and comparison sites [Fig. 9]. Responsive Feeding (RF) remained high in both areas, increasing more in the comparison area [Fig. 10]. Breastfeeding within one hour of birth and consumption of iron rich foods also illustrated remarkable improvements in the intervention site, though there was a steady decline in iron rich foods in the comparison site [Fig: 11, 12]. Reported receipt of Vitamin A also declined in both sites in the final evaluation, but this was likely due to the national campaign prior to the baseline which escalated the initial levels [Fig 13]. Anthropometric measures also indicated improvements in percentage of children who were underweight, wasted or stunted in both sites [Fig 14-19]. 0 20 40 60 80 100 Y1 Y2 Y3 Y4 Kaduha Kigeme 0 20 40 60 80 100 Y1 Y2 Y3 Y4 Kaduha Kigeme Fig 11: Breast feeding within 1h of birth Fig 12: Increased intake of Iron rich foods Fig 13: Receipt of Vitamin A Fig 14: Underweight Prevalence-Moderate Fig 15: Underweight Prevalence-Severe Fig 16: Wasting Prevalence-Moderate Fig 18: Stunting Prevalence- Moderate Fig 19: Stunting Prevalence - Severe Fig 17: Wasting Prevalence- Severe Figure 8. Minimum Meal Frequency Figure 9. Introduction of Semi solid food Figure 10. Responsive Feeding Rwanda ICSP Final Evaluation Report September 2015 Page 23 of 997 These findings provide considerable evidence for the effectiveness of a combined strategy of Nutrition Weeks and the ongoing CBNP strategy. The CNBP with Nutrition Weeks is more effective than the standard CBNP alone at improving the diet of children under two years. Children 6-23 months in the intervention area achieved MAD, the primary outcome of this research, at twice the rate that children in the comparison area did. Additionally, close to half (40%) of the children in the intervention area achieved MAD. Minimum Dietary Diversity more than doubled in the intervention area, but decreased in the comparison area, although not significantly; the 95% confidence intervals from baseline to endline overlapped. The Nutrition Weeks and CBNP interventions were both successful in establishing kitchen gardens, and a majority of mothers with kitchen gardens reported that the produce was used to feed children. Likewise, the animal husbandry projects were instrumental in providing food sources for children and the income from both these strategies was used for food or health care [Fig 20]. The project also addressed other interventions for maternal and newborn care and hygiene practices. The proportion of mothers reporting four or more antenatal care (ANC) visits increased in both project sites, and those accessing care in the first trimester and skilled birth attendance also increased [Fig 21-23]. Mothers reporting newborn visits within 2 days of birth from an appropriate provider (including ASMs) increased from less than 50% in both areas to 97% in Kaduha and 99% in Kigeme. 0 20 40 60 80 Baseline Final Kaduha Kigeme 0 20 40 60 80 Baseline Final Kaduha Kigeme Fig 21: Mothers Reporting 4+ ANC Fig 22: ANC in 1st trimester Fig 23: Mothers Reporting SBA Fig 20: Mother’s Reports of Kitchen Gardens and Animal Husbandry Practice at the end of the project Rwanda ICSP Final Evaluation Report September 2015 Page 24 of 997 Modern contraceptive prevalence also showed improvements from baseline levels of <60% to more than 70%. Iron supplementation during pregnancy was high at baseline, at 80%, but declined the following year to about 70% and then resumed to 80% during the rest of the project term in both sites. Effective point-of-use (POU) water treatment showed a sharp increase during the first year (likely due to District emphasis on hygiene during the first year) and declined the following years, though remaining above baseline; the trends in soap at hand washing places also showed a sharp increase in the first year, and thereafter remained the same. Though there was a slight increase in those having functional toilets, it was still below 40% at the end of the project. Safe feces disposal increased from 71% (Kaduha) to more than 80% at the final evaluation. There was a 6% decrease in diarrhea prevalence in children in Kaduha, but prevalence remained the same at 20% in Kigeme. However, a higher percentage of children with diarrhea were reported to receive Oral Rehydration Solution (ORS) or home available fluid at the end of the interventions in both project sites [Fig 26]. The trends were similar for children receiving more fluids in both sites, but zinc treatment during diarrhea declined in the intervention site. Prevalence of cough and rapid breathing also declined in Kaduha, and care seeking for cough improved following project interventions in both sites [Fig 27, 28]. Immunization levels were already high (>80%) at baseline for Measles, Pentavalent 1 and 2, and showed slight improvements at the final evaluation. Since malaria was not endemic in Nyamagabe, there were no direct project interventions but all tracked indicators illustrated a slight decline from baseline levels for treatment of fever, bednet use etc. Reports of household visits by CHWs increased progressively every year [Fig 29, 30] and participation in Nutrition Weeks also improved in Kaduha. End of the project survey measured home visits by ICG and delivery of health messages by churches. In Kaduha, 60% of respondents reported having an ICG member visit in the last month, and 39% reported receiving health information from a church, with respondents in Kigeme reporting 38% and 29%, respectively. Fig 24: Effective Water Treatment Fig 25: Soap at Handwashing Stations Fig 26: Children with diarrhea receiving ORS Fig 27: Cough in the Past 2 weeks Fig 28: Care seeking for Cough Symptoms Fig 29: Household Visits by CHWs Rwanda ICSP Final Evaluation Report September 2015 Page 25 of 997 Fig 30: ICG Visit, Church information Qualitative evaluations conducted with the district health teams and community stakeholders on value and effectiveness of project interventions further amplified the evidence on project interventions. The value of the ICG, CHW and Nutrition Weeks interventions was appreciated by all stakeholders interviewed, generating community-wide interest and engagement. This resulted in solidarity and gender equity with fathers taking responsibility for child rearing, health care, cooking, participation in community based activities (especially in the cooking demonstrations for Nutrition Weeks), and sharing household chores with the women [Annex XVII]. The leadership oversight, health promotion and equity-oriented strategies advocated by the ICG, home visits, with preventive and curative and referral functions of the CHWs strengthened the community health system’s capacity. It also enhanced the linkages with the district teams at the hospital and health center level, establishing strategic information systems through SMS, support to campaigns and joint partnerships in achieving the district goals for health improvement. More importantly, in their KIIs, the district team indicated reduced illness incidence, prompt illness care seeking, increased service utilization, and reduced mortality, attributing it to the health promotion efforts of the project. The most impressive outcomes were evidenced for nutrition interventions through the operations research study on Nutrition Weeks, with increased meal frequency, dietary diversity, animal husbandry and the establishment of kitchen gardens. Most of the stakeholder participants remarked that the ICG model was sustainable as it integrated existing community-based and health system entities to engage communities and promote health care. As a CHW from Kaduha remarked “the savings group empowered us economically to buy livestock, and members in our community who were poor could pay for the medical health insurance. We are thankful for the support of the district leaders and cell leaders; we function as one team. We are selected based on how we practice healthy behaviors: dish racks, clothes line, cleanliness of households, etc. Nutrition Weeks was initially perceived as a strategy for the poor, now they see it as a community activity. Even teachers left school to attend Nutrition 0 50 100 ICG Visit Health info from church Kaduha Kigeme Rwanda ICSP Final Evaluation Report September 2015 Page 26 of 997 Weeks. Before it was women’s activities, now men bring children to the Nutrition Weeks and help in cooking demonstrations.” However, the training and supervisory oversight will need to be assumed by the district health system, through existing leadership structures. The role of pastors and other religious leaders was also emphasized to create and enhance trust between communities and health systems and also endorse and triangulate health information during their household visits or at church. The Vice Mayor’s perspectives on project contributions further enhanced the value of interventions as he felt that the model should be scaled up in other districts as it achieved both national and district priorities for health policy, especially for nutrition. The findings from the OR evaluation were shared annually with the communities and the Nyamagabe district and national MOH. Though the district health team is keen on continuing and adapting the strategy, the specific mechanism for integration and supervision oversight has not been determined, as the cooking demonstrations will require appropriate technical support during the initial stages. The end of project (EOP) goals set for a majority of the indicators were an ambitious target, as baseline levels were quite low for key indicators. Health promotion efforts need to be complemented by other system level investments to ensure access, and to create an enabling environment to foster the behavior change in the communities. Targets for the indicators in the table below were not fully achieved by end of project for either one or both hospital zones, though there was a substantial improvement from baseline levels for most. The end of project evaluation occurred almost five months before the project ended and hence it is likely that some of the targets were achieved. Contextual factors such as extreme poverty and limited access due to mountainous terrains are a strong impediment to achieving optimal results for exclusive health promotion interventions. Table 7. Unmet EOP targets Kigeme Kaduha Baseline Endline EOP Target Baseline Endline EOP Target Minimum Dietary Diversity in children 6-23 months 38.9% 27.7% 55% 21.9% 52.9% 60% Minimum Acceptable Diet for children 6-23 months 3.3% 19.0% 50% 3.0% 40.4% 50% Children 6-23 months receiving foods rich in iron 23.3% 8.2% 50% 15.2% 31.9% 50% Pregnant women receiving iron pills 81.4% 89.7% 90% 80.4% 83.2% 90% 4+ ANC visits 48.9% 60.3% 75% 45.5% 59.4% 75% 2 TT during pregnancy 68.3% 80.0% 80% 68.4% 77.3% 80% ORS or HAF 22.9% 36.1% 70% 23.1% 40.0% 70% More fluids for diarrhea 40.0% 63.9% 70% 36.9% 67.5% 70% Zinc treatment for diarrhea 10.0% 20.8% 70% 24.6% 15.0% 70% care seeking for pneumonia symptoms 45.1% 66.4% 70% 44.2% 63.2% 70% CHW home visit during the past month 21.9% 43.3% 75% 26.7% 62.0% 75% participation in Nutrition Weeks in the last 6 months n/a n/a n/a n/a 76% 80% With continued support from the district, the generation of savings groups and other community oriented strategies, the integrated package of community interventions will likely have a more profound effect on the health outputs and outcomes in the long term. The results indicate that the complementary Nutrition Weeks strategy was more effective than the ongoing CBNP alone at improving dietary diversity and minimum acceptable diet. Competing health priorities may be a challenge to invest entirely upon nutrition interventions, though it remains a high priority for national policy. Initial outlay of investments will require substantial financial and time investments for district teams, but once established the scale of returns will be evident as communities take initiative and ownership of the systems. Though the Nutrition Weeks strategy has demonstrated great potential for a community Rwanda ICSP Final Evaluation Report September 2015 Page 27 of 997 owned strategy for addressing malnutrition and health care, contextual considerations will be necessary to determine the opportunity costs and financial investments for the district teams before decisions are made for scale up. The strategic leveraging of district health system and community leadership through the ICG providing technical capacity, equitable coverage, and management oversight of CHWs offers an excellent mechanism to achieve Rwanda’s health system priorities, which require optimal community engagement. KEY SUCCESS FACTORS The project benefited greatly by using previous project staff who had experience establishing CG and working with community-based systems. The project team made phenomenal investments throughout the project lifecycle, for establishing robust community-based health systems and creating synergies with the ongoing priorities of the district team supporting their programs and partnering on most of the health initiatives launched by the districts. Training and management oversight of 536 ICG in the entire district was a challenging feat to accomplish within the short period, made more challenging due to limited geographic access to the communities. During the initial stages, Dr Judy Mclean and her students at the University of British Columbia were instrumental in designing the OR research and also assisting with the Nutrition Weeks qualitative research, drawing on their research and nutrition expertise. Dr. Fidele Ngabo, former Director of Maternal and Child Health Unit of the Rwanda MOH, was the other PI of the OR study. The project team capacity building efforts include monthly and quarterly leadership meetings to update on technical and management aspects of the project. As the existing health information system in Rwanda does not obtain information on household behavior change practices on a routine basis, the project developed a community mobilization tracking system. This provides a record of CHW performance, coverage, hand washing systems, and other behavior change indicators. Exit interviews with mothers following the Nutrition Weeks demonstrations indicated a great enthusiasm for the information and skills obtained. Mothers also met independently to review the content. The BCC and supervision strategies were specifically designed for each stakeholder group and tools were standardized. Flip charts and counseling cards for BCC, maternal and newborn health, IYCF, posters and songs for prevention of malaria and pneumonia were developed. Posters, summary of IMCI, and Nutrition Weeks recipe booklets were also made available for other community members along with radio spots. PROJECT CONTRIBUTIONS TO LEARNING AND EVIDENCE The project team made conscious efforts to create a learning forum for strategic stakeholders based on the evidence. Presentations on findings from evaluations were shared with the national nutrition technical working group, nutrition summits, and other national and district policy makers. Students from University of British Columbia, Future Generations and teams from USAID and UNICEF visited the project site. Subsequent to the launch of the project and dissemination of preliminary findings, WR received funding support from UNICEF for expanding the program in Rutsiro, Gasabo and Rusizi districts. Funding was also provided by FAO for complimentary food security activities in Kitabi and Nkomane sectors. The Nyamagabe district team recommended OneUN (a group of United Nations agencies) to adapt the WR strategy of ICG and Nutrition Weeks for their nutrition program. The project team was also engaged with the MCSP project to learn about the ICG strategy. World Relief’s MCH Regional MCH Advisor, Melene Kabadege, was invited to present the findings to 20 Ministers of Health at a meeting in Washington DC organized by USAID. Rwanda ICSP Final Evaluation Report September 2015 Page 28 of 997 Other partnerships were forged with the WFP, OneUN, WV, FAO, UNICEF and CRS who were also engaged in food security interventions providing food supplements to pregnant women, as well as micronutrient powder (MNP). The research capacity of the project team and district partners was enhanced through participation in the cluster surveys, qualitative research and operations research study, and the use of smartphone technology for data collection and data analysis. One of the most profound contributions of the project intervention was the transformation of male community members, who played an active role in child care and assisting women in domestic activities including cooking and kitchen gardening. Though men and women face different obstacles in care seeking and women typically are charged with domestic and childcare responsibilities, this was gradually changing as men were seen taking their children for health care and immunizations. Components of the research were integrated in other WR grant proposals. In a proposal to TEARfund Australia for WR Indonesia, a Family Days nutrition intervention was designed based on the Rwanda OR. The strategies for nutrition education including cooking demonstration for the whole family to reinforce the messages provided by the churches were integrated in the interventions for the remote highlands of Papua. Nutrition Weeks were also adapted for implementation in a World Bank-funded nutrition project in Malawi which began in 2015. In Rwanda, WR’s UNICEF project applied the NW concept for the introduction of MNP. Additionally, both NW and CG were included in a 2015 USAID Rwanda Mission RFA for eight districts, raising the possibility of broad scale-up in the near future. In decentralized health systems where health sector wide approaches are integrated, sector monitoring and evaluation systems generally lead to improvement in accountability and learning, which may ultimately lead to better performance and results on the ground [15]. CHWs continue to play a pivotal role in service delivery and the data routinely generated through their systems are increasingly relied upon for providing information for program management, evaluation and quality assurance [16]. Though the system of using CHWs has been effective, the quality of the data is not always optimal. The project made considerable contributions to instituting effective community-based information systems through the ICG model, which fostered effective information systems and management of health issues at the district level, building capacity for integrated information systems. PROJECT CHALLENGES AND LIMITATIONS The project experienced delays due to delays in IRB approvals (more than three months), the development, translation and endorsement of the Nutrition Week curriculum, and leadership replacement due to the departure of key project personnel—including MOH investigators and the WR Director of MCH. There was an initial resistance by men to engage in the Nutrition Weeks. This was overcome by leveraging the community leadership and male ICG members who held community meetings and made home visits to advocate to men for participation. During church services, pastors also encouraged men to participate in Nutrition Weeks. Annual KPC evaluations were also resource and time intensive, especially during the rainy seasons. The existing CBNP strategy was not well designed and initially developed for facility based rehabilitation, and GMP sessions were only held in a few communities with minimal use of data. The project team invested considerable effort during the initial phases to develop the system and design robust monitoring systems for strategic decision making, as these indicators were not previously integrated in the district health information systems. Screening for severe malnutrition by the MUAC method was not standardized resulting in a high volume of errors and poor sensitivity. This was eventually integrated as a module for CHW training. Supervision of the GMP program was also extremely low with less than 30% reporting supervision. Supervision guidelines were also established for appropriate support to the GMP activities. Rwanda ICSP Final Evaluation Report September 2015 Page 29 of 997 In the first two years, the project supplied the ingredients required for the NW demonstrations, though eventually the community was requested to generate these food commodities. This was met with initial resistance, but was eventually accepted. About 17% of the Nutrition Weeks groups organically formed income generating support groups to facilitate the interventions, which was not a planned activity. Changes to the health care environment have to be accounted for and regulated in an operations research study. CRS launched a nutrition program in 2013, providing livestock, prompting kitchen gardens and conducting GMP sessions in two cells (three to four villages each) of the project area. The district and project team intervened to ensure that these interventions were only provided in selected cells to avoid contamination of results in the comparison site. Other interventions in the project area that may have contributed to the results include the integration of the 1000 day national campaign messages and MNP distribution (UNICEF) in 2014, the distribution of livestock in two sectors of the project area by FAO with WR Farmer Field schools in the same sectors, and the distribution of food supplements by WFP through a WV project to families in the lowest two poverty categories. Referral for children with severe malnutrition was a major challenge initially as the WFP had already predetermined a target figure that could be treated at the health center. Hence children were sent back home if the health center already achieved the target, resulting in adverse perceptions and adherence to CHW or ICG counsel. The project team had to renegotiate these targets and ensure that children received appropriate case management or admission for these cases. Some mothers were reluctant to weigh their child in the UNICEF weighing scales as they were used by other community members and were unhygienic. The project team advocated for toilet seat covers, to accommodate their requests. CONCLUSIONS Despite Rwanda’s extraordinary progress in the recent years, and winning the ‘triple crown’ reputation of fast economic growth, poverty reduction and narrowing the equity gap, challenges remain in reaching the goals for an equitable people-centered health care system that addresses the unfinished agenda of malnutrition and emerging trends of non-communicable diseases. Rwanda has launched many successful innovations, and the current evidence on Nutrition Weeks and ICG interventions illustrates a promising future for the country. Emerging initiatives like the USAID’s 5-year Maternal and Child Survival Program, which focuses on scaling up successful service integration and capacity building innovations for optimal service delivery in primary care settings, need to consider these local solutions for enhancing community capabilities and ownership for long term sustainability. The CG Model has been successful in achieving significant improvements in health care seeking behavior and mortality impact in other settings, as it employs an extensive cadre of community based volunteers to focus exclusively in health promotion interventions [7]. However, limited evidence on its sustainability and integration within existing national systems and community-based structures has been a major limitation. The Nyamagabe model of ICG actively engages various community and district leadership in joint training, decision making, and program implementation with the CHWs to ensure quality, equitable coverage, management efficiency, community acceptance and to address barriers to effective execution of interventions. The integrated model did pose some initial challenges as local leaders had other responsibilities and were unavailable for training or lacked the competencies. CHW master trainers were selected to cascade the training to the ICG members including village leaders. The cascade training model resulted in establishing key monitoring systems to ensure communication and information was standardized, to mitigate errors and unrealistic community expectations. This required enormous time investments of project staff during the initial stages of the project. Rwanda ICSP Final Evaluation Report September 2015 Page 30 of 997 Results from the KPC surveys and qualitative assessments indicate impressive gains and returns of project investments, with significant differences between intervention and comparison sites for the OR nutrition interventions. Though the EOP targets were too high considering the lack of geographical access to health services, the upward trends indicate that these goals will be eventually achieved with the continued support of the district health team and community entities through the ICGs. Focused niche strategies like Nutrition Weeks are essential for targeting key health behaviors and interventions, especially for nutrition combined with other hygiene and food security interventions to prevent the onset of disease. Results from the Nutrition Weeks intervention demonstrated stronger behavior change results than CBNP, which relies primarily on large group education and demonstration. It is likely that the hands-on practice of cooking foods and feeding children facilitated the increase in dietary diversity among Nutrition Weeks participants. The People-Centered health care framework proposed by WHO advocates for placing people and communities at the center of the health service planning to ensure that health services are more comprehensive, responsive, integrated and accessible to address diverse population needs [1]. The ICG model is a promising strategy for the delivery of people-centered care as it addresses and accommodates the perspectives of communities and priorities of the health care system building trust, equity, and achieving the goals for universal health coverage empowering people as co-producers of health. The CG model has evolved in Rwanda and has come to a phase of fruition, where community health care initiatives can be tactically integrated within the health system architecture, beyond achievements of short term project goals and objectives. However, government ministries will benefit from continued engagement of NGO’s like WR, who have distinctive competencies and experiences in equipping and empowering community entities. Rwanda has witnessed transformational change in the past two decades, driven by major economic, political, social, technological and environmental forces. In this complex and dynamic environment, health care organizations need to creatively innovate to ensure a resilient, responsive and catalytic service delivery system to meet the needs and expectations of its people. To quote the mothers in Mugano Sector “It would be very nice to have the Tangiraneza (Start Well) project continued, or to at least start a new project called KOMEZANEZA (Continue Well).” RECOMMENDATIONS The main recommendation for this project is based on the reflections made by the Vice Mayor of Nyamagabe, who was keen to scale up the model in other districts, and use their district as a learning lab, as the model has demonstrated to be an effective strategy to reach the goals for national priorities. To retain the collaborative elements and partnerships, he believed that the district could play a pivotal role in initiating the meetings to plan and design the ongoing initiatives and determine the leadership and management oversight of these community mechanisms. The district letterhead, he remarked, would bring the profile and value for planning the sustainability initiatives. The mobile phone alerts through RapidSMS linking CHWs to nearby facilities for referral and real time information systems, needs to be sustained and integrated into the ongoing district health information system architecture. Findings from the Nutrition Weeks and ICG model also indicate their potential for long term gains and achieving national priorities. Reported bottlenecks for active engagement in the Nutrition Weeks and supply of essential commodities for the group cooking exercise were successfully addressed in some communities. These best practices must be shared with other sites and WR and NGO projects through photo voice and other media to effectively communicate the problem solving measures instituted in this project. The WR team has already integrated key success elements in other ongoing initiatives and programs in other country contexts, but it should be shared with a wider audience for effective adaptation. The CG model has been experimented widely in many countries, but few have demonstrated successful integration within existing health care systems. A research publication on the potential, limitation and Rwanda ICSP Final Evaluation Report September 2015 Page 31 of 997 challenges of the ICG would provide key insights for other NGO’s adapting the CG model for community￾based health care. Effective support systems for optimizing CHW performance, creating contextually appropriate supervisory and incentive systems with local leaders was one of the distinctive features of this project. National CHW movements will benefit greatly from this ICG model, as the CHW workforce can be effectively leveraged to achieve universal and equitable coverage and quality. Sustaining motivation and performance of CHWs has been a universal challenge, especially in contexts with minimal monetary compensatory mechanisms or incentives. In Rwanda, the PBF initiative has reported remarkable success in achieving health system goals, however the performance payment mechanisms for CHWs continue to pose challenges, posing great risks to the continued performance of CHWs. The CHW savings schemes instituted in Nyamagabe have been successful in some sites, but undocumented in other communities. The key challenges in this mechanism for performance payment and problem solving mechanisms that have been evidenced to be successful, would provide an excellent learning opportunity for other health systems that rely on this volunteer workforce. The ICG meet regularly, and have similar task expectations for home visits, etc, however, it is likely that CHWs are assigned more responsibilities for the ICG expectations. Though this was not evident in any of the qualitative research findings, it would be important to interview and document some of the challenges perceived by CHWs in the ICG model. Interviews with the project team indicated enormous levels of sacrificial investments to meet project demands and goals engaging with the district team as partners. An internal documentation of promising practices and challenges would enhance organizational and individual learning for WR as they engage in scaling up programs in other health systems globally. The Nutrition Weeks strategy and ICG model are innovative mechanisms for consideration in post conflict and transitional contexts to build trust, solidarity and strengthen linkages with developmental agencies and the national governments. Table 8. Recommendations Finding Conclusion Recommendation Action Who Is Responsible Effective integration of CHW and local leaders through ICG Model Achievement of universal coverage for key MNCH interventions Ensure ongoing implementation in Nyamagabe and scaling up to other projects; maintain RapidSMS system for CHW reporting; research publication on ICG & CHW performance; document CHW savings scheme & CHW challenges with ICG; WR internal documentation of promising practice for consideration in development & post conflict contexts Dissemination of evidence to national and global stakeholders. Research Publication WR HQ, USAID, MCSP, CORE Group Evidence of Nutrition Weeks interventions Improvements in key nutrition, child feeding and food security indicators Integration in Rwanda’s national nutrition policy and CBNP to be complemented with Nutrition Weeks activities, kitchen gardening etc.; share best practices with other sites; share with broader audience & WR internal documentation of promising practice Advocate for uptake of Nutrition Weeks interventions with national technical advisory groups and other global entities including WFP, UNICEF, etc. WR, MOH Technical Advisory Group CHW Incentive Systems Inadequate documentation Obtain information through informal feedback from CHW 15-20 CHW informal interviews to determine effectiveness of WR Internal documentation Rwanda ICSP Final Evaluation Report September 2015 Page 32 of 997 incentive systems Rwanda ICSP Final Evaluation Report September 2015 Page 33 of 34 REFERENCES 1. Kell E. WHO Global Strategy on People-centered and Integrated Health Services. Interim Report. WHO. WHO/HIS/SDS/2015.6 2. World health statistics 2012. Geneva: World Health Organization, 2012 (http://www.who.int/gho/publications/world_health_statistics/2012/en). 3. Binagwaho, A., P. Kyamanywa, et al. (2013). "The human resources for health program in Rwanda--new partnership." N Engl J Med 369(21): 2054-2059. 4. UNICEF (2013). Committing to Child Survival: A Promise Renewed. United Nations Children's Fund. 5. Danquah, I., J. B. Gahutu, et al. (2014). "Anaemia, iron deficiency and a common polymorphism of iron￾regulation, TMPRSS6 rs855791, in Rwandan children." Trop Med Int Health 19(1): 117-122. 6. Republic of Rwanda (2011) Rwanda Demographic and Health Survey 2010. National Institute of Statistics of Rwanda. Kigali 7. Ricca J, Kureshy N, Leban K, Prosnitz D, Ryan L. Community-based intervention packages facilitated by NGOs demonstrate plausible evidence for child mortality impact. Health Policy Plan 2013 8. Edward A, Ernst P, Taylor C, Becker S, Mazive E, Perry H. Examining the evidence of under-five mortality reduction in a community-based programme in Gaza, Mozambique. Trans R Soc Trop Med Hyg 2007; 101(8): 814-22. 9. Langston, A., Weiss, J., Landegger, J., Pullum, T., Morrow, M., Kabadege, M., Mugeni, C., Sarriot, E. (2014). Plausible role for CHW peer support groups in increasing care seeking in an integrated community case management project in Rwanda: a mixed methods evaluation. Glob Health Sci Pract, 2(3):342-354. 10. Davis T, Wetzel C, Hernandez Avilan E, et al. Reducing child global undernutrition at scale in Sofala Province, Mozambique, using Care Group Volunteers to communication health messages to mothers. Global Health: Science and Practice 2013; 1(1): 35-51. 11. Perry et al, (2015) “Care Groups I: An Innovative Community-Based Strategy for Improving Maternal, Neonatal, and Child Health in Resource-Constrained Settings 12. Rwanda Demographic Health Survey, 2010 13. The Thousand Days partnership, http://www.thousanddays.org/ 14. MOH, Official Community Based Nutrition Evaluation Report, December, 2010 15. Holvoet, N. and L. Inberg (2014). "Taking stock of monitoring and evaluation systems in the health sector: findings from Rwanda and Uganda." Health Policy Plan 29(4): 506-516. 16. Mitsunaga, T., B. Hedt-Gauthier, et al. (2013). "Utilizing community health worker data for program management and evaluation: systems for data quality assessments and baseline results from Rwanda." Soc Sci Med 85: 87-92. 17. Priedeman Skiles, M., S. L. Curtis, et al. (2013). "An equity analysis of performance-based financing in Rwanda: are services reaching the poorest women?" Health Policy Plan 28(8): 825-837. Rwanda ICSP Final Evaluation Report September 2015 Page 34 of 34 ANNEXES I. List of Publications and Presentations Related to the Project II. Work Plan Table III. Rapid CATCH Table IV. Final KPC Report V. Community Health Worker Training Matrix VI. Evaluation Scope of Work VII. Data Collection Instruments VIII. Disclosure of Any Conflicts of Interest IX. Evaluation Team Members, Roles, and Their Titles X. Final Operations Research Report XI. Stakeholder Debrief PowerPoint Presentation XII. Project Data Form XIII. Year 3 (MTE) KPC Report XIV. Qualitative Data Findings XV. Summary of Project Activities Rwanda ICSP Final Evaluation Report September 2015 Page 34 of 997 ANNEX I. LIST OF PUBLICATIONS AND PRESENTATIONS RELATED TO THE PROJECT 1. Care Group Technical Advisory Group (TAG) meeting - Washington DC, May 29-30, 2014 “From Care Groups to CHW Peer Support Groups: Scaling up in Rwanda” 2. MCHIP Close-out Event – Washington DC, June xx, 2015 “Scaling up Integrated Community Case Management with Interpersonal Social and Behavior Change Communication in Rwanda, Kabeho Mwana “Life for a Child”Expanded Impact Child Survival Project, 2006-2011” 3. International Conference on Community Health (Kigali, Rwanda, January, 2011). 4. Effective Strategies to Mobilize Community Health Workers to Promote Behavior Change in Rwanda. Presentation at 2011 International Summit on Community Health; Kigali, Rwanda. 5. Perry H, Morrow M, Davis T, Borger S, Weiss J, DeCoster M, et al. Care Groups II: a summary of the child survival outcomes achieved in high-mortality, resource-constrained settings using volunteer health workers. Glob Health Sci Pract. 2015;3(3). 6. Perry H, Morrow M, Davis T, Borger S, Weiss J, DeCoster M, et al. Care Groups I: An Innovative Community-Based Strategy for Improving Maternal, Neonatal, and Child Health in Resource-Constrained Settings Glob Health Sci Pract. 2015;3(3). Rwanda ICSP Final Evaluation Report September 2015 Page 35 of 997 ANNEX II. WORK PLAN TABLE Result Major Activities Year 1 Year 2 Year 3 Year 4 Personnel Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Project Design, Planning and Start-Up All Secure formal agreements with MOH; consult USAID Mission X X WRR Country Office IR3 Design Innovation OR and meet with MOH and University partners X X X WR HO IR2 Community Mobilization and formation of Village-level Integrated Care Groups with CHWs, village leaders and religious leaders. X X ICSP Manager& CM Officers All Hire guards, purchase equipment and supplies X ICSP Manager; WR HR Coordinator WR Logistic Manager ICSP Administrative Assistant All Hire 2 Motorbike drivers X ICSP Manager; WR HR Coordinator ICSP Administrative Assistant All DIP Preparation and detailed work plan X X X ICSP Team; HO Technical Unit Key Project Activities BCC Activities IR2 Launching the ICSP Tangira neza X WRR Country Office; ICSP Team IR2 Quarterly Meetings with Partners X X X X X X X X X X ICSP Manager, M&E Officers IR1 Build MOH and Sector Social Affairs –in-Charge capacity to train and supervise BCC activities. X X Tangiraneza ICSP CM Staff, MOH IR1 Train CHW Cell Coordinator and In charge of Social Affairs at cell level to supervise CG in Interventions and BCC. X X Tangiraneza ICSP CM Officers Community Health –in-Charge Sector Social Affairs –in-Charge Rwanda ICSP Final Evaluation Report September 2015 Page 36 of 405 Result Major Activities Year 1 Year 2 Year 3 Year 4 Personnel Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 IR2 Quarterly meeting for Care group leaders and supervisors X X X X X X X X X X X X X Tangira neza ICSP CM Officers, In charge of Social affairs at cell level IR2 Quarterly meeting with Local Leaders and Religious Leaders on BCC X X X X X X X X X X X X X Tangira neza ICSP CM Officers, In charge of Social affairs at cell and sector levels IR1 Care Group Leaders lead monthly Integrated CGs X X X X X X X X X X X X X Care Group Leaders IR1 BCC (HH health education) X X X X X X X X X X X X X Care group Members: CHW, Village Leaders IR1 Follow up Care Group BCC activities X X X X X X X X X X X X X Tangira neza ICSP CM Officers In charge of Social affairs at cell level CHW Cell Coordinator IR2 Distribute annual incentives to CG members X X Tangira neza ICSP CM Offocers IR2 Mobilize churches to assist vulnerable households with kitchen gardens & tippy taps. X X X X X X X X X X X X X Tangira neza ICSP CM Offocers Nutrition Activities IR2 Participate in Nutrition Technical Working Group; Solicit input and share findings. X X X X X X X X X X X X ICSP Manager, HO Tech Unit; ICSP Nutrition Officers IR1 Conduct TOT on CBNP X ICSP Nutrition Officers, MOH IR1 Train CHWs on CBNP X X ICSP Nutrition Officers, MOH IR3 Develop Nutrition Week Curriculum X X ICSP Team, MOH/NTWG, HO Technical WG IR3 Train MOH trainers and In Charge of Social Affairs on Nutrition Week X ICSP Nutrition Officers, MOH IR3 Train Village Nutrition Committees on Nutrition Week X X X X X X X X X X ICSP Nutrition Officers, MOH Rwanda ICSP Final Evaluation Report September 2015 Page 37 of 405 Result Major Activities Year 1 Year 2 Year 3 Year 4 Personnel Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 IR2 Mobilize Sector Nutrition Committees through quarterly Meeting X X X X X X X X X X X Tangira neza ICSP Nutrition Officers, Hospital Nutrition Supervisors IR2 Participate to DPEM semi annually meeting X X X X X X ICSP Manager, ICSP Nutrition and Community Mobilization Officers IR1 Implement and follow up Growth Monitoring sessions X X X X X X X X X X X X X CHWs; HC In charge of CH activities IR1 Implement and follow up Kitchen Garden and assist vulnerable Families X X X X X X X X X CHWs, In Charge of Social affairs at cell level, Sector Agronomist IR3 Implement Nutrition Weeks Innovation/ OR activities X X X X X X X X X X Village Nutrition Committee, ICSP Team.In charge of Social Affairs and HC in charge of Nutrition IR2 OR to compare CBNP, ‘Nutrition Week' Innovation, and control communities, prior to district level scale-up X X X X UBC, MOH, ICSP Officers, HO Technical Unit Maternal & Newborn Care IR1 Build HC and Hospital staff capacity to train ASM on MNC and Rapid SMS X X ICSP MNC Officers; MOH IR1 Support HC trainers to train ASM on MNC and Rapid SMS X X ICSP MNC Officers ; HC IR2 Support HC to follow up ASM providing Newborn and post partum care X X X X X X X X X X X X X X ICSP MNC Officers , HC; ASM Community Case Management IR1 Community Case Management Refresher training X ICSP CCM Officers, MOH IR2 Support HC staff to supervise CCM activities X X X X X X X X X X X X ICSP CCM Officers, HC Rwanda ICSP Final Evaluation Report September 2015 Page 38 of 405 Result Major Activities Year 1 Year 2 Year 3 Year 4 Personnel Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Baselines, Monitoring & Evaluation, & Reporting All Review/Planning Meetings with MOH X X X X X X X X X ICSP Manager, WRR Director of Programs All Monthly and Annual Reporting X X X X X X X X X X X X X X X X ICSP Manager, M&E Officers All Monthly Health Information System reporting X X X X X X X X X X X X X X X X M&E Managers All Community-Health Information (Data Collection and Analysis) X X X X X X X X X ICSP M&E Officers, MOH, CHWs, All Quarterly Analysis of M+E data and feedback skill-building at HC and District levels X X X X X X X X X X X X X X X X M&E Officers; MOH All Annual CHW Performance Review X X X X ICSP CCM Officers, MOH All Project monthly meetings X X X X X X X X X X X X X X X ICSP Manager and Officers IR3 Develop the study protocol to present to RNEC for OR X X X UBC, HO Technical Advisor, ICSP Manager IR3 Annual and Final Evaluations & OR Dissemination X X X X UBC, HO Technical Advisor, ICSP Manager Final Evaluation X ICSP Manager, WRR Director of Programs Technical Assistance and Trips All Visits by World Relief HO Technical Advisors X X X X HO Technical Unit All Visit by World Relief Regional Technical Advisor X X X X X X X X X X X X X X X X Regional Technical Advisor Rwanda ICSP Final Evaluation Report September 2015 Page 39 of 405 ANNEX III. RAPID CATCH TABLE Rapid CATCH Table Indicator Location Baseline Estimate (%) MTE Estimate (%) Final Estimate (%) % infants aged <6 months who were exclusively breast-fed in the last 24 hours Kaduha (Intervention) 91.1 92.9 96.7 Kigeme (Comparison) 98.9 94.3 88.9 * % of infants and young children age 6- 23 months fed according to the Minimum Acceptable Diet *WHO 2008 definition Kaduha (Intervention) 2.96 38.6 40.4 * Kigeme (Comparison) 3.3 24.5 19 * % of children age 6- 23 months who received a dose of Vitamin A in the last 6 months: card verified or mother’s recall Kaduha (Intervention) 70.4 66.2 Kigeme (Comparison) 77.04 60.98 % of children 0-23 months who are underweight (-2 SD for the median weight for age, according to WHO reference population) Kaduha (Intervention) 10.6 7.6 (indicator calculated for 6-23 mos) 10.8 Kigeme (Comparison) 6.7 15.4 (indicator calculated for 6-23 mos) 8.6 % mothers of children age 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child Kaduha (Intervention) 45.5 59.4 * Kigeme (Comparison) 48.9 60.3 % of mothers with children age 0-23 months who received Kaduha (Intervention) 68.4 77.3 Rwanda ICSP Final Evaluation Report September 2015 Page 40 of 405 at least two Tetanus toxoid vaccinations before the birth of their youngest child Kigeme (Comparison) 68.3 80 * % children age 0-23 months whose births were attended by skilled personnel Kaduha (Intervention) 83 92.99 * Kigeme (Comparison) 91.7 97.5 % of mothers of children 0-23 m. whose youngest child received a post-natal visit from an appropriate trained health worker within 2 days of birth Kaduha (Intervention) 37.7 97.5 * Kigeme (Comparison) 44.2 99.7 * % mothers of children 0-23 months who are using a modern contraceptive method Kaduha (Intervention) 57.5 73.11 * Kigeme (Comparison) 62.5 78.9 * % of households of children age 0-23 months that treat water effectively Kaduha (Intervention) 50 75.7 78.9 * Kigeme (Comparison) 56.4 57 66.7 % of mothers of children age 0-23 months who live in households with soap at the place for hand washing Kaduha (Intervention) 38.6 73.7 85.3 * Kigeme (Comparison) 43.9 73 76.9 * % of children age 0- 23 months with diarrhea in the last 2 weeks who received ORS and/ or recommended home fluids Kaduha (Intervention) 23.1 40 Kigeme (Comparison) 22.9 36.1 Rwanda ICSP Final Evaluation Report September 2015 Page 41 of 405 % of children age 0- 23 months with chest￾related cough and fast and/ or difficult breathing in the last 2 weeks who were taken to an appropriate health provider Kaduha (Intervention) 44.2 63.2 Kigeme (Comparison) 45.1 66.4 % of children age 12- 23 months who received a measles vaccination Kaduha (Intervention) 87.4 85.99 Kigeme (Comparison) 83.4 89.8 % of children aged 12-23 months who received Pentavalent-1 (DTP1 +HepB + Hib) by vaccination card or mother’s recall by the time of the survey Kaduha (Intervention) 89.3 90.5 Kigeme (Comparison) 86.9 96.6 % of children aged 12-23 months who received Pentavalent-3 (DTP3 with HepB and Hib) according to the vaccination card or mother’s recall by the time of the survey Kaduha (Intervention) 84.3 89.2 Kigeme (Comparison) 84.1 93.9 % of children age 0- 23 months who slept under an insecticide￾treated bed net (in malaria risk areas, where bed net use is effective) the previous night Kaduha (Intervention) 66.9 50.3 * Kigeme (Comparison) 66.9 49.7 * % of children age 0- 23 months with a febrile episode during the last two weeks Kaduha (Intervention) 30.7 45.5 Rwanda ICSP Final Evaluation Report September 2015 Page 42 of 405 who were treated with an effective anti￾malarial drug within 24 hours after the fever began. Kigeme (Comparison) 36.0 46.2 Key Indicators Table Indicator Location Baseline Estimate (%) MTE Estimate (%) Final Estimate (%) % of children 0-23 months who were put to the breast within one hour of birth Kaduha (Intervention) 48.3 82.3 82.2 * Kigeme (Comparison) 51.1 78.7 86.7 * % of mothers of children 0-23 months who disposed of the youngest child’s feces safely the last time a stool passed. Kaduha (Intervention) 71.4 80.7 84.4 * Kigeme (Comparison) 82.8 81 89.4 % of children 0-23 months with diarrhea in the previous two weeks Kaduha (Intervention) 17.2 11.1 Kigeme (Comparison) 19.4 20 % of children 0-23 months with diarrhea in the last two weeks who were offered more fluids during the illness Kaduha (Intervention) 36.9 67.5 Kigeme (Comparison) 40 63.9 % of children 0-23 months with diarrhea in the last two weeks who were offered the same amount or more food during the illness Kaduha (Intervention) 63.1 82.5 Kigeme (Comparison) 64.3 75 % of children 0-23 months with diarrhea in the last two weeks who were treated with zinc supplements Kaduha (Intervention) 24.6 15 Kigeme (Comparison) 10 20.8 Rwanda ICSP Final Evaluation Report September 2015 Page 43 of 405 ANNEX IV. FINAL KNOWLEDGE, PRACTICE, AND COVERAGE REPORT World Relief Rwanda Innovation Child Survival Project Nyamagabe District, Rwanda October 2011-September 2015 Final Knowledge Practices and Coverage (KPC) Survey Report Including Indicators for Operations Research Data collected: March 25-27 2015 Report submitted to USAID February 5, 2016 USAID/CSHGP Cooperative Agreement Award No. AID-OAA-A-11-00056 Report Authors Olga Wollinka, Consultant Melene Kabadege, World Relief Allison Flynn, World Relief Rachel Hower, World Relief Monisha Billings, Consultant, data analysis Rwanda ICSP Final Evaluation Report September 2015 Page 44 of 405 Acknowledgements The authors would like to acknowledge the many individuals who made this report possible through contributions ranging from development of the survey instrument to guidance on study design, sampling, technical support for electronic data collection using smart phones, data collection and supervision, data cleaning, analysis and interpretation of results. Please see Annex 2 for a list of all the year 4 KPC supervisors, interviewers, and their titles. Rwanda ICSP Final Evaluation Report September 2015 Page 45 of 405 Table of Contents Acknowledgements.....................................................................................................................................44 Table of Contents.......................................................................................................................................45 Acronyms ...................................................................................................................................................47 Executive Summary...................................................................................................................................49 Background................................................................................................................................................52 Project Location ................................................................................................................ 52 Project area health, social, and economic conditions...................................................... 52 Project goals, objectives, interventions and KPC survey objectives................................. 56 Table 2: Key Activities for the Selected High Impact Technical Interventions ................. 58 Process and Partnership Building............................................................................................................60 Methods......................................................................................................................................................61 Questionnaire development............................................................................................. 61 KPC indicators by intervention area, and definitions ............................................................... 61 Table 3. Study Indicators................................................................................................... 62 Training ............................................................................................................................. 67 ICSP Tangiraneza Year 4 Final KPC & OR Study Timeline, January- September 2015 ..................................................................................................................... 69 Results of the EOP KPC Survey.................................................................................................................71 Discussion ..................................................................................................................................................77 Rwanda ICSP Final Evaluation Report September 2015 Page 46 of 405 Annex 1. M&E Table ......................................................................................................... 80 Annex 2. KPC supervisors, interviewers, and their roles................................................ 104 Annex 3. Training schedule for supervisors and interviewers........................................ 106 Annex 4. Population data used to select 30-clusters...................................................... 107 Annex 5. Consent Form for KPC Respondents................................................................ 127 Annex 6. Year 4 KPC Survey Questionnaire with Translation ......................................... 129 Annex 7. Sampled Villages in Nyamagabe District.......................................................... 177 Annex 8. Indicator Tabulation Plan-Year 4 KPC .............................................................. 180 Annex 9. Project Resource Requirements of Year 4 KPC Survey .................................... 196 Annex 10. Year 4 KPC Raw Data for each question ........................................................ 198 Rwanda ICSP Final Evaluation Report September 2015 Page 47 of 405 Acronyms ACT Artesunate Combined Treatment (Coartem) ANC APHA ARI ASM BCC BF Ante-Natal Care American Public Health Association Acute Respiratory Infection Agente de Santé Maternelle (Maternal Health Agent) Behavior Change Communication Breastfeeding BMI Body Mass Index (method for calculating underweight) CAMERWA Central Purchasing Body for Medicines in Rwanda (Centrale d’achats de Medicaments du Rwanda) CATCH CBN CBNP CCM Core Assessment Tool on Child Health Community-Based Nutrition Community-Based Nutrition Program Community Case Management CDC Community Development Committee CHW Community Health Worker C-IMCI Community-Integrated Management of Childhood Illness CORE COSA CMAM Child Survival Collaborations and Resources Group Health Committee (Comite de Sante) Community Management of Acute Malnutrition CSHGP Child Survival and Health Grants Program CSP CFSVA Child Survival Project Comprehensive Food Security and Vulnerability Analysis CTO DDP Cognizant Technical Officer, USAID District Development Plan DIP Detailed Implementation Plan DHS DRC EBF Demographic and Health Survey Democratic Republic of Congo Exclusive Breast Feeding EIP Expanded Impact Child Survival Project FE FP FY GDP GMP GoR Final Evaluation Family Planning Fiscal Year Gross Domestic Product Growth Monitoring and Promotion Government of Rwanda HBM Home-Based Management (of fever) HC HF Health Center In-Home Fortification HFA Health Facility Assessment HMIS HQ HSSPII IFA IGA Health Management Information System Headquarters Health Sector Strategic Plan II Iron-Folic Acid Income-generating activities ICG Integrated Care Group IMCI IMU Integrated Management of Childhood Illness Inpatient Malnutrition Unit IR ITN Intermediate Result Insecticide Treated Bed Net IYCF Infant and Young Child Feeding Rwanda ICSP Final Evaluation Report September 2015 Page 48 of 405 LLIN Long Lasting Insecticide Treated Bed Nets LOE KPC Level of Effort Knowledge, Practice and Coverage MAM Moderate Acute Malnutrition MCH MCHIP MDP MINAGRI MINALOC MNC MNCH Maternal and Child Health Maternal and Child Health Integrated Program Millennium Development Goals Ministry of Agriculture Ministry of Local Government Maternal and Newborn Care Maternal, Newborn and Child Health M&E Monitoring and Evaluation MOH Rwandan Ministry of Health MOU Memorandum of Understanding MTE MUAC Midterm Evaluation Mid-Upper Arm Circumference OR ORS ORT OTP PBF PD Hearth Operations Research Oral Rehydration Solution Oral Rehydration Therapy Outpatient Therapeutic Program Performance Based Financing Positive Deviance/Hearth model PDA PENTA-1 PENTA-3 PI Personal Data Assistant Pentavalent-1 Pentavalent-3 Principle Investigator POU PVO Point-of-use US Private Voluntary Organization QA Quality Assurance RDHS RDT RFA RIDHS RT RUTF RWF Rwanda Demographic & Health Survey Rapid Diagnostic Test (for malaria) Request for Applications Rwanda Interim DHS Round Trip Ready to Use Therapeutic Food (Plumpy Nut) Rwandan Francs SBC SAM SMS Social and Behavior Change Severe Acute Malnutrition Short Message Service (text message) TBA Traditional Birth Attendant TOT TT Training of Trainers Tetanus Toxoid TWG UBC Technical Working Group University of British Columbia UNICEF USAID VAS United Nations Children’s Fund United States Agency for International Development Vitamin A Supplement WHO World Health Organization WR World Relief WRA Women of Reproductive Age Rwanda ICSP Final Evaluation Report September 2015 Page 49 of 405 Executive Summary Population of interest: Rwanda is a small, mountainous and densely populated country. The population is over 80% rural and most people rely on agriculture to meet their basic needs.1 The 2010 DHS Survey Final Report revealed that the Nyamagabe District had some of the highest rates of malnutrition, anemia and stunting nationwide2 . Moreover, rates of stunting, which is symptomatic of undernutrition during the key developmental period between conception and two years of age, commonly referred to as the ‘1000 days’, was reported by the DHS as 44% nationwide. Malnutrition of varying degrees gravely affects the cognitive and physical development of children and the well-being and productivity of women with serious consequences for the intergenerational cycle of poverty and undernutrition in Rwanda persisting without effective interventions being implemented3 . The project and methodology: In October 2011, World Relief (WR) was awarded a four year grant from the United States Agency for International Development (USAID) Child Survival and Health Grants Program to improve the health and undernutrition of children under five and pregnant women in Nyamagabe District, South Province, Rwanda. The WR Innovation CSP was designed to help the government of Rwanda achieve its Millennium Development Goals (MDGs) related to maternal and child health, particularly the elimination of malnutrition. The targeted population of Nyamagabe District is 330,510. 4 The total number of women beneficiaries is 111,431 and total number of children under five years of age is 41,314 children (12.5% of total population in 2011). The estimated Level of Effort per intervention is: Nutrition 40%, Maternal Newborn Care 35%, Diarrhea 15%, and Pneumonia 10%. As part of its endline assessment, the project carried out a Knowledge, Practices and Coverage (KPC) survey. This survey used parallel sampling with 30-cluster methodology to collect information from mothers of children 0-23 months in late March and early April, 2015. Two separate 30x12 cluster samples were randomly selected in each of two hospital zones that comprise Nyamagabe District. The combined sample included 720 households. The primary objectives of the survey were: 1. To measure endline values for indicators related to the project’s interventions, including USAID Key Indicators. 2. To collect baseline values for USAID Rapid CATCH indicators (some of which overlap with the project indicators). 3. To collect endline data for indicators related to the project’s operations research on the Nutrition Weeks innovation. The innovation: Nutrition Weeks innovation was introduced into the Community Based Nutrition Protocol (CBNP) in the intervention area, Kaduha hospital zone, while using the Kigeme hospital zone as the comparison group. This intervention was expected to improve the nutritional status of pregnant, lactating women, and children aged 0-23 months in the intervention area, as a result of enhanced Infant and Yong Child Feeding (IYCF) practices. CHWs in Kaduha received training and a step-by-step guide to implement Nutrition Weeks, which were scheduled three times each year. The Nutrition Weeks included 1 US Department of State Background Note. Accessed November 14, 2011. http://www.state.gov/r/pa/ei/bgn/2861.htm 2 2010 DHS Survey Final Report, published in February 2012. 3 Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008; 371(9610): 417-40. 4 Nyamagabe District Statistics 2011 Rwanda ICSP Final Evaluation Report September 2015 Page 50 of 405 all women with children under two and pregnant women. Mothers participated in week long, two-hour nutrition education sessions modeled after PD/Hearth, practicing cooking diverse local foods and responsively feeding their children in a supportive group with the goal of improving child diet and nutrition status. Results of KPC Survey: Of the KPC respondents, about 31%-32% were classified as those in ‘abject poverty’ or ‘very poor’, with around 67% identified as ‘poor’ in both zones of the district. The endline KPC survey also found 83.06% of respondents in Kaduha and 83.89% of respondents in Kigeme had self￾reported mutuelle membership. Of these, 98.99% in Kaduha and 91.39% in Kigeme had a membership card to show the interviewer. Both Kaduha and Kigeme hospital zones saw improvements over the life of the project with regards to international standards and recommendations for infant and young child feeding. Nutrition practices in Kaduha, where Nutrition Weeks intervention is implemented, showed marked improvements from baseline levels. The proportion of infants and young children age 6-23 months fed according to the Minimum Dietary Diversity (MDD) increased from 21.9% at baseline to 52.9% at EOP, falling slightly short of the target of 60%. However, Kigeme showed a decline in MDD from the baseline level 38.9% to 27.7%. The MDD estimates at EOP comparing Kaduha and Kigeme were statistically significantly different (a linear probability model (LPM) found the change in MDD from baseline to endline in the intervention area was 30% higher than the comparison area (p<0.001), controlling for time and location). Minimum Meal Frequency (MMF) increased dramatically from baseline levels in both zones (from 7.0% to 68.6% in Kaduha and from 7.4% to 65.8% in Kigeme), with both zones exceeding their EOP targets (though MMF EOP estimates between the two zones were not statistically significantly different). The proportion of infants and young children age 6-23 months fed according to the Minimum Acceptable Diet (MAD) increased in both zones. An LPM found that the change in MAD from baseline to endline in the intervention area was 23% higher than the comparison area (p<0.001), controlling for time and location. However, neither area achieved the target of 50% for this indicator. The proportion of children 0-23 months of age who were put to the breast within one hour had increased considerably from baseline levels and surpassed the target of 70% in both Kaduha and Kigeme, but were not significantly different from each other (48.32% to 82.22%; 51.1% to 86.67% respectively). Prelacteal feeding decreased in the two zones 10.99% to 0.28% in Kaduha and 10.70% to 1.69% in Kigeme; declining more than the target of 3%, though the two zones were not significantly different from each other. Exclusive breastfeeding of children 0-5 months remained high in Kaduha with a moderate increase from 91.11% (CI: 85.23-96.99%) at baseline to 96.67 (CI: 88.23-99.94%) at EOP. However a decline in exclusive breastfeeding was noted in Kigeme [98.89% (CI: 96.73-100.00%) at baseline to 88.89% (CI: 75.94-96.29%) at EOP. The EOP estimates of this indicator in the two zones were not statistically significantly different. Malnutrition indicators showed a decline in both zones, but this decline was not statistically significantly different. When the EOP estimates of these indicators between Kaduha and Kigeme were compared, there was no statistically significant difference. In Kaduha, the proportion of children 0-23 months who were underweight decreased from 17.8% (CI: 14.0-22.5%) at baseline to 13.33% (CI: 8.7-19.2%) at EOP, though not statistically significant. However, in Kigeme, there was an increase from 8.9% (CI: 6.6-15.0%) at baseline to 12.5% (CI: 8.28-18.56%) at EOP, though not statistically significant as well. When the EOP estimates of this indicator were compared between Kaduha and Kigeme there was no statistically significant difference. Rwanda ICSP Final Evaluation Report September 2015 Page 51 of 405 While measured for tracking purposes only, there was a decline in stunting in the two zones from their respective baseline levels, though neither change was significantly different. In Kaduha, stunting among 0-23 month old children was 44.3% (CI: 37.6-51.2%) at baseline, and declined to 31.39% (CI: 24.95- 39.00%). In Kigeme, stunting decreased from 33.4% (CI: 27.1-40.4%) at baseline to 26.39% (CI: 20.36- 33.76%) at EOP. EOP stunting levels in Kaduha and Kigeme were not statistically significantly different. The percentage of mothers of children who live in households with soap at the place for hand washing improved in both zones, from 38.6% (CI: 33.6-43.6) at baseline to 85.28% (CI: 79.6-90.3) at EOP in Kaduha and from 43.9% (CI: 38.8-49.0) to 76.94% (CI: 69.8-82.6) in Kigeme, both surpassing the EOP target of 65%, though not significantly different from one another. The percentage of children 0-23 months with diarrhea in the last two weeks who were offered the same amount or more food during the illness went up in both zones, reaching EOP targets of 75%. In Kaduha, it rose from 63.1% (CI: 51.4-74.8) at baseline to 82.5% (CI: 62.1-96.8) at EOP. In Kigeme, rates similarly rose from 64.3% (CI: 53.1-75.5) to 75% (CI: 57.8-87.9). As the confidence intervals overlapped, there was no statistically significant difference between the two zones at EOP. The proportion of households with children 0-23 months that received a visit from a community health worker (CHW) in the past month, according to reported purpose was 61.94% (CI: 51.14-68.80%) in Kaduha compared to 43.33% (CI: 35.98-50.91%) in Kigeme, and this was statistically significantly different. The estimates of this indicator were similar at baseline in Kaduha [26.7% (CI: 22.13-31.27%)] and Kigeme [21.9% (CI 17.63-26.17%)] but at EOP, Kaduha had higher estimates than Kigeme. Rwanda ICSP Final Evaluation Report September 2015 Page 52 of 405 Background Project Location Rwanda is a small, mountainous and densely populated country. The population is over 80% rural and most people rely on agriculture to meet their basic needs.5 The 2010 DHS Survey Final Report revealed that the Nyamagabe District (in South Province of Rwanda) had some of the highest rates of malnutrition, anemia and stunting nationwide6 . Moreover, rates of stunting, which is symptomatic of undernutrition during the key developmental period between conception and two years of age, commonly referred to as the ‘1000 days’, was reported by the DHS as 44% nationwide. Malnutrition of varying degrees gravely affects the cognitive and physical development of children and the well-being and productivity of women with serious consequences for the intergenerational cycle of poverty and undernutrition in Rwanda persisting without effective interventions being implemented7 . Project area health, social, and economic conditions The most recent (2010) DHS Survey Final Report reveals that Nyamagabe District has some of the highest rates of malnutrition, anemia and stunting nationwide8 . The District’s leading causes of child mortality are: neonatal complications, pneumonia, diarrhea and malnutrition. The 2014-2015 DHS Key Indicators document found 40.5% stunting including 13.9% severe stunting in the South Region where Nyamagabe is located9 . Most income-generating activities in Nyamagabe are agricultural. The crops grown, in order of importance, are: beans, Irish potatoes, sweet potatoes, wheat, bananas, sorghum, cassava, passion fruits, peas, maize and soy.10 The two primary cash crops are tea, grown in eastern Nyamagabe near the Nyungwe National Park, and coffee, which is grown throughout the district. The 2010 Nyamagabe District Development Plan explains that “very poor soil conditions, degradation by erosion, fragmentation and over-exploitation linked to lack of fallow land and poor agricultural practice due to lack of inputs has led to acute impoverishment of available land.” Moreover, the land available per family is quite limited. These factors contribute to 28% of the population living below the poverty line, and the constant threat of food insecurity11. Challenges to proper nutrition in Rwanda include shortage of land, poor soil, lack of animals (for fertilizer) and lack of enough animal protein or fat in the diet. At baseline, mothers also lacked knowledge about ideal BF practices, the proper times to introduce complementary foods, and proper fat content for diets of young children. Meal frequency was very low, and dietary diversity was also inadequate. Even health workers had erroneous beliefs about BF, complementary feeding, and nutrient content of foods (thinking tree tomatoes have iron, for example.) Children were given a very watery porridge, so nutrient density was poor, and the porridge itself was not enriched with any source of protein such as small fish, animal protein or even added oil (as they believed oil is bad for children’s 5 US Department of State Background Note. Accessed November 14, 2011. http://www.state.gov/r/pa/ei/bgn/2861.htm 6 2010 DHS Survey Final Report, published in February 2012. 7 Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008; 371(9610): 417-40. 8 2010 DHS Survey Final Report, published in February 2012 9 National Institute of Statistics of Rwanda (NISR) [Rwanda], Ministry of Health (MOH) [Rwanda], and ICF International. 2015. Rwanda Demographic and Health Survey 2014-15: Key Indicators. Rockville, Maryland, USA: NISR, MOH, and ICF International. 10 DDP, p. 10 11 ibid Rwanda ICSP Final Evaluation Report September 2015 Page 53 of 405 liver.) Frequent bouts of diarrhea are a significant problem, and since it is so common, mothers do not have a strong enough perception of the severity, and they do not seek treatment, nor do enough give continued fluids and foods for catch-up growth. Nyamagabe District has sufficient water sources, yet many people still use streams, dams, swamps and valleys12. Over 23% of the people travel nearly 3.5 km to the nearest clean water source; which is 3km further than the recommended national norm. Instead of the local government being in charge of management of the water infrastructure, maintenance and repair has been a responsibility of the general population. Due to poor management, existing infrastructure has been neglected, and left in a state of disrepair13. The Nyamagabe district health services were strengthened by WR through the CSHGP –funded Expanded Impact Project (EIP) that was implemented in six districts of southern and eastern Rwanda (funding ended in 2011). WR was responsible for Nyamagabe District and for overall training in Care Group methodology. The focus of EIP was to help the MOH roll out Community Case Management (CCM) for pneumonia and diarrhea through integrated Care Groups (CGs) that used MOH CHWs (1 per 2-3 villages). Nyamagabe is not endemic for malaria, although the government added CCM for malaria in the district in conjunction with national use of rapid diagnostic testing for malaria. The program did not address nutrition or maternal and newborn care, which are both key areas for the present Innovation CSP. There are 2 District hospitals, 16 health centers, and 1,608 CHWS (binome and ASM) across the 536 villages in Nyamagabe. The national plan Vision 2020 calls for one health center in each of the 17 sectors to improve the number of people living within 10 km of a health facility. According to the district development plan, there is only one physician for every 33,655 people (9 total), and the 2012 goal is for 15 doctors14. Due to the USAID supported system-strengthening for logistics and procurement as well as direct support of various donors, there are fairly reliable supplies of essential medicines. Clients pay for health services in Rwanda. In 2003, the MOH instituted a health insurance scheme known as mutuelle de santé. The 2012 Nyamagabe KPC baseline survey just found that 57% and 63% (Kaduha and Kigeme, respectively) of families with children under two surveyed in the district were enrolled. Enrolled individuals make a small co-payment to receive all primary care services and medications. Many hospital services are also covered. For families who are not yet enrolled, the cost of services is a major barrier to appropriate care-seeking, however, there are various NGO and government programs to assist poor families to enroll. Community Health Workers and Community Mobilization CHWs in Rwanda Rwanda has a system of community health workers such that every village (umudugudu) has each of the following: 1) One male and one female pair of CHWs (binome) in charge of community case management (malaria, pneumonia and diarrhea) and nutrition; one of the binome provides community￾based distribution of family planning as well, and 2) One maternal health agent (ASM), a female responsible for maternal and newborn health. The binome and ASM have indefinite terms of service once elected and trained. Each village and cell also has a representative in charge of Social Affairs, which falls 12 Ibid, p. 15 13 Ibid, p. 15 14 Ibid, p. 17 Rwanda ICSP Final Evaluation Report September 2015 Page 54 of 405 under the Ministry of Local Government (MINALOC). Behavior change is considered under the purview of MINALOC. CHWs are provided with a simple medical kit including a mid-upper arm circumference (MUAC) measuring tape, timer for counting breaths, amoxicillin for treating presumptive pneumonia, artemisinin-based combination therapy (ACT) for confirmed malaria, oral rehydration salts (ORS) and zinc for diarrhea, and a wooden box to store all medicines, data collection tools and other job aids. Rapid diagnostic test (RDT) kits to confirm malaria have been rolled out nationally. In these districts, CHWs also have a supply of gloves and a waste disposal box. TBAs and traditional healers: Although Traditional Healers exist, there is no MOH program for them now. WR trained them in EIP (2006-2011) to refer to facilities for sick child danger signs. Traditional Birth Attendants (TBAs) are no longer recognized in Rwanda; some former TBAs were trained to become maternal health CHWs (ASM) but are not allowed to do home deliveries. CHW incentives: The binome and ASM CHWs receive financial incentives via performance based financing. A small individual payment is made to each CHW in addition to a collective stipend that is paid into the CHW cooperative at health center level. CHW training and supervision: Each type of CHW is trained with others of the same role according to a standard protocol for each component of their responsibilities (e.g. 2 days for growth monitoring; 5 days for IYCF). Additionally, they attend monthly meetings en masse at the health center. However, as these meetings tend to focus on the income generation function of the CHW Cooperative, there is a separate monthly meeting specifically for CCM reporting and re-stocking of drug supplies. Supervision of CHWs occurs at two levels using standardized supervision tools. The health center in￾charge for community health is responsible for supervising all CHWs in the field once every three months. Additionally, peer supervision is to take place monthly via the CHW Cell-Coordinator, a competent (unpaid) peer elected to supervise the other CHWs (about 20) in his or her cell. CHW workload: Theoretically, all CHWs are responsible for conducting home visits in their village related to their area of expertise. However, they naturally focus their time most heavily on curative rather than preventive services with behavior change communication mostly done in the context of large community gatherings. In the March 2011 draft report of a 2010 c-IMCI evaluation of CHWs in Rwanda (Community Health Desk, Rwanda MOH, p. 14), analysis of CHW workload reported on “the basic elements of their work: seeing a sick child, completing the monthly report and traveling to the health center.” The study found that on average, CHW binomes spent about 9 hours per month on the combined tasks. Notably, BCC was not even included in the assessment, indicative of its ancillary role. Current status of CHW training in Nyamagabe: Before Tangiraneza began, training related to nutrition focused primarily on growth monitoring and screening for referral to the health center for rehabilitation. Through Tangiraneza, project staff have supported the MOH in training CHWs on its maternal, infant and young child feeding curriculum that was finalized at the start of the project. In addition to national protocols for CHW trainings, each district is mandated to do what it can towards the government’s goal to eliminate malnutrition. Integrated Care Groups In the prior Kabeho Mwana Expanded Impact Project, World Relief formed the CHWs in six districts of Rwanda into modified Care Groups for peer support and enhanced behavior change communication (BCC). The modified Care Groups enabled joint planning, data reporting and cross-training of all CHWs in C-IMCI messages. By dividing up geographic responsibility for home visits, all households with children under five could be reached monthly with BCC. Rwanda ICSP Final Evaluation Report September 2015 Page 55 of 405 This strategy is complementary to and enhances the MOH strategy for CHWs though is not formally MOH policy. The Final Evaluation for EIP found that these CHW peer groups fostered solidarity and support not experienced in the much larger CHW meetings at health center. In the current project, CHW groups were further modified to include village and religious leader representatives to enhance village level support and coordination, and have been termed “integrated” care groups. Mobilizing Faith Communities Religious leaders are highly regarded by their followers in Rwandan society and the vast majority of people identify themselves as Christian. A poll conducted by the Pew Forum on Religion and Public Life in 201015 reported that 93% of respondents were Christian, 5% Muslim, and 2% other, similar to data reported by the Rwanda government in 2006. Ninety eight percent polled said that religion was “very important” (90%) or “important” (8%) in their life. Weekly attendance at religious services was reported by 76% of respondents and an additional 12% participated monthly or yearly. These findings underscore the importance of engaging religious leaders and faith communities as part of community mobilization. The project engaged with parish leaders from all denominations on a quarterly basis at sector level. Initially, the members helped identify which church leaders should participate in the integrated Care Group at village level. They were also charged with making plans with the congregations under their leadership for reinforcing key health messages and helping the most vulnerable families in their communities with the support needed to follow recommended behaviors. For example, during rollout of messages on hand washing, congregations could be challenged to identify and support families for whom building a tippy tap might otherwise be out of reach—with the expectation that assistance be based on need regardless of religious affiliation. National standards/policies regarding maternal and child health, particularly nutrition National standards and policies regarding MCH and Nutrition are developed based on internationally￾accepted guidelines and programs. This Innovation CSP is designed to help the government of Rwanda achieve goals related to maternal and child health, and particularly for the elimination of malnutrition. The Rwanda MOH Strategic Plan for 2008-2012 notes that “the most influential International commitments providing direction to the HSSP-II are the MDGs, the African Health Strategy 2007-2015, the Paris Declaration, Accra Accord and Abuja Declaration.” Four MDGs are related to health: • Goal 1: Eradicate extreme poverty and hunger (malnutrition) • Goal 4: Reduce child mortality • Goal 5: Improve maternal health • Goal 6: Combat AIDS, malaria and other diseases The HSSP-II includes many strategies and interventions that are oriented towards speeding up the achievement of health-related MDGs. While great strides have been made to meet these goals, Goal 5, to improve maternal mortality, proved the most difficult to achieve. This plan outlines the additional interventions required to accelerate progress towards realizing this MDG. The HSSP-II is also guided by the Africa Health Strategy 2007-2015, which provides strategic direction to Africa’s efforts in creating better health for all along with an overarching framework to enable coherence within and between countries, civil society and the international community. The Strategy emphasizes the need to strengthen health systems, provide the poor with services and thereby contribute to equity. It 15 http://features.pewforum.org/africa/country.php?c=182 Rwanda ICSP Final Evaluation Report September 2015 Page 56 of 405 focuses on the health of women and children, where great challenges remain. It suggests that apart from the necessary attention for AIDS, malaria and TB, the substantial disease burden posed by other communicable and non-communicable diseases should not be overlooked. It also encourages sector-wide approaches to guarantee alignment of donor funding with nationally-determined plans and priorities. Rwanda signed on to the Abuja Declaration committing 15% of disposable GDP to its health sector. Furthermore, donor commitment to the Paris Declaration for aid harmonization (2005) and Accra Accord for aid effectiveness (2008) has resulted in improved donor co-ordination.16 Nutrition Policy The Second National Nutrition Summit held in Kigali in November, 2011 had the theme of “Supporting Progress in Rwanda’s Efforts to Eliminate Malnutrition”.17 Over 200 Rwandan and international participants and experts met to discuss progress on the consensus statement from the 2009 Nutrition Summit, which was “to prevent acute and chronic malnutrition (stunting), through a multi-sectoral approach featuring multiple well-proven and evidence-based interventions with a focus on community based nutrition programmes.” After two years of implementing District Plans to Eliminate Malnutrition (DPEM), participants described the following challenges issues: “lack of commitment and participation from local leaders at the district level, and the amount of work expected of community health workers (CHWs) despite the fact that they are voluntary workers. “All Summit participants agreed with the potential communication power of the concept of 1,000 Precious Days. This slogan should be adopted as a theme of the DPEMs in order to add a highly human, easy to understand concept and should be promoted in a major way at all levels with the objective of having all families take new interest and pride in this period and provide the special nutrition actions and protection needed to have the child reach the age of two years with their full potential intact for growth and development. The concept of “Agakono K’ umwana”, meaning a special pot for the child, should also be considered as a communication vehicle to drive the much needed high quality complementary feeding component of the 1,000 Precious Days.” Project goals, objectives, interventions and KPC survey objectives The WR Innovation CSP was designed to help the government of Rwanda achieve its Millennium Development Goals (MDGs) related to maternal and child health, particularly the elimination of malnutrition. The targeted population of Nyamagabe District is 330,510 (Nyamagabe District Statistics 2011). The total number of women beneficiaries is 111,431 and total number of children under five years of age is 41,314 children (12.5% of total population in 2011). The intervention activities and % level of effort are: Nutrition 40%, Maternal Newborn Care 35%, Diarrhea 15%, and Pneumonia 10%. As part of its endline assessment, the project carried out a Knowledge, Practices and Coverage (KPC) survey. This survey used parallel sampling with 30-cluster methodology to collect information from mothers of children 0-23 months in late March and early April, 2015. Two separate 30x12 cluster 16 The Rwanda Ministry of Health Strategic Plan for 2008-2012 can be found online at: 17 Second National Nutrition Summit, report can be found online: Rwanda ICSP Final Evaluation Report September 2015 Page 57 of 405 samples were selected in each of two hospital zones that comprise Nyamagabe District. The combined sample included 720 households. KPC Survey primary objectives: 1. To measure endline values for indicators related to the project’s interventions, including USAID Key Indicators. 2. To collect endline values for USAID Rapid CATCH indicators (some of which overlap with the project indicators). 3. To collect endline data for indicators related to the project’s operations research on the Nutrition Weeks innovation. The innovation: Nutrition Weeks innovation was introduced into the Community Based Nutrition Protocol (CBNP) in the intervention area, Kaduha hospital zone, while using the Kigeme hospital zone as the comparison group. This intervention was expected to improve the nutritional status of pregnant, lactating women, and children aged 0-23 months in the intervention area, as a result of enhanced Infant and Yong Child Feeding (IYCF) practices. CHWs in Kaduha received training and a step-by-step guide to implement Nutrition Weeks, which were scheduled three times each year. The Nutrition Weeks included all women with children under two and pregnant women. Mothers participated in week long, two-hour nutrition education sessions modeled after PD/Hearth, with a goal of learning about foods, feeding practices, and other behaviors that will prevent undernutrition. Fathers and alternate caregivers also participated in select sessions in order to reinforce learning and healthy IYCF practices when mothers are not present. CSP Goals The overall goal of the World Relief Innovation Child Survival Project is to reduce morbidity, mortality, and undernutition of children under five and pregnant women in Nyamagabe District, Rwanda. The aim of the operations research component of the project is to identify a feasible way for the Ministry of Health in Rwanda to use existing staff and CHWs to reduce and prevent undernutrition in children who are in their first 1,000 days of life in Nyamagabe District. The results of the project will yield valuable data relevant to scaling up the approach in Rwanda and contribute to the international body of knowledge on feasible approaches to prevent undernutrition. To facilitate this, Dr Fidele Ngabo, formerly the Director of the Maternal and Child Health Unit for the Ministry of Health was appointed as a Principal Investigator along with Dr. Judy Mclean, PhD, Senior Instructor of International Nutrition at the University of British Columbia. Two consecutive Heads of the Nutrition Desk for the Ministry of Health, Alphonsine Nyiransabimana and then Alexis Muzindutsi, were Co-Investigators, along with Melene Kabadege, WR Maternal & Child Health Regional Technical Advisor for Burundi, Congo & Rwanda, who had the idea for Nutrition Weeks. CSP Objectives The project’s Strategic Objective is “Improved capacity of MOH staff and CHWs to implement high impact maternal, newborn and child health intervention at the community level.” The main objective of the operational research (OR) component is to identify and test the effectiveness and feasibility of the Nutrition Weeks innovation when added to the standard CBNP. This intervention is expected to improve the nutritional status of infants and young children aged 6-23 months from baseline to the end of study in the intervention area (Kaduha hospital zone) compared to that of the comparison area (Kigeme hospital zone), as a result of improved Infant and Yong Child Feeding (IYCF) practices. Proxy indicators will be used assess improvements made. Rwanda ICSP Final Evaluation Report September 2015 Page 58 of 405 Technical Package: Table 1: Project goal, strategic objective, and intermediate results Project Goal: To reduce morbidity, mortality and underlying nutrition of children under five and pregnant women in Nyamagabe District of Rwanda. Strategic Objective: Improve capacity of MOH staff and CHWs to implement high impact maternal, newborn and child health interventions at the community level. IR 1. Improved geographic access to and demand for high quality MNCH services IR 2. Improved coordination of and impact of community health activities IR 3. Innovation tested to improve the effectiveness of the Community Based Nutrition Program Activities: Activities: Activities: 1) Build capacity of Community Health Supervisor and Hygienists from all 16 Health Centers as TOT trainers for the CHW Cell Coordinators and the Social Affairs in-charges at Cell level. In turn, these 2 cadres of workers will train Care Groups. 2) The Cell-Coordinators will train 1608 CHWs (each one in charge of 2-3 CGs) in all interventions (Nutrition, MNC, Diarrhea and Pneumonia). The Social Affairs in-charge at the cell level will train CHWs for Nutrition Weeks, supporting the CHW Coordinator in BCC/ community mobilization. 3) Train Kaduha area CBN Village Committees with the ‘Nutrition Week’ innovation. 4) Train 536 maternal health CHWs (ASM) in MNC package. 1) CHWs, religious leaders and community representatives meet monthly to: • Make action plans based on data reported by CHWs • Cross-train in BCC for key family practices based on barrier analysis and BC strategy; • Coordinate regular home visits • Improve referral to appropriate CHW and/or health facility. 2) Build capacity of Sector and Cell level In-Charge of Social Affairs to support BCC. 3) Mobilize churches to assist vulnerable households with kitchen gardens & tippy taps. 1) Conduct Operations Research comparing standard CBNP activities vs. CBNP plus the addition of the ‘Nutrition Week’ intervention. Evaluate impact with regard to cost and feasibility for scale up. 2) Participate in Nutrition Technical Working Group; Improve awareness, solicit input and share findings. 3) Improve CHWs records and reporting system for nutrition. CSP Intervention activities The estimated Level of Effort per intervention is: Nutrition 40%, Maternal Newborn Care 35%, Diarrhea 15%, and Pneumonia 10%. The following table shows key indicators for each intervention. Table 2: Key Activities for the Selected High Impact Technical Interventions Nutrition – 40% Level of Effort (LOE) Community-Based Growth Monitoring held every month with quality counseling based on weight Rwanda ICSP Final Evaluation Report September 2015 Page 59 of 405 for age growth plots Underweight children screened with MUAC and severely underweight or SAM cases referred to health centers Pregnant women screened with MUAC and referred for supplemental food if under 18.5 cm (will be held during Nutrition Week in Kaduha area) Children enrolled in OTP and those discharged from IMU will get a referral card from Facility to Community and will be followed up by CHWs. Integrated Care Groups use the Triple A process (per MOH protocol) to seek and implement solutions to malnutrition in community Results of growth monitoring shared with churches to elicit specific support for families with malnourished children Nutrition Weeks (described in Section 4 Innovation) held in each community 3 times per year De-worming and vitamin A distribution provided twice a year during MCH week. Promotion of Kitchen Gardens as recommended by the MINAGRI (responsible for Kitchen Gardens) and with technical assistance from government agronomists or NGOs in the district working in agriculture Provision of rabbits for community breeding to improve access to animal-source foods (paid by matching funds) Plan and follow up the implementation of the District Plan to Eliminate Malnutrition in Kaduha and Kigeme hospital zones Provide technical support to the implementation and supervision of PNBC Package (GM, cooking demonstration, IGA, etc.) Maternal Newborn Care – 35% LOE Support the MOH to train the maternal health CHWs (ASM) to identify and register WRA and pregnant women, promote ANC, birth preparedness, institutional deliveries, use of family planning, attend postnatal checks for mothers and newborns and refer women and newborns with danger signs to health facilities. Orient the Integrated Care Groups to key MNC messages they will promote to women and men including: • Attending ANC, value of institutional deliveries • Recognition of danger signs in pregnancy, delivery, post-partum, in the newborn • Maternal nutrition and decreased work load during pregnancy • Consumption of Iron-folic acid (IFA) and acquisition of Vitamin A supplements post-partum • Child spacing • ASMs help families make a birth plan and promote savings for the related costs or mutuelle enrollment • Integrated Care Groups develop emergency transport plan and community savings for medical emergencies. • Advocate for Facility Training and quality improvement on Post Natal Care • Provide Technical Support to Integrated Supervisions at community level Rwanda ICSP Final Evaluation Report September 2015 Page 60 of 405 Diarrhea – 15% LOE Coordinate refresher training for CHWs in CCM with emphasis on use of zinc and continued fluids and feeding during illness. Reinforce CHW’s Counseling and communication skills Integrated Care Groups promote point of use water purification, Community-Led-Total Sanitation, and treatment-seeking for diarrhea to improve utilization rates for zinc in addition to oral rehydration solution (ORS). Collaboration with Hygiene Clubs when they are started in Nyamagabe (district was not included in recent choice), through participation of Executive Committee member in Integrated Care Group. Hygiene promotion through churches Pneumonia – 10% LOE Coordinate refresher training for CHWs in CCM with emphasis on use of amoxicillin and increased fluids and feeding during illness. Collaboration with Ministry of Infrastructure and on-going projects to promote improved stoves to reduce indoor smoke Hygiene promotion to prevent transmission of respiratory infections Integrated Care Groups promote recognition of danger signs and prompt care-seeking based on C￾IMCI package. Process and Partnership Building Methods of identifying and engaging local partners/stakeholders in the KPC Most were experienced and trained from previous KPCs. Most were also MOH staff or representatives of local government. In fact, overall World Relief employed a minimum number of staff relative to the size of the population and number of CHWs being trained. WR’s role was more one of facilitation and capacity-building instead of direct implementation, which is the responsibility of MOH and local government. The Project Manager and Officers participated in National-level Technical Working Groups corresponding with their areas of focus and facilitated MOH capacity-building at the district, sector and community levels. Local officials, MOH staff, volunteers, and civic leaders were involved in every phase of the project, including the KPC and all evaluations. KPC Participants included: • 15 Health Center Nutritionists • 2 Hospital staff in charge of M&E • 28 sector staff in charge of Social Affairs at cell level • 4 University of Rwanda Students • 13 WR staff The WR MCH Regional Technical Advisor participated as the survey coordinator. The refresher trainings were organized for one day including piloting the questionnaire. The interviewers were between 20 and 40 years of age, fluent in Kinyarwanda and had completed both secondary school and some level of Rwanda ICSP Final Evaluation Report September 2015 Page 61 of 405 higher technical education. The enumerators received refresher training on how to use the PDA tablets, as well as how to properly collect anthropometric measurements. Each enumerator had the opportunity to practice data collection in the field in Kabajogo, Nyamugali and Nyarusange villages, Gasaka sector. During the data collection the new enumerators were together with the experienced ones, in order to get more support from the stronger enumerators and to ensure good quality of data collection and proper use of PDA tablets. Specific roles of local partners/stakeholders in the KPC survey As described above, except for just 13 WR staff and 4 University of Rwanda students, the entire KPC was conducted by MOH staff and representatives of local government. Constraints in making the KPC process more participatory There were no constraints to making the KPC process more participatory. Methods Questionnaire development The baseline questionnaire was developed using guidance and modules from USAID KPC 2000+ and Rapid CATCH 2008. Additionally, the 2008 WHO Indicators for Assessing Infant and Young Child Feeding Practices were used for indicators, questions and tabulation plans related to IYCF. The WHO guidance was similar to but not identical to the Rapid CATCH guidance on the same. In consultation with Jennifer Winestock Luna, Senior Advisor for Monitoring and Evaluation at MCHIP, it was agreed to use the more current WHO guidance on IYCF, particularly in light of the focus on dietary diversity, meal frequency and minimum acceptable diet as critical measures for the project’s operations research. The original questionnaire was reviewed by MCHIP prior to use. Upon guidance from MCSP, a few additional questions were added to the endline questionnaire with regards to household financial behaviors related to nutrition. Scope of the survey, Survey length, Versions of the questionnaire (if more than one type of respondent is sampled), Translation into local languages The final questionnaire had 106 questions, some with multiple sub-questions (particularly with regard to infant and young child feeding). Major topics included: demographic information, maternal and newborn care, nutrition and child feeding, anthropometry, diarrhea and hygiene, pneumonia case management, malaria prevention and case management, immunization and interaction with community health workers and Care Group members. The questionnaire was translated into Kinyarwanda and used for households with children under the age of two years. In the rare case where the caregiver was not the biological mother of the child, questions pertaining to maternal and newborn care, including immediate breastfeeding were not deemed relevant and skipped. Interviews using the questionnaire took 60-70 minutes to conduct. The questionnaire was prepared for electronic data collection by entering it into Mobile Data Studio. Data were collected on 23 project hand held tablets and 13 personal smart phones of the enumerators. KPC indicators by intervention area, and definitions Study indicators The expansive list of indicators was included to enable refinement of project objectives and activities based on those indicators that show the greatest need and opportunity for project impact. Please refer to the Tabulation Plan in the Annex for more detailed definitions of each indicator. Rwanda ICSP Final Evaluation Report September 2015 Page 62 of 405 Table 3. Study Indicators Breastfeeding and Nutrition (LOE 40%) Immediate breastfeeding of newborns Percent of children 0-23 months who were put to the breast within one hour of birth. (Key indicator MNC) (OR) Prelacteal feeding Percent of children 0-23 months given liquids prior to the initiation of breastfeeding. Exclusive breastfeeding Percent of children age 0-5 months who were exclusively breastfed during the last 24 hours. (RC) Continued breastfeeding at 1 year Percent of children 12-15 months who are still breastfeeding. Continued breastfeeding at 2 years Percent of children 20-23 months who are still breastfeeding. Minimum Dietary Diversity % infants and young children age 6-23 months fed according to the Minimum Dietary Diversity (OR) Minimum Meal Frequency % infants and young children age 6-23 months fed according to the Minimum Meal Frequency (OR) Minimum Acceptable Diet % infants and young children age 6-23 months fed according to the Minimum Acceptable Diet *WHO 2008 definition (OR, RC*) Consumption of iron-rich foods % infants 6–23 months of age who consumed food rich in iron. (Include micronutrient powders if/when program expands to Nyamagabe) Age appropriate introduction of semi-solid foods Proportion of infants 6–8 months of age who receive solid, semi￾solid or soft foods. Responsive feeding Percent of Caregivers who assist child when eating (of children who consume soft, semi-solid or solid foods). This indicator will get revised at next survey; will reference HF project data for baseline at that time. Self- Feeding Percent of children who consume soft, semi-solid or solid foods) who are self-feeding Vitamin A Supplementation in the last 6 months Percent of children age 6-23 months who received a dose of Vitamin A in the last 6 months: card verified or mother’s recall. (RC 8, OR) Anthropometry Underweight for Age Percent of children 0-23 months who are underweight (-2 SD for the median weight for age, according to WHO reference population). Disaggregate underweight by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) (RC) Acute Malnutrition / Wasting % children 0-23 months who are underweight for height (-2SD for the median height for age, according to WH0 reference population). Disaggregate wasting by moderate (≤-2SD and >-3SD) and severe Rwanda ICSP Final Evaluation Report September 2015 Page 63 of 405 (≤ -3SD) (OR) Acute Malnutrition - MUAC Percent of children 6-23 months acutely malnourished as measured by MUAC Disaggregate by ‘at risk’, moderate and severe acute malnutrition Stunting – Height for Age Percentage of children 0-23 months who are under height/length for age (-2SD for the median height for age, according to WHO reference population) Disaggregate stunting by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) Maternal Newborn Care (LOE 35%) 4+ ANC visits % mothers of children age 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child. (RC1) ANC in first trimester % mothers of children age 0-23 months who had antenatal visit in the first trimester when they were pregnant with the youngest child Tetanus toxoid %mothers with children age 0-23 months who received at least two TT vaccinations before the birth of their youngest child. (RC2) Skilled birth attendance % children age 0-23 months whose births were attended by skilled personnel. (RC3) Newborn post-natal check-up within 2 days of birth % of mothers of children 0-23 m. whose youngest child received a post-natal visit from an appropriate trained health worker within 2 days of birth. (RC4) Current Contraceptive Use Among Mothers of Young Children % mothers of children 0-23 months who are using a modern contraceptive method. (RC5) Increase iron-folic acid supplementation during pregnancy. Percentage of mothers who received tablets; average number of days consumed of those who received pills. (OR) Control of Diarrheal Disease (LOE 15%) Prevention Point of Use water treatment Percentage of households of children age 0-23 months that treat water effectively. (RC15, OR) Improve appropriate hand washing practices Percentage of mothers of children age 0-23 months who live in households with soap at the place for hand washing. (RC16, OR) Hand washing at appropriate times Percentage of mothers of children age 0-23 months who wash hands with soap at all four key times Latrine/toilet in good condition Percentage of households of children age 0-23 months that have a toilet facility in appropriate condition Safe feces disposal Percentage of mothers of children 0-23 months who disposed of Rwanda ICSP Final Evaluation Report September 2015 Page 64 of 405 the youngest child’s feces safely the last time a stool passed. (Key Indicator) Two week prevalence of diarrhea Percentage of children 0-23 months with diarrhea in the previous two weeks (Key Indicator) ORT use for diarrhea Percentage of children age 0-23 months with diarrhea in the last 2 weeks who received ORS and/ or recommended home fluids. (RC13) 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. (Key Indicator) Feeding during diarrhea Percentage of children 0-23 months with diarrhea in the last two weeks who were offered the same amount or more food during the illness. (Key Indicator) Zinc treatment for diarrhea Percentage of children 0-23 months with diarrhea in the last two weeks who were treated with zinc supplements. (Key Indicator) Pneumonia Case Management (LOE 10%) Prevalence of pneumonia Percent of children 0-23 months with cough and rapid and/or difficult breathing during two weeks prior to survey Care seeking for pneumonia Percent of children age 0-23 months with chest-related cough and fast and/ or difficult breathing in the last 2 weeks who were taken to an appropriate health provider. (RC14) Immunization Measles Percentage of children age 12-23 months who received a measles vaccination by time of survey by card or mother’s recall. (RC9) Access to Immunization Services Percentage of children aged 12-23 months who received Pentavalent-1 (DTP1 +HepB + Hib) by vaccination card or mother’s recall by the time of the survey. (RC10) Health System Performance regarding immunization services Percentage of children aged 12-23 months who received Pentavalent-3 (DTP3 with HepB and Hib) according to the vaccination card or mother’s recall by the time of the survey. (RC) Malaria (not an official intervention) LLIN/ITN use Percentage of children age 0-23 months who slept under an insecticide-treated bed net (in malaria risk areas, where bed net use is effective) the previous night. (RC17) Two week prevalence of fever (tracking only) Percent of children 0-23m with fever in the past two weeks. Treatment of Fever in Malarious Zones Percentage of children age 0-23 months with a febrile episode during the last two weeks who were treated with an effective Rwanda ICSP Final Evaluation Report September 2015 Page 65 of 405 anti-malarial drug within 24 hours after the fever began. (RC12) NOTE: Because of Rapid Diagnostic Testing, only children with a positive test should receive a drug. This is not reflected in Rapid Catch Indicator. Care-seeking for fever Percentage of children age 0-23 months with a febrile episode during the last two weeks who sought treatment from appropriate provider. (Measured because of RDT issues explained above.) Process Indicators – CHWs and Nutrition Weeks CHW Home Visits Percent of households with children 0-23 months that received a visit from a CHW in the past month, according to reported purpose Participation in Nutrition Weeks Percentage of mothers with children 0-23 months who participated in “Nutrition Week” intervention at least once in the past 6 months for 4 or more days. Sampling design and type of design used This survey used parallel sampling with 30-cluster methodology to collect information from mothers of children 0-5 months and from mothers of children 6-23 months. Two separate, 30x12 cluster samples were randomly selected in each of two hospital zones that comprise Nyamagabe District, using population proportional to size. Within each cluster, nine mothers were selected with children 6-23 months and three different mothers with children 0-5 months. The two different hospital zones (Kaduha and Kigeme) correspond to the intervention and comparison populations evaluated in the project’s operations research. Data collection for the OR component was nested in the broader KPC Survey. Because of the dual survey purposes, sampling took into account not only the needs of standard child survival projects using 30x10 cluster methodology, but also measurement of the primary outcome indicator for the operation’s research. The primary outcome indicator for the OR is based on infants 6- 23m who are fed the minimum acceptable diet, as defined by WHO for IYCF in 2008. Formula used for sample size calculation for OR component: n = D [(Zα + Zβ)2 * (P1 (1 - P1) + P2 (1 - P2)) / (P2 - P1)2 ] Where, D= 2; Zα =1.645; Zβ = 0.84; α= 0.05; β= 0.80 Table 4. Sample Size Calculations based on Primary Outcome Indicator (M.A.D.) Proportion of infants and young children of ages 6m-23m fed according to minimum appropriate feeding practices** in sample 1. Proportion of infants and young children of ages 6m￾23m fed according to minimum appropriate feeding practices in sample 2 ∆ n1 = n2 N Rwanda ICSP Final Evaluation Report September 2015 Page 66 of 405 p1 p2 0.37** 0.47 0.10 596 1191 0.37 0.52 0.15 265 530 0.37 0.57 0.20 148 295 0.37 0.67 0.30 62 125 0.37 0.77 0.40 32 63 0.37 0.87 0.50 17 34 *At the time of sample size calculation, ‘minimum appropriate feeding practices’ was the closest indicator to minimum acceptable diet available. The final 2010 DHS report with calculation of MAD was not available until later. ** Source: Addendum to the 2005 Rwanda DHS (IYCF). http://www.measuredhs.com/pubs/pdf/FR183/Rwanda_IYCF_KM-2005.pdf From the above calculation, in order to detect a 15% or greater difference in the proportion of infants and young children of ages 6m-23m fed according to the minimum acceptable diet between baseline and end of study in the intervention area and in the comparison area, with α =0.05 and 80% power, we would need a total of 530 infants and young children of ages 6m-23m, with a minimum of 265 in each arm. In order to have a consistent number of children 6-23m in each of 30 clusters, 265 was rounded up to 270 per arm yielding 9 children 6-23m per cluster. In order to measure indicators like exclusive breastfeeding, limited to infants 0-5 months, a minimum sample of 75 infants was recommended by MCHIP at baseline. However, that number was increased to 90 in order to be evenly divisible by 30, so as to have the same number in each cluster. Another benefit to increasing the sample of 0-5 months to 90 was that with 270 6-23 month-olds, the sample for each age group would be proportional to the approximate composition of children under two years (assuming no infant mortality, for simplicity). As such, when calculating indicators based on children 0-23 months, neither sub-age group is inherently over-represented. In summary, the sample in each hospital zone totaled 360 mothers; 90 with children 0-5 months and 270 with children 6-23 months. The two 30x12 cluster samples combined totaled 720 interviews. Household Selection Process The starting point for each cluster was determined in the following manner: the survey team asked village leaders to identify the center of the village. From that central point, a random direction was selected by spinning a bottle. Surveyors would then walk in a straight line in the randomly chosen direction until they reached a house with a child under 24 months, which would become the first mother interviewed. The second and subsequent households were selected by continuing in the same direction in a straight line, until a second house with a child under 24 months, then a third house, and so forth. This was repeated until 3 mothers of children 0-5 months and 9 mothers of children 6-23 months were interviewed. Households were defined as a group of people who eat from the same cooking pot or whose meals are prepared together. In cases where the mother was not available at the time the interviewer arrived at the home, the interviewer returned to the same house later in the day. If the mother was still not available by the end of the day, then the house was skipped. In cases with two children under 24 months, the younger child was selected (unless the quota for children 0-5 months had already been reached, in which case the youngest child 6-23 months would be selected). In the case of twins, the first born of the two was selected. Mothers were interviewed alone unless the husband objected in which case he was allowed to be present as well. If the mother was under 21, by requirement of law, consent Rwanda ICSP Final Evaluation Report September 2015 Page 67 of 405 from her husband or other guardian was obtained in addition to her own consent to participate in the interview. Training Selection of interviewers, training (duration, trainers, content/structure of sessions) Most interviewers were experienced and trained from previous KPCs. Most were also MOH staff or representatives of local government. The enumerators received refresher training on how to use the PDA tablets, as well as how to properly collect anthropometric measurements. Each enumerator had the opportunity to practice data collection in the field in Kabajogo, Nyamugali and Nyarusange villages, Gasaka sector. During the data collection the 10 new enumerators were together with the experienced ones, in order to get more support from the stronger enumerators and to ensure good quality of data collection and proper use of PDA tablets. Strengthening local capacity to conduct future small-sample surveys As stated above, most of the survey participants were MOH staff or representatives of local government. Most of these participants served as supervisors or interviewers in more than one of the project’s KPC surveys, and two surveys (one in the intervention area and one in the comparison area) were held annually for four years. Thus, the members of the MOH and local governments are well practice in conducting surveys. Data collection Average length of interview: 60 minutes Number of days for data collection: 3 days. By using 23 WR PDA tablets and 13 smart phones, the survey could be carried out faster by simultaneously working in the two areas: Kaduha and Kigeme Hospital zones. Major constraints/field problems: As it was the start of the rainy season, for a few days the rain disturbed data collection. Geographic constraint: Some villages randomly selected were very far and inaccessible by motorbikes so the enumerators had to walk a long time in order to reach the selected households. The survey team was very experienced, so just a few quality-control procedures were employed. The 10 new interviewers were paired with experienced interviewers. The six supervisors covered an average of less than ten interviewers each. The Regional Technical Advisor observed 3-4 interview teams each day of data collection. Data was cleaned carefully, and the teams returned to the households if necessary to confirm the responses. Data Analysis Data from excel database were transferred into STATA 10 for the majority of the analysis. Data were transferred into SPSS for initial calculations. New variables were created for composite indicators. Design effect of 2 was used to calculate confidence intervals, as this is most conservative. Raw data used in this analysis are in Annex 10. Epi Info Emergency Nutrition Assessment (ENA) for anthropometry was used to obtain z scores. Description of person(s) involved in data management/analysis Raw data was completed by Melene Kabadege (WR Regional Technical Advisor), WR M&E Officers Beatrice Nyiranzeyimana and Camarade Rutambwe and Allison Flynn (WR HQ Health Advisor). WR HQ staff Rachel Hower helped to analyze some indicators. Dr. Monisha Billings analyzed all indicators, Rwanda ICSP Final Evaluation Report September 2015 Page 68 of 405 including those for the Operations Research, and helped with the preliminary report. Aubrey Bauck also conducted some analysis for the Operations Research. Quality-control procedures (e.g., error checking during the data entry process) Supervisors reviewed completed questionnaires before leaving the village in which data had been collected, to ensure completeness and accuracy of the forms. In the event of missed data, interviewers returned to the households to gather the missing information. The entry of each questionnaire was double-checked for accuracy and data cleaning was done by the M&E Officers and MCH Regional Technical Advisor. Basic statistical analyses including primarily frequencies and ranges were conducted to identify inconsistencies, so that the data could be cleaned accordingly. Ethical Considerations World Relief received ethical approval each year from the Rwanda National Ethics Committee (RNEC) for its Operations Research, including data collection for the KPC Survey. Approval for the endline survey and OR was received on March 23, 2015. Prior to beginning the interviews at the household level, enumerators explained the nature of the survey using a detailed consent form and gave the interviewee an opportunity to pose questions. Following protocol requested by RNEC, a paper with a standard script written about the study was either read by the mother or read aloud by a CHW (but not by the enumerator team). It was explained to the mother how the information collected would be used, how anonymity would be maintained, and that there would be no compensation for participation or sanction for those not wishing to participate. Interviewees signed on a separate page to indicate that they understood and consented to be interviewed. Enumerators signed after each informed consent to verify that the process was properly performed. Interviewees were given a copy of the information form with contact details for the investigators in case they wished to withdraw from the survey or express any concerns after the team had departed. (Please see Annex 5 for the Consent Form.) If the mother was under legal age, consent from her husband or guardian was required in addition to her own. Respondent names were collected to facilitate returning to households in the event of missing data. However, as all analysis and reporting is in the aggregate, it would not be possible to identify specific respondents. Rwanda ICSP Final Evaluation Report September 2015 Page 69 of 405 ICSP Tangiraneza Year 4 Final KPC & OR Study Timeline, January- September 2015 Activity Jan Feb March April May June July August September 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 Meeting with MOH Co- Investigator to prepare OR Stakeholder’s meeting to provide updates on OR Develop study protocol including consent forms, draft questionnaires, Interview & FGD guides and sampling frame: Submit protocol to MOH for sign-off – Jan 30, 2015 Submit protocol to RNEC for ethical approval – Feb 16, 2015 Prepare electronic data collection software – March 2015 Prepare enumerator training: March 2015 Train ICSP M&E Officers :March, 2015 Train Supervisors March, 2015 Train data collection teams March, 2015 Conduct pilot exercise March, 2015 Revise questionnaire and software for electronic data collection – March, 2015 Field data collection for KPC March – April, 2015 Data cleaning April 2015 Data analysis April 2015 Train teams collecting Qualitative Rwanda ICSP Final Evaluation Report September 2015 Page 70 of 405 information April, 2015 Conduct Qualitative assessment April - May, 2015 (Kaduha) Qualitative Data Analysis and Reporting May 2015 Presentation of KPC preliminary results to MOH and partners June, 2015 Arrival of the Evaluator and meetings with MOH; Project staff and stakeholders Final Evaluation led by the consultant ICSP Final OR and Final Evaluation Report writing June –August 2015 Submit the Final Evaluation report to MoH & USAID Share the Final Evaluation results with Nutrition Technical Working Group Disseminate the FE findings to District Stakeholders Disseminate the Final Evaluation results to community leaders and Integrated Care Groups Rwanda ICSP Final Evaluation Report September 2015 Page 71 of 405 Fig 6: Minimum Acceptable Diet Fig 7: Minimum Dietary Diversity Results of the EOP KPC Survey Of the KPC respondents, about 31%-32% were classified as those in ‘abject poverty’ or ‘very poor’, with around 67% identified as ‘poor’ in both zones of the district. The endline KPC survey also found 83.06% of respondents in Kaduha and 83.89% of respondents in Kigeme had self￾reported mutuelle membership. Of these, 98.99% in Kaduha and 91.39% in Kigeme had a membership card to show the interviewer. Following a three year intervention period, there were significant differences in reports of children 6-23m consuming minimum acceptable diet in the intervention site, almost a 15 fold increase from baseline (3%-40%), compared to a six fold increase in the comparison area (3%-19%) [Fig 6]. ) A linear probability model (LPM) found that the change in MAD from baseline to endline in the intervention area was 23% higher than the comparison area (p<0.001). Children 6-23 months in the intervention area achieved MAD, the primary outcome of this research, at twice the rate that children in the comparison area did. Close to half (40%) of the children in the intervention area achieved MAD. Likewise, there were significant differences between comparison and intervention sites for minimum dietary diversity (22-53% in intervention, vs 39-28% in comparison) [Fig 7]. Minimum Dietary Diversity more than doubled in the intervention area, but decreased in the comparison area, although not significantly; the 95% confidence intervals from baseline to endline overlapped. An LPM found the change in MDD from baseline to endline in the intervention area was 30% higher than the comparison area (p<0.001). Minimum meal frequency increased from 7% to 69% in intervention and 7% to 66% in comparison sites, though the differences were not significant. Active Feeding (AF) remained high in both areas, with the intervention area measuring 100% at endline, but the increase was greater in the comparison area [Fig: 10]. An LPM found the change in AF from baseline to endline in the intervention area was 14% lower than the comparison area (p<0.001), controlling for time and location. Improvements were evident in age appropriate introduction of semi solid foods, with no statistically significant differences between intervention and comparison sites [Fig 9]. Rwanda ICSP Final Evaluation Report September 2015 Page 72 of 405 The proportion of children 0-23 months of age who were put to the breast within one hour had increased considerably from baseline levels and surpassed the target of 70% in both Kaduha and Kigeme, but were not significantly different from each other (48.32% to 82.22%; 51.1% to 86.67% respectively) [Fig 11]. Prelacteal feeding decreased in the two zones 10.99% to 0.28% in Kaduha and 10.70% to 1.69% in Kigeme; declining more than the target of 3%, though the two zones were not significantly different from each other. Exclusive breastfeeding of children 0-5 months remained high in Kaduha with a moderate increase from 91.11% (CI: 85.23-96.99%) at baseline to 96.67 (CI: 88.23-99.94%) at EOP. However a decline in exclusive breastfeeding was noted in Kigeme [98.89% (CI: 96.73-100.00%) at baseline to 88.89% (CI: 75.94-96.29%) at EOP. The EOP estimates of this indicator in the two zones were not statistically significantly different. The proportion of infants 6–23 months of age who consumed food rich in iron was evaluated. There was a significant increase in iron-rich food consumption from the baseline level of 15.19% (CI: 10.91-19.47%) to 31.85% (CI: 24.10-40.42) in Kaduha. However a decline was noted in Kigeme. At EOP, Kaduha had an estimate of 31.85% (CI: 24.10-40.42) in iron-rich food consumption while Kigeme had an estimate of only 8.15% (CI: 4.14-14.11%) and this difference was statistically significant. [Fig 12]. Reported receipt of Vitamin A also declined in both sites in the final evaluation, but this was due to the national campaign just prior to the baseline which escalated the initial levels [Fig 13]. Fig 8: Minimum Meal Frequency 0 20 40 60 80 100 Y1 Y2 Y3 Y4 Kaduha Kigeme Fig 9: Introduction of Semi solid food 0 20 40 60 80 100 Y1 Y2 Y3 Y4 Kaduha Kigeme Fig 10: Active or Support Feeding Rwanda ICSP Final Evaluation Report September 2015 Page 73 of 405 Malnutrition indicators showed a decline in both zones, but this decline was not statistically significantly different [Fig 14-19]. When the EOP estimates of these indicators between Kaduha and Kigeme were compared, there was no statistically significant difference. In Kaduha, the proportion of children 0-23 months who are underweight decreased from 17.8% (CI: 14.0-22.5%) at baseline to 13.33% (CI: 8.7-19.2%) at EOP, though not statistically significant. However, in Kigeme, there was an increase from 8.9% (CI: 6.6-15.0%) at baseline to 12.5% (CI: 8.28-18.56%) at EOP, though not statistically significant as well. When the EOP estimates of this indicator were compared between Kaduha and Kigeme there was no statistically significant difference. While measured for tracking purposes only, there was a decline in stunting in the two zones from their respective baseline levels, though neither change was significantly different. In Kaduha, stunting among 0-23 month old children was 44.3% (CI: 37.6-51.2%) at baseline, and declined to 31.39% (CI: 24.95-39.00%). In Kigeme, stunting decreased from 33.4% (CI: 27.1-40.4%) at baseline to 26.39% (CI: 20.36-33.76%) at EOP. EOP stunting levels in Kaduha and Kigeme were not statistically significantly different. Figure 11. Breastfeeding within 1 hour of birth Figure 11. Increased intake of iron-rich foods Figure 12. Receipt of Vitamin A 20 40 60 80 100 Y1 Y2 Y3 Y4 Kaduha Kigeme 0 10 20 30 40 Y1 Y2 Y3 Y4 Kaduha Kigeme 0 50 100 Baseline Final Kaduha Kigeme Rwanda ICSP Final Evaluation Report September 2015 Page 74 of 405 Both areas were successful in establishing kitchen gardens, and a majority of mothers reported that the produce was used to feed children. Likewise, the animal husbandry projects were instrumental in providing food sources for children and the income from both these strategies was used for food or health care [Fig 20]. Figure 20. Mother’s Reports of Kitchen Gardens and Animal Husbandry Practice The project also addressed other interventions for maternal and newborn care and hygiene practices. Proportion of mothers reporting four or more ANC visits increased in both project sites, and those accessing care in the first trimester and skilled birth attendance also increased [Fig 21-23]. Mothers reporting newborn visits within two days of birth increased dramatically in both the intervention site (37.7-97.5%) and the comparison site (44.2-99.7%). Figure 13. Underweight Prevalence- moderate Figure 14. Underweight Prevalence Severe Figure 15. Wasting Prevalence Moderate Figure 16. Wasting Prevalence Severe Figure 17. Stunting Prevalence Moderate Figure 18. Stunting Prevalence Severe 0 20 40 60 80 100 Kitchen Gardens Produce for feeding children Animal husbandry Animals used to feed children Income from Gardens used for food Income from garden used for healthcare Kaduha Kigeme Rwanda ICSP Final Evaluation Report September 2015 Page 75 of 405 Modern contraceptive prevalence also showed improvements from baseline levels of <60% to more than 70%. Iron supplementation during pregnancy was at high levels, at 80%, but declined the following year to about 70% and then resumed to 80% during the rest of the project term in both sites. Effective point-of-use (POU) water treatment showed a sharp increase during the first year and declined the following year [Fig 24]; the trends in soap at hand washing places also showed a sharp increase in the first year, and thereafter remained the same [Fig 25]. The use of exclusive vessels for hand washing was higher among mothers in Kaduha than in Kigeme [22.29 (CI: 16.08- 29.41%), 8.57% (CI: 4.51-13.82%)] and this was statistically significant. The safe disposal of feces increased from baseline levels in both zones, though not statistically significantly. Though there was a slight increase in those having functional toilets it was still below 40% at EOP; safe feces disposal in Kaduha increased from 71% to 84%, and from 83% to 89% in Kigeme. There was a 6% decrease in diarrhea prevalence in children in Kaduha, but prevalence remained the same at 20% in Kigeme. However, a higher percentage of children with diarrhea were reported to receive ORS or home available fluid at the end of the interventions in both project sites [Fig 26]. The trends were similar for children receiving more fluids in both sites, but zinc treatment during diarrhea declined in the experimental site. The percentage of children 0-23 months with diarrhea in the last two weeks who were offered the same amount or more food during the illness went up in both zones, reaching EOP targets of 75%. In Kaduha, it rose from 63.1% (CI: 51.4-74.8) at baseline to 82.5% (CI: 62.1-96.8) at EOP. In Kigeme, rates similarly rose from 64.3% (CI: 53.1-75.5) to 75% (CI: 57.8-87.9). As the confidence intervals overlapped, there was no statistically significant difference between the two zones at EOP. Figure 21. Mothers Reporting 4+ ANC Visits Figure22. ANC in 1st trimester Figure 23. Mothers Reporting SBA 0 50 100 Y1 Y2 Kaduha Kigeme 0 50 100 Y1 Y2 Kaduha Kigeme Rwanda ICSP Final Evaluation Report September 2015 Page 76 of 405 Prevalence of cough and rapid breathing also declined in Kaduha, and care seeking for cough improved following project interventions in both sites [Fig 27, 28]. Immunization levels were already high (>80%) at baseline for Measles, Pentavalent 1 and 2, and showed slight improvements at the final evaluation. Since malaria was not endemic in Nyamagabe, there were no direct project interventions, but all tracked indicators illustrated a slight decline from baseline levels for treatment of fever, bed net use etc. Reports of household visits by CHWs increased progressively every year [Fig 29, 30] and participation in Nutrition Weeks also improved in Kaduha. The proportion of households with children 0-23 months that received a visit from a community health worker (CHW) in the past month, according to reported purpose was 61.94% (CI: 51.14-68.80%) in Kaduha compared to 43.33% (CI: 35.98- 50.91%) in Kigeme, and this was statistically significantly different. The estimates of this indicator were similar at baseline in Kaduha [26.7% (CI: 22.13- 31.27%)] and Kigeme [21.9% (CI 17.63- 26.17%)] but at EOP, Kaduha had higher estimates than Kigeme. In Both Kaduha and Kigeme, visits by ICG members were also reported and almost 40% also reported receiving health information from their church. The end of project (EOP) goals set for a majority of the indicators were an ambitious target, as baseline levels were quite low for key indicators. Targets for the indicators in the table below Figure 27. Cough in the Past 2 weeks Figure 28. Care seeking for Cough Symptoms Figure29. Household Visits by CHWs Figure 30. ICG Visit, Received Health Information from a Church -10 10 30 50 Baseline Final Kaduha Kigeme 0 50 100 Baseline Final Kaduha Kigeme 0 20 40 60 80 100 Y1 Y2 Y3 Y4 Kaduha Kigeme Figure 24. Effective Water Treatment Figure 25. Soap at Handwashing Stations Figure 26. Children with diarrhea receiving ORS 0 20 40 60 80 100 Y1 Y2 Y3 Y4 Kaduha Kigeme 0 20 40 60 80 100 Y1 Y2 Y3 Y4 Kaduha Kigeme 0 20 40 60 Baseline Final Kaduha Kigeme Rwanda ICSP Final Evaluation Report September 2015 Page 77 of 405 were not fully achieved by end of project for either one or both hospital zones, though there was a substantial improvement from baseline levels for most. The end of project evaluation occurred almost five months before the project ended and hence it is likely that some of the targets have been achieved. Contextual factors such as extreme poverty and limited access due to mountainous terrains are a strong impediment to achieving optimal results for exclusive health promotion interventions. Table 5. Unmet EOP targets Kigeme Kaduha Baseline Endline EOP Tt Baseline Endline EOP Tt Minimum Dietary Diversity in children 6-23 months 38.9% 27.7% 55% 21.9% 52.9% 60% Minimum Acceptable Diet for children 6-23 months 3.3% 19.0% 50% 3.0% 40.4% 50% Children 6-23 months receiving foods rich in iron 23.3% 8.2% 50% 15.2% 31.9% 50% Pregnant women receiving iron pills 81.4% 89.7% 90% 80.4% 83.2% 90% 4+ ANC visits 48.9% 60.3% 75% 45.5% 59.4% 75% 2 TT during pregnancy 68.3% 80.0% 80% 68.4% 77.3% 80% ORS or HAF 22.9% 36.1% 70% 23.1% 40.0% 70% More fluids for diarrhea 40.0% 63.9% 70% 36.9% 67.5% 70% Zinc treatment for diarrhea 10.0% 20.8% 70% 24.6% 15.0% 70% care seeking for pneumonia symptoms 45.1% 66.4% 70% 44.2% 63.2% 70% CHW home visit during the past month 21.9% 43.3% 75% 26.7% 62.0% 75% participation in NW in the last 6 months n/a n/a n/a n/a 76% 80% Discussion A majority of the indicators targeted by the project exceeded the targets set for the end of project. The most impressive improvements were in the nutrition interventions, due to the capacity building efforts for the ongoing CBNP program and the NW innovation. Both Kaduha and Kigeme hospital zones saw improvements over the life of the project with regards to international standards and recommendations for infant and young child feeding. Nutrition practices in Kaduha, where Nutrition Weeks intervention is implemented, showed marked improvements from baseline levels. Minimum Acceptable Diet (MAD), the primary indicator for the OR, increased significantly from baseline levels in both zones. The change was significantly higher in Kaduha, where the NW intervention was implemented. Children 6-23 months in the intervention area achieved MAD, the primary outcome of this research, at twice the rate that children in the comparison area did. Close to half (40%) of the children in the intervention area achieved MAD. Minimum Acceptable Diet is a composite indicator made up of MMF and MDD. While the two areas achieved similar increases in MMF, there were significant differences in MDD. Minimum Dietary Diversity more than doubled in the intervention area, but decreased in the comparison area, although not significantly; the 95% confidence intervals from baseline to endline overlapped. This is important because higher dietary diversity has been shown to reduce Rwanda ICSP Final Evaluation Report September 2015 Page 78 of 405 stunting.18 It is somewhat surprising that MDD declined in the comparison area, since indicators for other optimal feeding practices (MMF, TICF, AF) increased, which could suggest differences in food security between the two areas or differences in ability to change this specific behavior. Though the poverty levels of the two areas were not statistically different at baseline, a food security comparison was not conducted. The two areas had similar topography (located in the same district and sharing a border) and very similar nutrition indicators at baseline, so it is unlikely that food security was very different between the two at baseline. Alternatively, the difference may have been due to behavior rather than food availability. Likely the opportunity to practice cooking in a new way during NW sessions reinforced nutrition lessons and enabled mothers to make greater behavior changes than mothers in the comparison area who passively listened to messages and observed demonstrations. Active Feeding improved to 100% in the intervention area and to 98% in the comparison area. The bigger change was in the comparison area because the baseline, while still relatively high at 79%, was lower there than in the intervention area. The results suggest that the CBNP and ICG structure are effective at achieving AF without NW. Nutrition Weeks enabled mothers to practice cooking with diverse local foods and actively feed their children with peer support. The result was bigger impact on feeding practices than mothers in the comparison area achieved. This is consistent with findings from a study on a PD/Hearth program (daily cooking and feeding practice is part of PD/Hearth), where mothers participating in PD/Hearth adopted positive feeding behaviors including the types of foods used.19 Perhaps it was easier for the mothers in the comparison area to adopt other optimal food practices (AF, MMF, TICF) without hands-on practice, but some aspect of the behaviors needed to increase dietary diversity was more challenging. Future research could target barriers to dietary diversity in particular. The intervention and comparison areas both achieved large increases for MMF and TICF. Though slightly greater progress was made in the intervention area, the differences between the two areas were not statistically significant for these two indicators. This suggests that the CBNP and ICG structure are effective at affecting these behavior changes without NW. The project achieved many targets related to maternal and newborn care (MNC). Because both Kigeme and Kaduha received the same intervention activities related to MNC, it is not surprising that the results were similar in the two areas. The proportion of children 0-23 months of age who were put to the breast within one hour increased considerably from baseline levels and surpassed the target of 70% in both Kaduha and Kigeme, but were not significantly different from each other (48.32% to 82.22%; 51.1% to 86.67% respectively). Prelacteal feeding decreased in the two zones 10.99% to 0.28% in Kaduha and 10.70% to 1.69% in Kigeme; declining more than the target of 3%, though the two zones were not significantly different from each other. Exclusive breastfeeding of children 0-5 months remained high in Kaduha with a moderate increase from 91.11% at baseline to 96.7 at EOP. However a decline in exclusive breastfeeding was noted in Kigeme [98.89%] at baseline to 88.89% at EOP. The EOP estimates of this indicator 18 Rah JH et al (2010). Low dietary diversity is a predictor of child stunting in rural Bangladesh. European Journal of Clinical Nutrition (2010) 64, 1393-1398. 19 Pachon, H.,Schroeder, D., Marsh, D. et al. Effect of an integrated nutrition program on complementary food intake of children in rural northern Vietnam. Food and Nutrition Bulletin. Vol. 23, No.4, Supplement, Dec. 2002 Rwanda ICSP Final Evaluation Report September 2015 Page 79 of 405 in the two zones were not statistically significantly different. These results suggest that ICGs are an effective way to address MNC health behaviors. Likewise, achievements related to diarrhea and pneumonia were similar in the two areas. The percentage of mothers of children who live in households with soap at the place for hand washing improved in both zones, from 38.6% at baseline to 85.3% at EOP in Kaduha and from 43.9% to 77.0% in Kigeme, both surpassing the EOP target of 65%, though not significantly different from one another. The percentage of children 0-23 months with diarrhea in the last two weeks who were offered the same amount or more food during the illness went up in both zones, reaching EOP targets of 75%. In Kaduha, it rose from 63.1% at baseline to 82.5% at EOP. In Kigeme, rates similarly rose from 64.3% to 75%. As the confidence intervals overlapped, there was no statistically significant difference between the two zones at EOP. Care seeking for pneumonia improved in both areas, but not significantly, and neither achieved the 70% EOP target. In Kaduha, it increased from 44.2% – 63.2% and in Kigeme, it increased from 45.1% - 66.4% at EOP. It may be that ICGs are more effective at influencing health behaviors that occur in the home more than behaviors that require leaving the home (i.e., care seeking). Behaviors like care seeking may require more effort, or may require permission from the husband or grandmother. However, since CHWs can provide community case management of acute respiratory infection at the household level, and these CHWs were part of the ICGs, it is somewhat surprising that the gains for care seeking for pneumonia were not even higher. The proportion of households with children 0-23 months that received a visit from a community health worker (CHW) in the past month, according to reported purpose was 61.94% in Kaduha compared to 43.33% in Kigeme, and this was statistically significantly different. The estimates of this indicator were similar at baseline in Kaduha [26.7%] and Kigeme [21.9%] but at EOP, Kaduha had higher estimates than Kigeme. This is an interesting finding because, except for the NW intervention, both zones received the same activities, including ICGs and CHW training. Perhaps participation in NW (extra training, possibly more visible signs of impact in the community) gave the CHWs additional motivation in other aspects (i.e. home visits) of the job. The project shared KPC results with stakeholders at the district level and the national level. First, KPC results were shared with the district to foster continued good communication and ownership of the findings. The project held another event at the district level at the end-of-project meeting, when the Final Evaluation findings were shared. The participants were District partners including: HC leaders, Sector and District Leaders, District Stakeholders. In between these two events, the project organized a dissemination meeting to share project results with key National stakeholders from UNICEF, WHO, MCSP, CONCERN, MOH and others. The event included dissemination of KPC preliminary results and final evaluation findings. Rwanda ICSP Final Evaluation Report September 2015 Page 80 of 405 Annex 1. M&E Table Demographic Information Kigeme Kaduha Mother’s Age Mean Median 29.01 28.50 29.86 30.00 Mother’s Education Mean Median None/ Did not complete primary: 31.39 % Primary: 47.78 % Secondary: 6.11 % Past Secondary: 0.00 % None/ Did not complete primary: 38.33 % Primary: 37.5 % Secondary: 5.56 % Past Secondary:0.83 % Household Size Mean Median 5.18 5 5.05 5 Poverty Level (Ubudehe) 1. 9.17% 2. 22.78% 3. 67.50% 4. 0.56% 5. 0.00% 1. 8.89% 2. 23.06% 3. 66.94% 4. 1.11% 5. 0.00% Health Insurance (Mutuelle) Percent Yes (95% ConfInt) Percent No (95% ConfInt) 83.89% (CI: 77.69 – 88.94%) 16.11% (CI: 11.06-22.315% 83.06% (CI: 77.07-88.46%) 16.94% (CI: 11.54-22.92%) Health Insurance Card Percent Yes (95% ConfInt) Percent No (95% ConfInt) 91.39% (CI: 85.72-95.33%) 8.61% (CI: 4.66-14.27%) 97.99% (CI: 94.27-99.59%) 2.01% (CI: 0.41-5.73%) Rwanda ICSP Final Evaluation Report September 2015 Page 81 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target I. Breastfeeding and Nutrition (40% LOE) Improve breastfeeding practices Immediate breastfeeding of newborns: Percent of children 0- 23 months who were put to the breast within one hour of birth. (Key indicator MNC) (OR) Kaduha 48.32% (CI: 43.14- 53.50%) 71.4% (CI:66.26- 76.54%) 82.3% (CI: 76.6- 88.0%) 82.22% (CI: 75.84- 87.51%) 296 360 70% Kigeme 51.1% (CI: 45.94- 56.26%) 72.6% (CI:67.52- 77.68%) 78.7% (CI: 72.9- 84.4%) 86.67% (CI: 80.81- 91.27%) 312 360 70% Prelacteal feeding Percent of children 0-23 months given liquids prior to the initiation of breastfeeding. Kaduha 10.99% (CI: 7.74- 14.24%) 6.4% (CI: 3.6- 9.1%) 3.7% (CI : 0.8- 6.5%) 0.28% (CI: 0.00- 2.05%) 1 356 3% Kigeme 10.70% (CI:7.42- 13.92%) 9.1% (CI: 5.8- 12.3%) 2.0% (CI: 0.5- 3.5%) 1.69% (CI: 0.35- 4.84%) 6 356 3% Exclusive Breastfeeding (tracking only) Percent of children age 0-5 months who were exclusively breastfed during the last 24 hours. (RC) Kaduha 91.11% (CI:85.23- 96.99%) By age: 0-1m: 64.0% 2-3m: 86.2% 4-5m: 63.6% 0-3m:87.0% 90.1% (CI:83.96- 96.24) By age: 0-1 m: 91.7% 2-3 m: 91.7% 4-5 m: 92.9% (CI: 85.1- 97.3%) By age: 0-1 m: 91.4% 2-3 m: 94.3% 4-5 m: 96.67 (CI: 88.23- 99.94%) By age: 0-1m: 96.43% 2-3m: 97.14% 4-5m: 87 27 34 26 61 90 28 35 27 63 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 82 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target 87.1% 0-3 m: 91.7% 84.0% 0-3 m: 93.1% 96.29% 0-3m: 96.83% Kigeme 98.89% (CI: 96.73- 100.00%) 0-1m: 87.5% 2-3m: 96.8% 4-5m: 96.8% 0-3m: 98.2% 83.8% (CI:75.41- 92.19%) 0-1m: 87.5% 2-3m: 96.8% 4-5m: 96.8% 0-3m: 98.2% 94.3% (CI: 86.0- 98.4) 0-1 m: 96.0% 2-3 m: 96.8% 4-5 m: 80.0% 0-3 m: 95.7% 88.89% (CI: 75.94- 96.29%) 0-1m: 78.95% 2-3m: 100.00% 4-5m: 91.30% 0-3m: 88.06% 80 30 29 21 59 90 38 29 23 67 N/A Continued breastfeeding at 1 year (tracking only) Percent of children 12-15 months who are still breastfeeding. Kaduha 85.42% (CI:5.44- 95.40%) 100.0% (CI:100.0- 100.0%) 93.0% (CI: 85.2- 100%) 94.03% (CI: 80.23- 99.28%) 63 67 N/A Kigeme 93.44% (87.23- 99.65%) 97.9% (CI: 93.8- 101.9%) 98.0% (CI: 93.9- 100%) 89.83% (CI: 73.47- 97.89%) 53 59 N/A Continued breastfeeding at 2 years (tracking Percent of children 20-23 months who are still breastfeeding. Kaduha 86.79% (CI:77.67- 95.91%) 97.4% (CI: 92.4- 102.3%) 87.9% (CI: 75.8- 99.9%) 91.49% (CI: 73.00- 98.97%) 43 47 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 83 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target only) Kigeme 90.91% (CI: 82.42- 99.40%) 88.4% (CI: 78.8- 97.9%) 93.3% (CI: 83.9- 100%) 89.74% (CI: 68.30- 98.77%) 35 39 N/A Improve Infant and Young Child Feeding Practices % infants and young children age 6-23 months fed according to the Minimum Dietary Diversity (OR) Kaduha 21.85% (CI: 16.92- 26.78%) By age: 6-11m: 0.0% 12-17m: 31.7% 18-23m: 40% 38.8% (CI: 32.1- 45.4%) By age: 6-11m: 32.2% 12-17m: 36.8% 18-23m: 51.9% 49.4% (CI: 42.0- 56.9%) By age: 6-11m: 41.0% 12-17m: 54.9% 18-23m: 54.8% 52.9% (CI: 46.1- 59.6%) By age: 6-11m: 43.2% 12-17m: 55.6% 18-23m: 63.5% 118 38 40 40 223 88 72 63 60% Kigeme 38.89% (CI: 33.08- 44.70%) By age: 6-11m: 0.0% 12-17m: 50.6% 18-23m: 51.6% 31.0% (CI: 24.9- 37.0%) By age: 6-11m: 22.2% 12-17m: 38.5% 18-23m: 34.2% 39.3% (CI: 32.6- 46.3%) By age: 6-11m: 36.3% 12-17m: 41.9% 18-23m : 38.5% 27.7% (CI: 22.0- 34.0%) By age: 6-11m: 20.6% 12-17m: 26.1% 18-23m: 41.7% 64 21 18 25 231 102 69 60 55% Rwanda ICSP Final Evaluation Report September 2015 Page 84 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target % infants and young children age 6-23 months fed according to the Minimum Meal Frequency (OR) Kaduha 7.04% (CI: 3.99- 10.09%) 66.5% (CI: 58.7 - 74.3%) 70.4% (CI: 63.3- 67.8%) 68.6% (CI: 62.1- 74.6%) 153 223 55% Kigeme 7.41% (CI: 4.07- 10.21%) 50.9% (CI: 44.0- 57.8%) 60.6% (CI: 53.6- 67.3%) 65.8% (CI: 59.3- 71.9%) 152 231 60% % infants and young children age 6-23 months fed according to the Minimum Acceptable Diet *WHO 2008 definition (OR, RC*) Kaduha 2.96% (CI: 0.92- 4.94%) 32.5% (CI: 24.9- 40.2%) 38.6% (CI: 31.6 – 46.0%) 40.4% (CI: 33.9- 47.1%) 90 223 50% Kigeme 3.33% (CI: 1.19- 5.47%) 22.8% (CI: 16.1- 29.5%) 24.5% (CI: 18.8- 30.9%) 19.0% (CI: 14.2- 24.7%) 44 231 50% Consumption of iron-rich foods % infants 6–23 months of age who consumed food rich in iron. (Include micronutrient powders if/when program expands to Nyamagabe) Kaduha 15.19% (CI: 10.91- 19.47%) 15.3% (CI: 10.4- 20.1%) 25.4% (CI: 17.2- 33.6%) 31.85% (CI: 24.10- 40.42) 86 270 50% Kigeme 23.33% (CI: 18.29- 28.37%) 12.8% (CI: 8.4- 17.1%) 12.0% (CI: 6.3- 17.7%) 8.15% (CI: 4.14- 14.11%) 22 270 50% Age appropriate introduction of semi-solid foods Proportion of infants 6–8 months of age who receive solid, semi￾solid or soft foods. Kaduha 52.00% (CI: 38.15- 65.85%) 81.0% (CI: 69.1- 92.8)%) 78.9% (CI: 55.3- 100%) 93.3% (CI: 77.9- 99.2%) 28 30 75% Rwanda ICSP Final Evaluation Report September 2015 Page 85 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target Kigeme 58.50% (CI: 45.23- 71.77%) 79.1% (CI: 66.9- 91.2%) 75.0% (CI: 57.5- 92.5%) 87.3% (CI: 75.5- 94.7%) 48 55 75% Responsive feeding Percent of Caregivers who assist child when eating (of children who consume soft, semi-solid or solid foods) Kaduha 95.51% (CI: 92.90- 98.12%) 95.5% (CI: 92.6- 98.3%) 96.7% (CI: 93.8- 99.6%) 100% (CI: 100.0- 100.0% 255 255 Kigeme 79.05% (CI: 74.0- 84.1%) 92.1% (CI: 88.4- 95.7%) 95.0% (CI: 89.9- 100%) 98.4% (CI: 96.82- 99.97%) 246 250 Self- Feeding (tracking only) Percent of children who consume soft, semi-solid or solid foods) who are self-feeding Kaduha 4.49% (CI: %) 4.5% (CI:1.6- 7.3%) 3.3% (CI: 0.4- 6.2%) 0.00% 0 265 N/A Kigeme 20.95% (CI: %) 7.9% (CI: 4.9- 11.5%) 5.0% (CI: 0- 10.1%) 1.6% (CI: 0.48- 6.65%) 4 250 N/A Micronutrient Powder supplementation Percent of children age 6-23 months who received packets of micronutrient powder (MNP) in the last 3 months: mother’s recall. Kaduha Not included in survey Not included in survey Not included in survey 80.00% (CI: 72.25- 86.39%) 216 270 N/A Kigeme Not included in survey Not included in survey Not included in survey 67.78% (CI: 59.58- 75.89%) 183 270 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 86 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target Vitamin A Supplementation in the last 6 months Percent of children age 6-23 months who received a dose of Vitamin A in the last 6 months: card verified or mother’s recall. (RC 8, OR) Kaduha 70.37% (CI: 64.92- 75.82%) Not included in abridged survey Not included in abridged survey 66.15% (CI: 59.56- 72.75%) 178 269 N/A Kigeme 77.04% (CI: 72.02- 82.06%) Not included in abridged survey Not included in abridged survey 60.99% (CI: 54.28- 67.69%) 164 269 N/A Anthropometry Underweight for Age (tracking only) Percent of children 0-23 months who are underweight (-2 SD for the median weight for age, according to WHO reference population) Disaggregate underweight by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) (RC) Kaduha 17.8% (CI: 14.00- 22.50%) Severe: 7.2% (CI: 4.8-10.8%) Moderate: 10.6%(CI:7. 9-14.1%) 21.7% (CI: 17.0 – 27.2%) Severe: 5.7% (CI: 3.3-9.6%) Moderate : 16.0% (CI : 11.9- 21.1%) 10.8% (CI: 7.1- 16.1%) Severe: 3.2% (CI: 1.5-6.9%) Moderate : 7.6% (CI: 4.6- 12.3%) Yr 3 indicator calculated for 6-23 mos 13.33% (CI: 8.73- 19.19%) Severe: 2.50% (CI: 0.91- 6.43%) Moderate: 10.83% (CI: 6.48- 15.99%) 48 9 39 360 360 360 N/A Kigeme 8.9% (CI:6.6- 16.0% (CI: 11.4- 17.6% (CI: 12.0- 12.5% (CI: 8.28- 45 360 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 87 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target 15.0%) Severe: 2.2% (CI: 1.2-4.2%) Moderate: 6.7% (CI:4.5- 9.9%) 22.1%) Severe: 3.0% (CI: 1.5-5.8%) Moderate : 13.0% (CI: 9.2- 18.1%) 24.9%) Severe : 2.1% (CI: 0.8-5.5%) Moderate : 15.4% (CI: 10.5- 22.2%) Yr 3 indicator calculated for 6-23 mos 18.56%) Severe: 3.89% (CI: 1.58- 7.84%) Moderate: 8.61% (CI: 4.74- 13.37%) 14 31 360 360 Acute Malnutrition/ Wasting (tracking only) % children 0-23 months who are underweight for height (-2SD for the median height for age, according to WH0 reference population) Disaggregate wasting by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) (OR) Kaduha 7.6% (CI: 4.9- 11.6%) Severe 3.9% (CI:2.3- 6.8%) 8.7% (CI : 5.4- 13.6%) Severe 2.3% (CI : 1.0-5.2%) 6.5% (CI : 3.7- 11.0%) Severe: 1.1% (CI : 0.3-3.9%) 4.44% (CI: 1.94- 8.57%) [without edema: 4.18% (CI: 1.93- 8.57%) Severe: 0.83% (CI: 0.01- 3.06%) [without 16 15 3 2 360 359 360 359 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 88 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target Moderate 3.7% (CI:2.2- 5.9%) Moderate 6.3% (CI : 3.6- 11.0%) Moderate : 5.4% (CI: 3.0- 9.7%) Yr 3 indicator calculated for 6-23 mos edema: 0.56% (CI: 0.00- 3.06%) Moderate: 3.61% (CI: 1.23- 7.11%) 13 360 Kigeme 6.1% (CI:4.1 - 9.1%) Severe 2.2% (CI:1.1- 4.6%) 2.7% (CI : 1.2- 6.0%) Severe: 1.0% (CI: 0.2-4.4%) 5.9 % (CI: 2.8 - 11.9) Severe: 0.5 % (CI: 0.1 - 3.9) 4.72% (CI: 1.94- 8.57%) [without edema:4.18 % (CI: 1.95- 8.62%) Severe: 0.83% (CI: 0.01- 3.06%) [without edema: 0.28% (CI:0.00- 17 15 3 1 360 358 360 358 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 89 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target Moderate: 3.9% (CI:2.3- 6.4%) Moderate : 1.7% (CI: 0.7- 3.9%) Moderate : 5.3% (CI: 2.6- 10.4%) Yr 3 indicator calculated for 6-23 mos 3.07%) Moderate: 3.89% (CI: 1.58- 7.85%) 14 360 Acute Malnutrition (tracking only) Percent of children 6-23 months acutely malnourished as measured by MUAC Disaggregate by ‘at risk’, moderate and severe acute malnutrition Kaduha 8.3% (CI: 5.3- 12.7%) Severe : 1.5% Moderate 6.8% At Risk 18.52% 9.6% (CI: 5.8- 15.3%) Severe 2.4% (CI: 1.0-5.5%) Moderate 7.2% (CI: 4.1- 12.4%) 0.5% (CI: 0.1- 3.0%) Severe: 0.0% (CI : 0.0-2.0%) Moderate : 0.5% (CI: 0.1- 3.0%) Yr 3 indicator calculated 2.59% (CI: 0.46- 6.36%) Severe: 0.74% (CI: 0.02- 4.06%) [without edema:0.37 % (CI: 0.00- 2.69%) Moderate: 2.22% (CI: 0.46- 6.34%) At Risk: 18.52% (CI: 12.36- 7 2 1 6 50 270 270 269 270 270 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 90 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target for 6-23 mos 26.11%) Kigeme 5.2% (CI: 3.0- 8.9%) 0.4% severe 4.8% mod. 20.37% at￾risk 4.0% (CI: 2.0- 7.6%) Severe 0.0% (CI: 0.0-0.0%) Moderate : 4.0% (CI: 2.0- 7.6%) 5.3% (CI: 2.8- 9.8%) Severe: 0.0% (CI : 0.0-0.0%) Moderate : 5.3% (2.8- 9.8%) Yr 3 indicator calculated for 6-23 mos 5.19% (CI: 2.12- 10.39%) Severe: 0.74% (CI: 0.02- 4.06%) [without edema: 0 obs] Moderate: 5.12% (CI: 2.11- 10.39%) At Risk: 21.48% (CI: 14.89- 29.37%) 14 2 14 58 270 270 270 270 N/A Stunting (tracking only) Percentage of children 0-23 months who are under height/length for age Kaduha 44.3% (CI:37.6- 51.2%) 33.3% (CI: 26.1- 41.3%) 34.1% (CI: 27.6- 41.1%) 31.39% (CI: 24.95- 39.00%) 113 360 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 91 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target (-2SD for the median height for age, according to WHO reference population) Disaggregate stunting by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) Severe 25.1% Moderate 19.2% Severe: 13.3% (CI: 9.3- 18.8%) Moderate : 20.0% (CI: 14.8- 26.4%) Severe: 13.0% (CI : 8.9- 18.6%) Moderate : 21.1% (CI : 15.8- 27.5%) Yr 3 indicator calculated for 6-23 mos Severe: 12.22% (CI: 7.82- 17.92%) Moderate: 19.17% (CI: 13.93- 25.99%) 44 69 360 360 Kigeme 33.4% (CI:27.1- 40.4%) Severe : 12.5% Moderate 20.9% 34.0% (CI: 26.9- 41.9%) Severe: 11.7% (CI: 8.4- 16.0%) Moderate : 22.3% (CI: 17.6- 27.9%) 33.0% (CI: 26.2- 40.5%) Severe : 13.3% (CI: 8.4- 20.4%) Moderate : 19.7% (CI: 14.5- 26.2%) Yr 3 indicator calculated 26.39% (CI: 20.36- 33.76%) Severe: 7.22% (CI: 3.90- 12.33%) Moderate: 19.17% (CI: 13.93- 25.99%) 95 26 69 360 360 360 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 92 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target for 6-23 mos Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target II. Maternal & Newborn Care (35% LOE) Increase % of mothers who have 4+ ANC visits % mothers of children age 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child. (RC1) Kaduha 45.5% (CI: 40.34- 50.66%) Not included in abridged survey Not included in abridged survey 59.38% (CI: 51.64- 66.49%) 212 357 75% Kigeme 48.9% (CI: 43.74- 54.06%) Not included in abridged survey Not included in abridged survey 60.28% (CI: 53.01- 67.75%) 217 360 75% Increase % of mothers who have ANC in their first trimester (tracking only) % mothers of children age 0-23 months who had antenatal visit in the first trimester when they were pregnant with the youngest child Kaduha 54.5% (CI: 49.34- 59.56%) Not included in abridged survey Not included in abridged survey 68.07% (CI: 60.79- 74.91%) 243 357 N/A Kigeme 54.7% (CI: 49.56- 59.84%) Not included in abridged survey Not included in abridged survey 70.00% (CI: 62.74- 76.59%) 252 360 N/A Increase % of mothers who get %mothers with children age 0-23 months who received at least two Kaduha 68.43% (CI: 63.58- Not included in Not included in 77.31% (70.24- 276 357 80% Rwanda ICSP Final Evaluation Report September 2015 Page 93 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target at least two TT Tetanus toxoid vaccinations before the birth of their youngest child. (RC2) 73.22%) abridged survey abridged survey 83.33%) 68.33% (CI: 63.49- 73.11%) Not included in abridged survey Not included in abridged survey 80% (CI: 73.40- 85.58%) 288 360 80% Increase skilled birth attendance (tracking only) % children age 0-23 months whose births were attended by skilled personnel. (RC3) Kaduha 83.0% (CI: 79.11- 86.89%) Not included in abridged survey Not included in abridged survey 92.99% (CI: 87.90- 96.08%) 332 357 N/A 91.7% (CI: 88.85- 94.55%) Not included in abridged survey Not included in abridged survey 97.50% (CI: 94.41- 99.39%) 351 360 N/A Increase % of newborns who get a post-natal check-up within 2 days of birth (RC 4) % of mothers of children 0-23 m. whose youngest child received a post-natal visit from an appropriate trained health worker within 2 days of birth. (RC4) Kaduha 37.70% (CI: 32.68- 42.72%) Not included in abridged survey Not included in abridged survey 97.5% (CI: 95.14- 98.78%) 351 360 60% Kigeme 44.2% (CI: 39.07- 49.33%) Not included in abridged survey Not included in abridged survey 99.72% (CI: 96.94- 99.98%) 359 360 60% Current Contraceptive Use Among Mothers of Young Children % mothers of children 0-23 months who are using a modern contraceptive method. (RC5) Kaduha 57.5% (CI: 52.38- 62.62%) Not included in abridged survey Not included in abridged survey 73.11% (CI: 66.06- 79.52%) 261 357 N/A Kigeme 62.5% (CI: 57.5- Not included in abridged Not included in abridged 78.89% (CI: 72.19- 284 360 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 94 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target (tracking only) 67.5%) survey survey 84.61%) Increase iron￾folic acid supplementation during pregnancy. Percentage of mothers who received tablets; average number of days consumed of those who received pills. (OR) Kaduha 80.4% received (CI: 72.29- 84.51%) Average days: 35.37 69.4% received (CI: 64.1- 76.6%) Average days: 39.88 81.0% received (CI: 74.2- 87.8%) Average days: 41.53 83.19% received (CI: 76.95- 88.39%) Average days: 51.33 297 357 90% 60 days Kigeme 81.4% received (CI: 77.38- 85.42%) Average days: 33.45 70.9% received (CI: 65.7- 76.0%) Average days: 33.45 83.7% received (CI: 79.3- 88.0%) Average days: 42.00 89.72% received (CI: 84.00- 93.52%) Average days: 57.05 323 360 90% 60 days III. Control of Diarrheal Diseases (15% LOE) Prevention Increase % of households that treat water effectively POU Water Tx: Percentage of households of children age 0-23 months that treat water effectively. (RC15, OR) Kaduha 50.0% (CI: 44.83- 55.17%) 98.3% (CI: 96.6- 99.9%) 75.7% (CI: 68.3- 83.0%) 78.89 (CI: 72.19- 84.60%) 284 360 65% Kigeme 56.4% (CI: 51.28- 61.52%) 97.6% (CI: 95.2- 99.9%) 57.0% (CI: 48.6- 65.4) 66.67% (CI: 59.27- 73.50%) 240 360 65% Improve Percentage of mothers of children Kaduha 38.6% 78.1% 73.7% 85.28% 307 360 65% Rwanda ICSP Final Evaluation Report September 2015 Page 95 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target appropriate hand washing practices age 0-23 months who live in households with soap at the place for hand washing. (RC16, OR) (CI:33.57- 43.63) (CI:72.9- 83.2%) (CI: 63.5- 83.9) (CI: 79.56- 90.34%) Kigeme 43.9% (CI: 38.77- 49.03) 89.4% (CI: 85.4- 93.3%) 73.0% (CI: 63.2- 82.8%) 76.94% (CI: 69.79- 82.63%) 277 360 65% Exclusive Vessels for Hand Washing Percentage of mothers of children age 0-23 months who live in households with vessels used exclusively for hand washing Kaduha Not included in survey Not included in survey Not included in survey 22.29 (CI: 16.08- 29.41%) 72 323 Kigeme Not included in survey Not included in survey Not included in survey 8.57% (CI: 4.51- 13.82%) 27 315 N/A Hand Washing at Appropriate times (tracking only) Percentage of mothers of children age 0-23 months who wash hands with soap at all four key times Kaduha 2.8% (CI: 1.40- 5.20% 21.0% (CI: 16.3- 25.6% 29.7% (CI: 19.7- 39.6%) 0.83% (CI : 0.22- 2.62%) 3 360 N/A Kigeme 5.0% (CI: 3.10- 7.90%) 9.7% (CI: 6.3- 13.0%) 15.3% (CI: 9.5- 21.2%) 0.00% 0 360 N/A Latrine/toilet in good condition (tracking only) Percentage of households of children age 0-23 months that have a toilet facility in appropriate condition Kaduha 15.0% (CI: 11.31- 18.69%) 20.7% (CI: 16.1- 25.2%) 27.3% (CI : 19.3- 35.4%) 33.06% (CI: 26.45- 40.73%) 119 360 N/A Kigeme 26.9% (CI: 22.32- 31.48%) 14.0% (CI: 10.0- 17.9%) 23.3% (CI : 17.1- 29.6%) 33.61% (CI: 26.49- 40.73%) 121 360 N/A Safe feces Percentage of mothers of children Kaduha 71.4% 69.0% 80.7% 84.44% 304 360 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 96 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target disposal (tracking only) 0-23 months who disposed of the youngest child’s feces safely the last time a stool passed. (Key Indicator) (CI: 66.73- 76.07%) (CI: 63.7- 74.2%) (CI: 74.9- 86.5%) (CI: 78.31- 89.41%) Kigeme 82.8% (CI: 78.90- 86.70%) 76.3% (CI: 71.4- 81.1%) 81.0% (CI: 75.6- 86.4%) 89.44% (CI:84.01- 93.52) 322 360 N/A Prevalence Two week prevalence of diarrhea (tracking only) Percentage of children 0-23 months with diarrhea in the previous two weeks (Key Indicator) Kaduha 17.2% (CI: 13.30- 21.10%) Not included in abridged survey Not included in abridged survey 11.11% (CI: 6.92- 16.64%) 40 360 N/A Kigeme 19.4% (CI: 15.32- 23.48%) Not included in abridged survey Not included in abridged survey 20.00% (CI: 14.42- 26.59%) 72 360 N/A Improve home management of diarrhea (ORT use, increased fluids and continued feeding) Percentage of children age 0-23 months with diarrhea in the last 2 weeks who received ORS and/ or recommended home fluids. (RC13) Kaduha 23.1% (CI: 12.85- 33-35%) Not included in abridged survey Not included in abridged survey 40% (CI: 25.28- 54.72%) 16 40 70% Kigeme 22.9% (CI: 13.06- 32.74%) Not included in abridged survey Not included in abridged survey 36.11% (CI: 8.00- 20.82%) 26 72 70% Percentage of children 0-23 months with diarrhea in the last two weeks who were offered more fluids during the illness. (Key Indicator) Kaduha 36.9% (CI: 25.17- 48.63%) Not included in abridged survey Not included in abridged survey 67.50% (CI: 45.72- 88.11%) 27 40 70% Kigeme 40.0% (CI: 28.52- Not included in abridged Not included in abridged 63.89% (CI: 46.22- 46 72 70% Rwanda ICSP Final Evaluation Report September 2015 Page 97 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target 51.48%) survey survey 79.18%) Percentage of children 0-23 months with diarrhea in the last two weeks who were offered the same amount or more food during the illness. (Key Indicator) Kaduha 63.1% (CI: 51.37- 74.83%) Not included in abridged survey Not included in abridged survey 82.50% (CI: 62.11- 96.79%) 33 40 75% Kigeme 64.3% (CI: 53.08- 75.52%) Not included in abridged survey Not included in abridged survey 75% (CI: 57.79- 87.88%) 54 72 75% Zinc Treatment Increase use of zinc to treat diarrhea Percentage of children 0-23 months with diarrhea in the last two weeks who were treated with zinc supplements. (Key Indicator) Kaduha 24.6% (CI: 14.13- 35.07%) Not included in abridged survey Not included in abridged survey 15% (CI: 3.21- 37.89%) 6 40 70% Kigeme 10.0% (CI: 2.97- 17.03%) Not included in abridged survey Not included in abridged survey 20.83% (CI: 8.19- 36.02%) 15 72 70% IV. Pneumonia Case Management (LOE 10%) Prevalence Two week prevalence of suspected pneumonia (tracking only) Percent of children 0-23 months with cough and rapid and/or difficult breathing during two weeks prior to survey Kaduha 23.9% (CI: 19.49- 28.31%) Not included in abridged survey Not included in abridged survey 18.89% (CI: 13.45- 25.38%) 68 360 N/A Kigeme 31.4% (CI: 26.61- 36.19%) Not included in abridged survey Not included in abridged survey 31.39% (CI: 24.95- 39.00%) 113 360 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 98 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target Care Seeking Improve appropriate care seeking for pneumonia Percent of children age 0-23 months with chest-related cough and fast and/ or difficult breathing in the last 2 weeks who were taken to an appropriate health provider. (RC14) Kaduha 44.2% (CI: 33.70- 54.70%) Not included in abridged survey Not included in abridged survey 63.24% (CI: 46.49- 80.25%) 43 68 70% Kigeme 45.1% (CI: 35.93- 54.27%) Not included in abridged survey Not included in abridged survey 66.37% (CI: 52.94- 78.59%) 75 113 70% V. Immunization – Not an intervention; Rapid CATCH Only Measles vaccination (tracking only) Percentage of children age 12-23 months who received a measles vaccination.(RC9) Kaduha 87.4% (CI: 81.2- 92.10%) Not included in abridged survey Not included in abridged survey 85.99% CI: 76.45- 92.83%) 135 157 N/A Kigeme 83.4% (CI: 76.49- 89.10%) Not included in abridged survey Not included in abridged survey 89.79% CI: 79.84- 95.22%) 132 147 N/A Access to immunization services (tracking only) Percentage of children aged 12-23 months who received Pentavalent￾1 (DTP1 +HepB + Hib) by vaccination card or mother’s recall by the time of the survey . (RC10) Kaduha 89.3% (CI: 83.40- 93.60%) Not included in abridged survey Not included in abridged survey 90.45% (CI: 81.02- 95.52%) 142 157 N/A Kigeme 86.9% (CI: 80.30- 91.90%) Not included in abridged survey Not included in abridged survey 96.59% (CI: 88.60- 99.15%) 142 147 N/A Health System Performance regarding Percentage of children aged 12-23 months who received Pentavalent￾3 (DTP3 with HepB and Hib) Kaduha 84.3% (CI: 77.0- 89.7%) Not included in abridged Not included in abridged 89.17% (CI: 79.47- 94.66%) 140 157 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 99 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target Immunization services (tracking only) according to the vaccination card or mother’s recall by the time of the survey. (RC) survey survey Kigeme 84.1% (CI: 77.20- 89.70%) Not included in abridged survey Not included in abridged survey 93.88% (CI: 84.93- 97.77%) 138 147 N/A VI. Malaria – Not an official intervention; Rapid CATCH Prevention LLIN/ITN use Percentage of children age 0-23 months who slept under an insecticide-treated bed net (in malaria risk areas, where bed net use is effective) the previous night. (RC17) Kaduha 66.9% (CI: 61.80- 71.80%) Not included in abridged survey Not included in abridged survey 50.28% (CI: 37.55- 63.0%) 181 360 N/A Kigeme 66.9% (CI: 61.80- 71.80%) Not included in abridged survey Not included in abridged survey 49.72% (CI: 35.80- 63.65%) 178 360 N/A Prevalence Two week prevalence of fever (tracking only) Percent of children 0-23m with fever in the past two weeks. Kaduha 20.8% (CI: 16.61- 24.99%) Not included in abridged survey Not included in abridged survey 24.44% (CI: 18.36- 31.39%) 88 360 N/A Kigeme 23.9% (CI: 19.49- 28.31%) Not included in abridged survey Not included in abridged survey 28.88% (CI: 22.39- 36.09%) 104 360 N/A Treatment of fever: Treatment of Fever in Percentage of children age 0-23 months with a febrile episode during the last two weeks who were treated with an effective anti￾Kaduha 14.0% (CI: 7.60- 24.70%) Not included in abridged survey Not included in abridged survey 45.45% (CI: 30.75- 60.15%) 40 88 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 100 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target Malarious Zones (tracking only) NOTE: Because of Rapid Diagnostic Testing, only children with a positive test should receive a drug. This is not reflected in Rapid Catch Indicator. malarial drug within 24 hours after the fever began. (RC12) Kigeme 1.2% (CI: 0.0- 6.3%) Not included in abridged survey Not included in abridged survey 46.15% (CI: 32.65- 59.65%) 48 104 N/A Care-seeking for fever (Measured because of RDT issues explained above.) Percentage of children age 0-23 months with a febrile episode during the last two weeks who sought treatment from appropriate provider. Kaduha 53.30% (CI: 42.01- 64.59%) Not included in abridged survey Not included in abridged survey 64.77 (CI: 50.7- 78.9%) 57 88 N/A Kigeme 52.3% (CI41.74- 62.86%) Not included in abridged survey Not included in abridged survey 62.5% (CI: 49.3- 75.7%) 65 104 N/A VII. Process Indicators related to CHWs and Nutrition Weeks Contact with CHW for health education: Percent of households with children 0-23 months that received health information from a CHW in the past month, according to location (home visit, community meeting, health facility, Growth Monitoring and Counseling, Nutrition Week, etc.) CHW Home Visits Percent of households with children 0-23 months that received a visit from a CHW in the past month, according to reported purpose Kaduha 26.7% (CI: 22.13- 31.27%) 52.2% (CI: 46.3- 57.6%) 61.7% (CI: 53.6- 69.8%) 61.94% (CI: 51.14- 68.80%) 223 360 75% Kigeme 21.9% (CI 17.63- 26.17%) 27.7% (CI 22.6- 32.7%) 36.7% (CI: 28.2- 45.1%) 43.33% (CI: 35.98- 50.91%) 156 360 75% Rwanda ICSP Final Evaluation Report September 2015 Page 101 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target Participation in Nutrition Weeks: Percentage of mothers with children 0-23 months who participated in “Nutrition Week” intervention at least once in the past 6 months for 4 or more days. Kaduha 53.0% (CI: 47.3- 58.6%) 53.0% (CI : 44.3- 61.7%) 75.55% (CI: 68.22- 82.06%) 241 319 80% Kigeme N/A N/A N/A N/A NA Modified Care Group Home Visits Percent of households with children 0-23 months that received a visit from a Modified Care Group member, according to a reported purpose Kaduha Not included in survey Not included in survey Not included in survey 60.28% (CI: 53.01- 67.74%) 217 360 N/A Kigeme Not included in survey Not included in survey Not included in survey 38.06% (CI: 31.19- 45.86%) 137 360 N/A Churches Providing Health Information: Percent of households with children 0-23 months that received health information from a church in the last month Kaduha Not included in survey Not included in survey Not included in survey 39.17% (CI: 32.25- 46.99%) 141 360 N/A Kigeme Not included in survey Not included in survey Not included in survey 29.17% (CI: 22.89- 36.68%) 105 360 N/A VIII. Food Security Kitchen Gardens Percent of households of children 0-23 months who own a kitchen garden Kaduha Not included in survey Not included in survey Not included in survey 71.39% (CI: 64.48- 78.12%) 257 360 N/A Kigeme Not included in survey Not included in survey Not included in survey 55.83% (CI: 47.98- 62.95%) 201 360 N/A Kitchen Garden Percent of households of children Kaduha Not Not Not 98.44% 253 257 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 102 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target used for feeding children 0-23 months with a kitchen garden where children eat the food produced or where income from kitchen gardens is used for food or healthcare included in survey included in survey included in survey (CI: 94.511- 99.81%) Kigeme Not included in survey Not included in survey Not included in survey 97.01% (CI: 91.56- 99.38%) 195 201 N/A Small animal husbandry: Percent of households of children 0-23 months who raise small animals Kaduha Not included in survey Not included in survey Not included in survey 54.17% (CI: 46.87- 61.87%) 195 360 N/A Kigeme Not included in survey Not included in survey Not included in survey 56.94% (CI: 49.09- 64.02%) 205 360 N/A Small animals used for feeding children Percent of households who raise small animals where children eat the food produced or spend income from small animals sales toward food or health care. Kaduha Not included in survey Not included in survey Not included in survey 95.38% (CI: 88.49- 98.32%) 186 195 N/A Kigeme Not included in survey Not included in survey Not included in survey 96.09% (CI: 90.35- 98.93%) 197 205 N/A Income from kitchen gardens and small animals Percent of households of children 0-23 months who spend income from kitchen gardens or small animals toward food or health care Kaduha Not included in survey Not included in survey Not included in survey Food: 88.19% (CI: 76.84- 94.45%) Health Care: 40.16% (CI: 28.51- 112 51 127 127 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 103 of 405 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Interval) Year 2 KPC Value (95% C.I.) Year 3 KPC Value (95% C.I.) EOP Value (95% Confidence Interval) Numerator Denominator EOP Target 53.63%) Food/Healt h Care: 92.91% (CI: 82.70- 97.41%) 118 127 Kigeme Not included in survey Not included in survey Not included in survey Food: 86.14% (CI: 76.10- 92.30%) Health Care: 43.37% (32.52- 54.71%) Food/Healt h Care: 94.58% (88.12- 98.67%) 143 72 157 166 166 166 N/A Rwanda ICSP Final Evaluation Report September 2015 Page 104 of 405 Annex 2. KPC supervisors, interviewers, and their roles Year 4 Coordinator: Melene Kabadege, WR MCH Regional Technical Advisor  Supervisors Nyiranzeyimana Beatrice, ICSP staff  Umuhire Claire, ICSP staff  Umutoni Carmen, ICSP staff  Bizimungu Gaspard, Kigeme Hospital M&E Officer  Bisetsa Innocent, Kaduha Hospital M&E Officer  Ndayishimiye Daniel, WR staff  Interviewers Narcisse Ngiruwonsanga, ICSP staff  Germaine Rusagara, ICSP staff  Musangwa Adolphe, ICSP staff  Ntawukuriryayo Fidele, ICSP staff  Ndikumana Martin, ICSP staff  Ruganza Rutambwe Camarade, ICSP Staff New Staff (Trained by EIP) Musafiri Jean Baptiste, ICSP Staff New Staff (Trained by EIP) Mugisha Marie Louise, ICSP Staff New Staff Mugarura Jean Marie Vianney, In Charge of Social Affairs - Cell level  Niyonasenze John, In Charge of Social Affairs - Cell level  Nkuriza Aloys, In Charge of Social Affairs - Cell level  Muhayimana Thimothee, In Charge of Social Affairs - Cell level  Munyurwa Felix, In Charge of Social Affairs - Cell level  Vuzimpundu Jacqueline, In Charge of Social Affairs - Cell level  Niyonasenze John, In Charge of Social Affairs - Cell level  Nkundakwizera P.Celestin, In Charge of Social Affairs - Cell level  Sezitegeye Joseph, In Charge of Social Affairs - Cell level  Musoni J.M.V, In Charge of Social Affairs - Cell level  Rwasibo Joseph, In Charge of Social Affairs - Cell level  Nkuriza Aloys, In Charge of Social Affairs - Cell level  Sibomana Laurent, In Charge of Social Affairs - Cell level  Mukeshimana Vincent, In Charge of Social Affairs - Cell level  Musabyemariya Epiphanie, In Charge of Social Affairs - Cell level  Nyirahabimana Sarah, In Charge of Social Affairs - Cell level  Rwanda ICSP Final Evaluation Report September 2015 Page 105 of 405 Nyiracumi Alphonsine, In Charge of Social Affairs - Cell level  Nsengimana Aimable, In Charge of Social Affairs - Cell level  Hategekimana Augustin, In Charge of Social Affairs - Cell level  Nyirasikamwe Jacqueline, In Charge of Social Affairs - Cell level  Nzabamwita Evaliste, In Charge of Social Affairs - Cell level  Nyirahabimana Aima Marie, In Charge of Social Affairs - Cell level  Kwizera Audith, In Charge of Social Affairs - Cell level  Sibobugingo Aloys, In Charge of Social Affairs - Cell level  Ntibandetse Pascal, In Charge of Social Affairs - Cell level  Niyitegeka Paul, In Charge of Social Affairs - Cell level  Mukarusanga Francine, In Charge of Social Affairs - Cell level New staff Uwiringiyimana Damien, In Charge of Social Affairs - Cell level New Staff Ayinkamiye Esperence, HC Nutritionist  Kabaganda Grace, HC Nutritionist  Munyampirwa Donat, HC Nutritionist  Bamporiki Gémira, HC Nutritionist  Nikuze Laurentine, HC Nutritionist  Munganyinka Donatille, HC Nutritionist  Uwizanye Celine, HC Nutritionist  Hitabatuma Aloys, HC Nutritionist  Uwimana Consolee, HC Nutritionist  N.Nsengiyumva Clothilde, HC Nutritionist  Uwamahirwe Drothee, HC Nutritionist  Ntawuruhunga Marcelline, HC Nutritionist  Ahishakiye Therese, HC Nutritionist  Unyizihiye Vestine, HC Nutritionist  Nyirahabimana Immaculee, HC Nutritionist New Staff PAULIN, INTERN/University of Rwanda New Interviewer JEAN DE DIEU, INTERN/University of Rwanda New Interviewer THEOGENE , INTERN/University of Rwanda New Interviewer ERIC, INTERN/University of Rwanda New Interviewer Rwanda ICSP Final Evaluation Report September 2015 Page 106 of 405 Annex 3. Training schedule for supervisors and interviewers Activity March 2015 April 2015 1 2 3 4 1 2 3 4 Prepare enumerator training: March 2015 Train ICSP M&E Officers :March, 2015 Train Supervisors March, 2015 Train data collection teams March, 2015 Conduct pilot exercise March, 2015 Revise questionnaire and software for electronic data collection – March, 2015 Field data collection for KPC March – April, 2015 Rwanda ICSP Final Evaluation Report September 2015 Page 107 of 405 Annex 4. Population data used to select 30-clusters Kigeme Hospital Zone Total Pop. 169,087 Sample Number 196 Sampling interval 5,636 Hospital Sector Cell Village Population 70 Kigeme GASAKA REMERA GITWA 196 196 196 1 71 Kigeme GASAKA REMERA KABEZA 631 827 72 Kigeme GASAKA REMERA MURAMBI 497 1,324 73 Kigeme GASAKA REMERA MURIRO 663 1,987 74 Kigeme GASAKA REMERA NYAMIFUMBA 731 2,718 75 Kigeme Kamegeli Bwama Gitwa 916 3,634 76 Kigeme Kamegeli Bwama Kamiro 919 4,553 77 Kigeme Kamegeli Bwama Kigarama 616 5,169 78 Kigeme Kamegeli Kamegeli Kinyovu 817 5,986 5,832 2 79 Kigeme Kamegeli Kamegeli Ntaruka 937 6,923 80 Kigeme Kamegeli Kamegeli Rweru 533 7,456 81 Kigeme Kamegeli Kamegeli Sovu 510 7,966 82 Kigeme Kamegeli Kirehe Gasharu 691 8,657 83 Kigeme Kamegeli Kirehe Kigarama 800 9,457 84 Kigeme Kamegeli Kirehe Ryanyirataba 491 9,948 85 Kigeme Kamegeli Kizi Gakomeye 680 10,628 86 Kigeme Kamegeli Kizi Kagarama 587 11,215 87 Kigeme Kamegeli Kizi Kinyana 541 11,756 11,468 3 88 Kigeme Kamegeli Nyarusiza Bande 584 12,340 89 Kigeme Kamegeli Nyarusiza Nyarusange 418 12,758 90 Kigeme Kamegeli Nyarusiza Nyarusiza 737 13,495 91 Kigeme Kamegeli Nyarusiza Rutuna 666 14,161 Rwanda ICSP Final Evaluation Report September 2015 Page 108 of 405 92 Kigeme Kamegeli Rususa Bahina 451 14,612 93 Kigeme Kamegeli Rususa Baro 691 15,303 94 Kigeme Kamegeli Rususa Kigarama 558 15,861 95 Kigeme Kamegeli Rususa Muhembe 907 16,768 96 Kigeme Kibilizi Bugarama Kabarera 383 17,151 17,104 4 97 Kigeme Kibilizi Bugarama Kamina 580 17,731 98 Kigeme Kibilizi Bugarama Karandura 556 18,287 99 Kigeme Kibilizi Bugarama Kivumu 558 18,845 100 Kigeme Kibilizi Bugarama Munazi 458 19,303 101 Kigeme Kibilizi Bugarama Nyabusozi 524 19,827 102 Kigeme Kibilizi Bugarura Kasebuturanyi 793 20,620 103 Kigeme Kibilizi Bugarura Kirwa 614 21,234 104 Kigeme Kibilizi Bugarura Muyange 861 22,095 105 Kigeme Kibilizi Bugarura Nyakibyeyi 624 22,719 106 Kigeme Kibilizi Bugarura Uwinyana 670 23,389 22,740 5 107 Kigeme Kibilizi Gashiha Gasharu 630 24,019 108 Kigeme Kibilizi Gashiha Muduha 797 24,816 109 Kigeme Kibilizi Gashiha Muganza 892 25,708 110 Kigeme Kibilizi Gashiha Nyabubare 813 26,521 111 Kigeme Kibilizi Gashiha Rukamiro 909 27,430 112 Kigeme Kibilizi Karambo Gisoro 466 27,896 113 Kigeme Kibilizi Karambo Gitwa 443 28,339 114 Kigeme Kibilizi Karambo Kavumu 770 29,109 28,376 6 115 Kigeme Kibilizi Karambo Nyamirama 517 29,626 116 Kigeme Kibilizi Karambo Nyirakiraro 617 30,243 117 Kigeme Kibilizi Ruhunga Cyamashya 636 30,879 118 Kigeme Kibilizi Ruhunga Gakoma 1,020 31,899 119 Kigeme Kibilizi Ruhunga Kabuga 877 32,776 Rwanda ICSP Final Evaluation Report September 2015 Page 109 of 405 120 Kigeme Kibilizi Ruhunga Munombe 340 33,116 121 Kigeme Kibilizi Ruhunga Nyagishubi 753 33,869 122 Kigeme Kibilizi Ruhunga Ruhurura 757 34,626 34,012 7 123 Kigeme Kibilizi Uwindekezi Birembo 475 35,101 124 Kigeme Kibilizi Uwindekezi Gatovu 630 35,731 125 Kigeme Kibilizi Uwindekezi Karumbi 888 36,619 126 Kigeme Kibilizi Uwindekezi Kigarama 521 37,140 127 Kigeme Kibilizi Uwindekezi Mugote 661 37,801 128 Kigeme Kibilizi Uwindekezi Uwamataba 774 38,575 129 Kigeme KITABI KAGANO BUSUSURUKE 1,054 39,629 130 Kigeme KITABI KAGANO KINTOBO 931 40,560 39,648 8 131 Kigeme KITABI KAGANO TURONZI 755 41,315 132 Kigeme KITABI KAGANO UWABUMENYI 736 42,051 133 Kigeme KITABI KAGANO UWARWUBATSI 789 42,840 134 Kigeme KITABI KAGANO UWINTYABIRE 985 43,825 135 Kigeme KITABI MUJUGA GAHANDE 1,120 44,945 136 Kigeme KITABI MUJUGA GASASA 790 45,735 45,284 9 137 Kigeme KITABI MUJUGA MUJUGA 651 46,386 138 Kigeme KITABI MUJUGA MUKAKA 911 47,297 139 Kigeme KITABI MUJUGA RWUFE 1,490 48,787 140 Kigeme KITABI MUJUGA UWANYAKANYERI 918 49,705 141 Kigeme KITABI MUJUGA UWINKA 895 50,600 142 Kigeme KITABI MUKUNGU GAHIRA 573 51,173 50,920 10 143 Kigeme KITABI MUKUNGU GATARE 681 51,854 144 Kigeme KITABI MUKUNGU KARAMBI 854 52,708 145 Kigeme KITABI MUKUNGU UWICURANGIRO 525 53,233 146 Kigeme KITABI MUKUNGU UWURUNAZI 600 53,833 147 Kigeme KITABI SHABA BITABA 870 54,703 Rwanda ICSP Final Evaluation Report September 2015 Page 110 of 405 148 Kigeme KITABI SHABA GAKOKO 1,030 55,733 149 Kigeme KITABI SHABA MUGANZA 872 56,605 56,556 11 150 Kigeme KITABI SHABA MUYANGE 1,116 57,721 151 Kigeme KITABI SHABA UWAKAGORO 635 58,356 152 Kigeme KITABI SHABA UWINKA 870 59,226 153 Kigeme KITABI UWINGUGU GISARENDA 836 60,062 154 Kigeme KITABI UWINGUGU KIGALI 891 60,953 155 Kigeme KITABI UWINGUGU RUBUYE 810 61,763 156 Kigeme KITABI UWINGUGU RUHANGA 756 62,519 62,192 12 157 Kigeme KITABI UWINGUGU UWIMISIGATI 1,077 63,596 158 Kigeme KITABI UWINGUGU UWURUNAZI 722 64,318 159 Kigeme MBAZI MANWARI KARAMBI 739 65,057 160 Kigeme MBAZI MANWARI KIBUMBA 749 65,806 161 Kigeme MBAZI MANWARI KIGARAMA 533 66,339 162 Kigeme MBAZI MANWARI MUHORORO 482 66,821 163 Kigeme MBAZI MUTIWINGOMA GATWA 700 67,521 164 Kigeme MBAZI MUTIWINGOMA KABERE 529 68,050 67,828 13 165 Kigeme MBAZI MUTIWINGOMA KABUGA 609 68,659 166 Kigeme MBAZI MUTIWINGOMA MUDUHA 380 69,039 167 Kigeme MBAZI MUTIWINGOMA NYAMIRAMA 475 69,514 168 Kigeme MBAZI NGAMBI GASEKE 606 70,120 169 Kigeme MBAZI NGAMBI KABEZA 445 70,565 170 Kigeme MBAZI NGAMBI KIVOMO 610 71,175 171 Kigeme MBAZI NGAMBI MAHERESHO 783 71,958 172 Kigeme MBAZI NGAMBI MUNANIRA 573 72,531 173 Kigeme MBAZI NGARA BUTARE 822 73,353 174 Kigeme MBAZI NGARA GASHARU 642 73,995 73,464 14 175 Kigeme MBAZI NGARA GISIZA 464 74,459 Rwanda ICSP Final Evaluation Report September 2015 Page 111 of 405 176 Kigeme MBAZI NGARA GITUNTU 405 74,864 177 Kigeme MBAZI NGARA NYAGISHUMBU 553 75,417 178 Kigeme MBAZI NGARA RUSEKE 574 75,991 179 Kigeme TARE BUHORO GISANZE 595 76,586 180 Kigeme TARE BUHORO GITOVU 778 77,364 181 Kigeme TARE BUHORO KANSEREGE 281 77,645 182 Kigeme TARE BUHORO KIRWA 496 78,141 183 Kigeme TARE BUHORO NYABWOMA 470 78,611 184 Kigeme TARE BUHORO RWUFE 420 79,031 185 Kigeme TARE BUHORO RYARUBONDO 558 79,589 79,100 15 186 Kigeme TARE GASARENDA KAGARAMA 716 80,305 187 Kigeme TARE GASARENDA KIMINAZI 299 80,604 188 Kigeme TARE GASARENDA KIVURUGA 665 81,269 189 Kigeme TARE GASARENDA MURAGARA 498 81,767 190 Kigeme TARE GASARENDA MUSE 421 82,188 191 Kigeme TARE GASARENDA MWUFE 324 82,512 192 Kigeme TARE GASARENDA UWINKOMO 203 82,715 193 Kigeme TARE GATOVU GASENGA 527 83,242 194 Kigeme TARE GATOVU KIGUSA 2,903 86,145 84,736 16 195 Kigeme TARE GATOVU KIMINAZI 743 86,888 196 Kigeme TARE GATOVU MUHATTI 521 87,409 197 Kigeme TARE GATOVU RUZIBA 356 87,765 198 Kigeme TARE KAGANZA AKANYIRANDORI 596 88,361 199 Kigeme TARE KAGANZA BIVUMU 570 88,931 200 Kigeme TARE KAGANZA BUREMERA 646 89,577 201 Kigeme TARE KAGANZA CYIMICCANGA 663 90,240 202 Kigeme TARE KAGANZA RUGANZA 541 90,781 90,372 17 203 Kigeme TARE NKUMBURE BIRARO 480 91,261 Rwanda ICSP Final Evaluation Report September 2015 Page 112 of 405 204 Kigeme TARE NKUMBURE BIREKA 572 91,833 205 Kigeme TARE NKUMBURE GAHEMBE 411 92,244 206 Kigeme TARE NKUMBURE KIBWIIJE 596 92,840 207 Kigeme TARE NKUMBURE MUBEZI 514 93,354 208 Kigeme TARE NKUMBURE MUHUMO 613 93,967 209 Kigeme TARE NKUMBURE RUGETI 506 94,473 210 Kigeme TARE NKUMBURE RUKEREHO 399 94,872 211 Kigeme TARE NKUMBURE UWUMUGETI 367 95,239 212 Kigeme TARE NKUMBURE VUMWE 469 95,708 213 Kigeme TARE NYAMIGINA GAKOMA 643 96,351 96,008 18 214 Kigeme TARE NYAMIGINA MARYOHE 503 96,854 215 Kigeme TARE NYAMIGINA NGORORERO 507 97,361 216 Kigeme TARE NYAMIGINA NKOMERO 457 97,818 217 Kigeme TARE NYAMIGINA NYARUGEITI 561 98,379 218 Kigeme TARE NYAMIGINA RUKOKO 607 98,986 219 Kigeme TARE NYAMIGINA UWINTANA 363 99,349 220 Kigeme UWINKINGI BIGUMIRA BIGUMIRA 527 99,876 221 Kigeme UWINKINGI BIGUMIRA CYUMUGANZA 596 100,472 222 Kigeme UWINKINGI BIGUMIRA GAKOKO 839 101,311 223 Kigeme UWINKINGI BIGUMIRA MAGUMIRA 679 101,990 101,644 19 224 Kigeme UWINKINGI GAHIRA BUNYUNYU 658 102,648 225 Kigeme UWINKINGI GAHIRA GAHIRA 804 103,452 226 Kigeme UWINKINGI GAHIRA GITITI 708 104,160 227 Kigeme UWINKINGI GAHIRA KIBUGAZI 766 104,926 228 Kigeme UWINKINGI GAHIRA KUNYU 806 105,732 229 Kigeme UWINKINGI GAHIRA RUGEYO 771 106,503 230 Kigeme UWINKINGI GAHIRA UWINKINGI 705 107,208 231 Kigeme UWINKINGI KIBYAGIRA BISHYA 841 108,049 107,280 20 Rwanda ICSP Final Evaluation Report September 2015 Page 113 of 405 232 Kigeme UWINKINGI KIBYAGIRA CYUMUGANZA 476 108,525 233 Kigeme UWINKINGI KIBYAGIRA KABUGA 653 109,178 234 Kigeme UWINKINGI KIBYAGIRA KABUSEKURU 487 109,665 235 Kigeme UWINKINGI KIBYAGIRA KAGANO 651 110,316 236 Kigeme UWINKINGI KIBYAGIRA SABAKE 766 111,082 237 Kigeme UWINKINGI KIBYAGIRA SEKERA 920 112,002 238 Kigeme UWINKINGI MUDASOMWA GACACA 705 112,707 239 Kigeme UWINKINGI MUDASOMWA KARAMBO 820 113,527 112,916 21 240 Kigeme UWINKINGI MUDASOMWA NSINDUKA 722 114,249 241 Kigeme UWINKINGI MUDASOMWA RUSHUBI 567 114,816 242 Kigeme UWINKINGI MUDASOMWA UWANJYOGORO 686 115,502 243 Kigeme UWINKINGI MUNYEGE BITABA 656 116,158 244 Kigeme UWINKINGI MUNYEGE GAHANGO 619 116,777 245 Kigeme UWINKINGI MUNYEGE KANYAMPONGO 571 117,348 246 Kigeme UWINKINGI MUNYEGE KIMINA 625 117,973 247 Kigeme UWINKINGI MUNYEGE MUNYEGE 798 118,771 118,552 22 248 Kigeme UWINKINGI MUNYEGE NYARURAMBI 771 119,542 249 Kigeme UWINKINGI RUGOGWE MABENDE 593 120,135 250 Kigeme UWINKINGI RUGOGWE MUNINI 750 120,885 251 Kigeme UWINKINGI RUGOGWE MWISHYOGWE 598 121,483 252 Kigeme UWINKINGI RUGOGWE NYAMUGARI 653 122,136 253 Kigeme UWINKINGI RUGOGWE RUGETI 598 122,734 254 Kigeme UWINKINGI RUGOGWE SUBUKINIRO 848 123,582 1 Kigeme CYANIKA GITEGA BUTARE 455 124,037 2 Kigeme CYANIKA GITEGA GASEKE 369 124,406 124,188 23 3 Kigeme CYANIKA GITEGA GASHARU 488 124,894 4 Kigeme CYANIKA GITEGA GITEGA 543 125,437 5 Kigeme CYANIKA GITEGA KIGARAMA 460 125,897 Rwanda ICSP Final Evaluation Report September 2015 Page 114 of 405 6 Kigeme CYANIKA GITEGA MIKO 421 126,318 7 Kigeme CYANIKA GITEGA MUNYERERI 481 126,799 8 Kigeme CYANIKA GITEGA MUSASA 472 127,271 9 Kigeme CYANIKA GITEGA RUSARASI 416 127,687 10 Kigeme CYANIKA GITEGA RWINGOMA 396 128,083 11 Kigeme CYANIKA KARAMA BIRAMBO 354 128,437 12 Kigeme CYANIKA KARAMA KARABA 625 129,062 13 Kigeme CYANIKA KARAMA KARAMA 524 129,586 14 Kigeme CYANIKA KARAMA MUGAMBA 611 130,197 129,824 24 15 Kigeme CYANIKA KARAMA MUNYINYA 686 130,883 16 Kigeme CYANIKA KARAMA NYAMISAVE 313 131,196 17 Kigeme CYANIKA KARAMA NYANZA 710 131,906 18 Kigeme CYANIKA KARAMA RWAMAGANA 592 132,498 19 Kigeme CYANIKA KIYUMBA GATARE 356 132,854 20 Kigeme CYANIKA KIYUMBA GATENTWE 453 133,307 21 Kigeme CYANIKA KIYUMBA GIKOMERO 483 133,790 22 Kigeme CYANIKA KIYUMBA GISHIKE 365 134,155 23 Kigeme CYANIKA KIYUMBA KAGARAMA 463 134,618 24 Kigeme CYANIKA KIYUMBA KAVIRI 551 135,169 25 Kigeme CYANIKA KIYUMBA NYARUCYAMU 361 135,530 135,460 25 26 Kigeme CYANIKA NGOMA KABARERA 695 136,225 27 Kigeme CYANIKA NGOMA KAMUHIRWA 512 136,737 28 Kigeme CYANIKA NGOMA KAVUMU 668 137,405 29 Kigeme CYANIKA NGOMA KINGA 491 137,896 30 Kigeme CYANIKA NGOMA MURAMA 481 138,377 31 Kigeme CYANIKA NGOMA NYAMIRAMBO 437 138,814 32 Kigeme CYANIKA NYANZA BUHIGA 792 139,606 33 Kigeme CYANIKA NYANZA KIBINGO 955 140,561 Rwanda ICSP Final Evaluation Report September 2015 Page 115 of 405 34 Kigeme CYANIKA NYANZA MIRAMA 728 141,289 141,096 26 35 Kigeme CYANIKA NYANZA MUGOMBWA 683 141,972 36 Kigeme CYANIKA NYANZA NYABISINDU 640 142,612 37 Kigeme CYANIKA NYANZA RUGARAGARA 678 143,290 38 Kigeme CYANIKA NYANZOGA BIGAZI 596 143,886 39 Kigeme CYANIKA NYANZOGA GAFUHISHA 520 144,406 40 Kigeme CYANIKA NYANZOGA KAGARAMA 435 144,841 41 Kigeme CYANIKA NYANZOGA KARUVENYA 448 145,289 42 Kigeme CYANIKA NYANZOGA MBEHO 561 145,850 43 Kigeme CYANIKA NYANZOGA MUGARI 720 146,570 44 Kigeme CYANIKA NYANZOGA NYAMIRAMA 325 146,895 146,732 27 45 Kigeme CYANIKA NYANZOGA RUSENYI 436 147,331 46 Kigeme GASAKA KIGEME GAKOMA 1,093 148,424 47 Kigeme GASAKA KIGEME GITABA 850 149,274 48 Kigeme GASAKA KIGEME MUNOMBE 1,301 150,575 49 Kigeme GASAKA KIGEME NYANTANGA 910 151,485 50 Kigeme GASAKA NGIRYI KARAMBI 800 152,285 51 Kigeme GASAKA NGIRYI KIBANDA 797 153,082 152,368 28 52 Kigeme GASAKA NGIRYI KITAZIGURWA 1,079 154,161 53 Kigeme GASAKA NGIRYI MUNYEGE 757 154,918 54 Kigeme GASAKA NGIRYI NGIRYI 564 155,482 55 Kigeme GASAKA NGIRYI SUMBA 1,555 157,037 56 Kigeme GASAKA NYABIVUMU DUSEGO 401 157,438 57 Kigeme GASAKA NYABIVUMU GASHARU 567 158,005 158,004 29 58 Kigeme GASAKA NYABIVUMU NYABIVUMU 408 158,413 59 Kigeme GASAKA NYABIVUMU RARO 656 159,069 60 Kigeme GASAKA NYAMUGARI KABACUZI 1,632 160,701 61 Kigeme GASAKA NYAMUGARI KABAJOGO 997 161,698 Rwanda ICSP Final Evaluation Report September 2015 Page 116 of 405 62 Kigeme GASAKA NYAMUGARI KARAMA 1,032 162,730 63 Kigeme GASAKA NYAMUGARI KIGARAMA 940 163,670 163,640 30 64 Kigeme GASAKA NYAMUGARI NYAMUGARI 708 164,378 65 Kigeme GASAKA NYAMUGARI NYARUSANGE 1,316 165,694 66 Kigeme GASAKA NZEGA GASAKA 966 166,660 67 Kigeme GASAKA NZEGA GITANTU 945 167,605 68 Kigeme GASAKA NZEGA KADOMA 865 168,470 69 Kigeme GASAKA NZEGA NZEGA 617 169,087 169,087 Kaduha Hospital Zone Total Pop. 155,372 Sample Number 244 Sampling iterval 5,179 Hospital Sector Cell Village Population 143 Kaduha MUGANO SUTI GASIZA 244 244 244 1 144 Kaduha MUGANO SUTI MATYAZO 474 718 145 Kaduha MUGANO SUTI RWAMIKO 452 1,170 146 Kaduha MUGANO SUTI TURYANGO 603 1,773 147 Kaduha MUGANO YONDE GISOVU 554 2,327 148 Kaduha MUGANO YONDE KANYEGENYEGE 554 2,881 149 Kaduha MUGANO YONDE NYARUSAZI 652 3,533 150 Kaduha MUGANO YONDE RUHAMIRA A 421 3,954 151 Kaduha MUGANO YONDE RUHAMIRA B 454 4,408 152 Kaduha MUSANGE GASAVE Gasura 505 4,913 153 Kaduha MUSANGE GASAVE Kabingo 516 5,429 5,423 2 154 Kaduha MUSANGE GASAVE Murambi 553 5,982 Rwanda ICSP Final Evaluation Report September 2015 Page 117 of 405 155 Kaduha MUSANGE GASAVE Nyabivumu 481 6,463 156 Kaduha MUSANGE GASAVE Nyakabuye 538 7,001 157 Kaduha MUSANGE JENDA Cyabagomba 509 7,510 158 Kaduha MUSANGE JENDA Kabakannyi 871 8,381 159 Kaduha MUSANGE JENDA Kavumu 661 9,042 160 Kaduha MUSANGE JENDA Kayogoro 687 9,729 161 Kaduha MUSANGE JENDA Nyakibungo 487 10,216 162 Kaduha MUSANGE JENDA Nyakirambi 633 10,849 10,602 3 163 Kaduha MUSANGE MASAGARA Cyabasana 415 11,264 164 Kaduha MUSANGE MASAGARA Cyaruvunge 447 11,711 165 Kaduha MUSANGE MASAGARA Gituntu 459 12,170 166 Kaduha MUSANGE MASAGARA Muhororo 374 12,544 167 Kaduha MUSANGE MASAGARA Mutakara 468 13,012 168 Kaduha MUSANGE MASAGARA Mutuntu 397 13,409 169 Kaduha MUSANGE MASAGARA Nyagihima 558 13,967 170 Kaduha MUSANGE MASANGANO Gasagara 709 14,676 171 Kaduha MUSANGE MASANGANO Kibumba 673 15,349 172 Kaduha MUSANGE MASANGANO Mubuga 559 15,908 15,781 4 173 Kaduha MUSANGE MASANGANO Nyakabuye 545 16,453 174 Kaduha MUSANGE MASANGANO Rutuntu 597 17,050 175 Kaduha MUSANGE MASIZI Karama 590 17,640 176 Kaduha MUSANGE MASIZI Munini 609 18,249 177 Kaduha MUSANGE MASIZI Murehe 587 18,836 178 Kaduha MUSANGE MASIZI Rwankango 542 19,378 179 Kaduha MUSANGE MASIZI Rwina 680 20,058 180 Kaduha MUSANGE NYAGISOZI Dusenyi 483 20,541 181 Kaduha MUSANGE NYAGISOZI Kibaga 508 21,049 20,960 5 182 Kaduha MUSANGE NYAGISOZI Remera 481 21,530 Rwanda ICSP Final Evaluation Report September 2015 Page 118 of 405 183 Kaduha MUSANGE NYAGISOZI Ruhunga 529 22,059 184 Kaduha MUSANGE NYAGISOZI Uwabarashi 430 22,489 185 Kaduha MUSEBEYA GATOVU Bisereganya 458 22,947 186 Kaduha MUSEBEYA GATOVU Gatovu 459 23,406 187 Kaduha MUSEBEYA GATOVU Gitovu 519 23,925 188 Kaduha MUSEBEYA GATOVU Kanyiranzoga 396 24,321 189 Kaduha MUSEBEYA GATOVU Nyarubande 338 24,659 190 Kaduha MUSEBEYA GATOVU Ryanyakayaga 344 25,003 191 Kaduha MUSEBEYA NYARURAMBI Cyabwimba 320 25,323 192 Kaduha MUSEBEYA NYARURAMBI Cyarwa 327 25,650 193 Kaduha MUSEBEYA NYARURAMBI Gatiti 541 26,191 26,139 6 194 Kaduha MUSEBEYA NYARURAMBI Giheta 280 26,471 195 Kaduha MUSEBEYA NYARURAMBI Kabere 506 26,977 196 Kaduha MUSEBEYA NYARURAMBI Mujyejuru 446 27,423 197 Kaduha MUSEBEYA NYARURAMBI Nyarurambi 360 27,783 198 Kaduha MUSEBEYA NYARURAMBI Rwabigeyo 375 28,158 199 Kaduha MUSEBEYA RUGANO Bugarama 396 28,554 200 Kaduha MUSEBEYA RUGANO Busanza 427 28,981 201 Kaduha MUSEBEYA RUGANO Gisiza 402 29,383 202 Kaduha MUSEBEYA RUGANO Kibandirwa 541 29,924 203 Kaduha MUSEBEYA RUGANO Rugano 495 30,419 204 Kaduha MUSEBEYA RUGANO Rukungu 468 30,887 205 Kaduha MUSEBEYA RUNEGE Bigugu 434 31,321 31,318 7 206 Kaduha MUSEBEYA RUNEGE Bitaba 492 31,813 207 Kaduha MUSEBEYA RUNEGE Gacundura 513 32,326 208 Kaduha MUSEBEYA RUNEGE Gakereko 534 32,860 209 Kaduha MUSEBEYA RUNEGE Ndogondwe 390 33,250 210 Kaduha MUSEBEYA RUNEGE Ruganza 576 33,826 Rwanda ICSP Final Evaluation Report September 2015 Page 119 of 405 211 Kaduha MUSEBEYA RUNEGE Rukaranka 484 34,310 212 Kaduha MUSEBEYA RUSEKERA Karambo 247 34,557 213 Kaduha MUSEBEYA RUSEKERA Ngoma 317 34,874 214 Kaduha MUSEBEYA RUSEKERA Rebero 461 35,335 215 Kaduha MUSEBEYA RUSEKERA Shaki 399 35,734 216 Kaduha MUSEBEYA RUSEKERA Uwimituza 521 36,255 217 Kaduha MUSEBEYA SEKERA Masinde 650 36,905 36,497 8 218 Kaduha MUSEBEYA SEKERA Mugano 593 37,498 219 Kaduha MUSEBEYA SEKERA Nkomero 702 38,200 220 Kaduha MUSEBEYA SEKERA Nyaruhura 619 38,819 221 Kaduha MUSEBEYA SEKERA Rubumburi 723 39,542 222 Kaduha MUSEBEYA SEKERA Rugazi 628 40,170 223 Kaduha MUSHUBI BUTETERI GORWE 360 40,530 224 Kaduha MUSHUBI BUTETERI KAGORWE 455 40,985 225 Kaduha MUSHUBI BUTETERI KIZANGANYA 506 41,491 226 Kaduha MUSHUBI BUTETERI MUGUNDA 376 41,867 41,676 9 227 Kaduha MUSHUBI BUTETERI MURAMBI 591 42,458 228 Kaduha MUSHUBI BUTETERI NGOMA 434 42,892 229 Kaduha MUSHUBI BUTETERI NYAKIBANDE 448 43,340 230 Kaduha MUSHUBI BUTETERI REMERA 471 43,811 231 Kaduha MUSHUBI BUTETERI RUSOYO 411 44,222 232 Kaduha MUSHUBI BUTETERI RWAMIKO 473 44,695 233 Kaduha MUSHUBI CYOBE CYOBE 414 45,109 234 Kaduha MUSHUBI CYOBE GASEKE 567 45,676 235 Kaduha MUSHUBI CYOBE GIYIKIREMA 473 46,149 236 Kaduha MUSHUBI CYOBE NYAGISUMO 517 46,666 237 Kaduha MUSHUBI CYOBE NYAKABINGO 646 47,312 46,855 10 238 Kaduha MUSHUBI CYOBE NYAKIRAMBI 388 47,700 Rwanda ICSP Final Evaluation Report September 2015 Page 120 of 405 239 Kaduha MUSHUBI CYOBE NYARUSHIKE 537 48,237 240 Kaduha MUSHUBI CYOBE RUTOYI 528 48,765 241 Kaduha MUSHUBI GASHWATI BWERAMANA 472 49,237 242 Kaduha MUSHUBI GASHWATI GASHWATI 741 49,978 243 Kaduha MUSHUBI GASHWATI MUHEMBE 651 50,629 244 Kaduha MUSHUBI GASHWATI MUKO 288 50,917 245 Kaduha MUSHUBI GASHWATI MUSHUBI 802 51,719 246 Kaduha MUSHUBI GASHWATI RUCUNDA 711 52,430 52,034 11 247 Kaduha MUSHUBI GASHWATI RUHINGA 280 52,710 248 Kaduha NKOMANE BITANDARA BUHANZI 556 53,266 249 Kaduha NKOMANE BITANDARA MUNANIRA 439 53,705 250 Kaduha NKOMANE BITANDARA MUTANDARA 718 54,423 251 Kaduha NKOMANE BITANDARA MUYANGE 392 54,815 252 Kaduha NKOMANE BITANDARA RUGEYO 531 55,346 253 Kaduha NKOMANE MUSARABA GATOROVE 351 55,697 254 Kaduha NKOMANE MUSARABA GIHUNGA 613 56,310 255 Kaduha NKOMANE MUSARABA KIMBOGO 361 56,671 256 Kaduha NKOMANE MUSARABA MUSARABA 505 57,176 257 Kaduha NKOMANE MUSARABA RUSOYO 360 57,536 57,213 12 258 Kaduha NKOMANE MUSARABA RUTARE 386 57,922 259 Kaduha NKOMANE MUSARABA RWIMPIRI 401 58,323 260 Kaduha NKOMANE MUTENGERI CYURWUVE 365 58,688 261 Kaduha NKOMANE MUTENGERI GIHWAHWA 362 59,050 262 Kaduha NKOMANE MUTENGERI KAVUMU 353 59,403 263 Kaduha NKOMANE MUTENGERI KIVUMU 541 59,944 264 Kaduha NKOMANE MUTENGERI MUTENGERI 247 60,191 265 Kaduha NKOMANE MUTENGERI TUBUYE 549 60,740 266 Kaduha NKOMANE NKOMANE BANDA 752 61,492 Rwanda ICSP Final Evaluation Report September 2015 Page 121 of 405 267 Kaduha NKOMANE NKOMANE KAGANO 627 62,119 268 Kaduha NKOMANE NKOMANE MUGARI 796 62,915 62,392 13 269 Kaduha NKOMANE NKOMANE MUTARAMA 588 63,503 270 Kaduha NKOMANE NKOMANE RUHINGA 785 64,288 271 Kaduha NKOMANE NYARWUNGO BISHARA 443 64,731 272 Kaduha NKOMANE NYARWUNGO BUCYERO 360 65,091 273 Kaduha NKOMANE NYARWUNGO MARAMBO 430 65,521 274 Kaduha NKOMANE NYARWUNGO NYARUHOMBO 249 65,770 67,571 14 275 Kaduha NKOMANE NYARWUNGO NYARWUNGO 354 66,124 276 Kaduha NKOMANE NYARWUNGO RANGI 584 66,708 277 Kaduha NKOMANE NYARWUNGO RUTOYI 605 67,313 278 Kaduha NKOMANE TWIYA GAKOMEYE 338 67,651 279 Kaduha NKOMANE TWIYA GISHENGE 421 68,072 280 Kaduha NKOMANE TWIYA KARUKOMA 521 68,593 281 Kaduha NKOMANE TWIYA KIBUGA 444 69,037 282 Kaduha NKOMANE TWIYA TWIYA 513 69,550 1 Kaduha BURUHUKIRO BUSHIGISHIGI BUSHIGISHIGI 665 70,215 2 Kaduha BURUHUKIRO BUSHIGISHIGI GIHARAYUMBU 589 70,804 3 Kaduha BURUHUKIRO BUSHIGISHIGI MUGOTE 795 71,599 4 Kaduha BURUHUKIRO BUSHIGISHIGI RUSEKERA 604 72,203 5 Kaduha BURUHUKIRO BYIMANA BISHYIGA 597 72,800 72,750 15 6 Kaduha BURUHUKIRO BYIMANA BUHORO 611 73,411 7 Kaduha BURUHUKIRO BYIMANA GAKANGAGA 611 74,022 8 Kaduha BURUHUKIRO BYIMANA GIHUMO 773 74,795 9 Kaduha BURUHUKIRO BYIMANA RUKERI 652 75,447 10 Kaduha BURUHUKIRO GIFURWE BITABA 391 75,838 11 Kaduha BURUHUKIRO GIFURWE GIFURWE 490 76,328 12 Kaduha BURUHUKIRO GIFURWE NGANZO 755 77,083 Rwanda ICSP Final Evaluation Report September 2015 Page 122 of 405 13 Kaduha BURUHUKIRO GIFURWE NYAMABERI 442 77,525 14 Kaduha BURUHUKIRO GIFURWE RURONZI 352 77,877 15 Kaduha BURUHUKIRO GIFURWE UWANKIRIYE 442 78,319 77,929 16 16 Kaduha BURUHUKIRO KIZIMYAMURIRO GIKUNGU 770 79,089 17 Kaduha BURUHUKIRO KIZIMYAMURIRO GISHWATI 934 80,023 18 Kaduha BURUHUKIRO KIZIMYAMURIRO KAGANO 840 80,863 19 Kaduha BURUHUKIRO KIZIMYAMURIRO KINABA 869 81,732 20 Kaduha BURUHUKIRO KIZIMYAMURIRO MINAGA 860 82,592 21 Kaduha BURUHUKIRO KIZIMYAMURIRO MUJERENGE 835 83,427 83,108 17 22 Kaduha BURUHUKIRO KIZIMYAMURIRO TANTARAMA 852 84,279 23 Kaduha BURUHUKIRO KIZIMYAMURIRO UWINZIRA 589 84,868 24 Kaduha BURUHUKIRO MUNINI CYINYOZA 560 85,428 25 Kaduha BURUHUKIRO MUNINI GITOVU 695 86,123 26 Kaduha BURUHUKIRO MUNINI MAGUMIRA 604 86,727 27 Kaduha BURUHUKIRO MUNINI MATSINDA 652 87,379 28 Kaduha BURUHUKIRO MUNINI MUNINI 691 88,070 29 Kaduha BURUHUKIRO MUNINI RUKWANDU 540 88,610 88,287 18 30 Kaduha BURUHUKIRO MUNINI UWINZOVU 735 89,345 31 Kaduha BURUHUKIRO RAMBYA BURUHUKIRO 895 90,240 32 Kaduha BURUHUKIRO RAMBYA KIBUBURO 448 90,688 33 Kaduha BURUHUKIRO RAMBYA MPANGA 527 91,215 34 Kaduha BURUHUKIRO RAMBYA NKAMBA 847 92,062 35 Kaduha BURUHUKIRO RAMBYA RUSEKE 496 92,558 36 Kaduha GATARE BOKOPFU KARAMBO 761 93,319 37 Kaduha GATARE BOKOPFU KARUMBI 641 93,960 93,466 19 38 Kaduha GATARE BOKOPFU MUHINGO 847 94,807 39 Kaduha GATARE BOKOPFU TWIYA 592 95,399 40 Kaduha GATARE GATARE GASHASHA 425 95,824 Rwanda ICSP Final Evaluation Report September 2015 Page 123 of 405 41 Kaduha GATARE GATARE KIYOVU 894 96,718 42 Kaduha GATARE GATARE MUREMBO 392 97,110 43 Kaduha GATARE GATARE RWAMAKARA 1,088 98,198 44 Kaduha GATARE GATARE UWISURI 882 99,080 98,645 20 45 Kaduha GATARE MUKONGORO GIKUNGU 505 99,585 46 Kaduha GATARE MUKONGORO KAGANO 675 100,260 47 Kaduha GATARE MUKONGORO KAGEYO 503 100,763 48 Kaduha GATARE MUKONGORO NYAKABUYE 595 101,358 49 Kaduha GATARE MUKONGORO RUKEREKO 679 102,037 50 Kaduha GATARE RUGANDA GASHARU 486 102,523 51 Kaduha GATARE RUGANDA GITUNTU 517 103,040 52 Kaduha GATARE RUGANDA KAMAMARA 529 103,569 53 Kaduha GATARE RUGANDA MASANGANO 525 104,094 103,824 21 54 Kaduha GATARE RUGANDA RUNABA 533 104,627 55 Kaduha GATARE RUGANDA RWANGAMBIRI 715 105,342 56 Kaduha GATARE SHYERU BAZIRO 919 106,261 57 Kaduha GATARE SHYERU BIMBA 567 106,828 58 Kaduha GATARE SHYERU KAGUSA 428 107,256 59 Kaduha GATARE SHYERU RUHANGA 590 107,846 60 Kaduha GATARE SHYERU RUSHYARARA 572 108,418 61 Kaduha KADUHA KAVUMU Bamba 484 108,902 62 Kaduha KADUHA KAVUMU BIZIGURO 599 109,501 109,003 22 63 Kaduha KADUHA KAVUMU GAHAMA 698 110,199 64 Kaduha KADUHA KAVUMU GATABA 550 110,749 65 Kaduha KADUHA KAVUMU GITEGA 479 111,228 66 Kaduha KADUHA KAVUMU JOMA 331 111,559 67 Kaduha KADUHA KAVUMU KABUGA 500 112,059 68 Kaduha KADUHA KAVUMU KAMONYI 619 112,678 Rwanda ICSP Final Evaluation Report September 2015 Page 124 of 405 69 Kaduha KADUHA KAVUMU KAREHE 686 113,364 70 Kaduha KADUHA KAVUMU KAVUMU 647 114,011 71 Kaduha KADUHA MURAMBI KASEMANYANA 542 114,553 114,182 23 72 Kaduha KADUHA MURAMBI KIBIRARO 560 115,113 73 Kaduha KADUHA MURAMBI NYARURYANGO 730 115,843 74 Kaduha KADUHA MURAMBI REBERO 660 116,503 75 Kaduha KADUHA MUSENYI BURENGO 643 117,146 76 Kaduha KADUHA MUSENYI GASOVU 623 117,769 77 Kaduha KADUHA MUSENYI GATOKI 717 118,486 78 Kaduha KADUHA MUSENYI KIRWA 500 118,986 79 Kaduha KADUHA MUSENYI MUNINI 462 119,448 119,361 24 80 Kaduha KADUHA MUSENYI NGANZO 657 120,105 81 Kaduha KADUHA MUSENYI NYAKIRAMBI 693 120,798 82 Kaduha KADUHA MUSENYI RUGANDA 604 121,402 83 Kaduha KADUHA NYABISINDU GITABAGE 423 121,825 84 Kaduha KADUHA NYABISINDU KABAZIRO 662 122,487 85 Kaduha KADUHA NYABISINDU KANYEGE 592 123,079 86 Kaduha KADUHA NYABISINDU KASEMAZI 687 123,766 87 Kaduha KADUHA NYABISINDU KIREHE 634 124,400 88 Kaduha KADUHA NYABISINDU KIVUMU 720 125,120 124,540 25 89 Kaduha KADUHA NYABISINDU MUDUHA 485 125,605 90 Kaduha KADUHA NYABISINDU MUKONGORO 515 126,120 91 Kaduha KADUHA NYAMIYAGA CYUGARO 653 126,773 92 Kaduha KADUHA NYAMIYAGA GASHIRU 325 127,098 93 Kaduha KADUHA NYAMIYAGA NKOMERO 544 127,642 94 Kaduha KADUHA NYAMIYAGA NYAKABINGO 708 128,350 95 Kaduha KADUHA NYAMIYAGA RUHUHA 531 128,881 96 Kaduha KADUHA NYAMIYAGA RUKERI 526 129,407 Rwanda ICSP Final Evaluation Report September 2015 Page 125 of 405 97 Kaduha KIBUMBWE BWENDA MUNYINYA 784 130,191 129,719 26 98 Kaduha KIBUMBWE BWENDA MURAMBI 478 130,669 99 Kaduha KIBUMBWE BWENDA MURWA 344 131,013 100 Kaduha KIBUMBWE BWENDA NYAGATOVU 433 131,446 101 Kaduha KIBUMBWE BWENDA NYAMIRAMA 638 132,084 102 Kaduha KIBUMBWE GAKANKA CYERU 738 132,822 103 Kaduha KIBUMBWE GAKANKA GIKOMERO 528 133,350 104 Kaduha KIBUMBWE GAKANKA MUNINI 452 133,802 105 Kaduha KIBUMBWE GAKANKA NKURUBUYE 750 134,552 106 Kaduha KIBUMBWE GAKANKA NYARUBUYE 468 135,020 134,898 27 107 Kaduha KIBUMBWE GAKANKA RAMBYA 374 135,394 108 Kaduha KIBUMBWE KIBIBI GATANDAGAGANYA 537 135,931 109 Kaduha KIBUMBWE KIBIBI KABERE 610 136,541 110 Kaduha KIBUMBWE KIBIBI KANYEGE 488 137,029 111 Kaduha KIBUMBWE KIBIBI KIRWA 617 137,646 112 Kaduha KIBUMBWE KIBIBI RWEZAMENYO 715 138,361 113 Kaduha KIBUMBWE KIBIBI RYINGARURA 326 138,687 114 Kaduha KIBUMBWE NYAKIZA DUSENYI 457 139,144 115 Kaduha KIBUMBWE NYAKIZA KARAMBO 448 139,592 116 Kaduha KIBUMBWE NYAKIZA KINYANA 348 139,940 117 Kaduha KIBUMBWE NYAKIZA MURAMBI 527 140,467 140,077 28 118 Kaduha KIBUMBWE NYAKIZA NYAKIZU 619 141,086 119 Kaduha KIBUMBWE NYAKIZA ZIGATI 440 141,526 120 Kaduha MUGANO GITONDORO GAKOIMEYE 885 142,411 121 Kaduha MUGANO GITONDORO GIITONDORO 946 143,357 122 Kaduha MUGANO GITONDORO GITUNTU 770 144,127 123 Kaduha MUGANO GITONDORO KARAMBI 583 144,710 124 Kaduha MUGANO GITONDORO MASO 579 145,289 145,256 29 Rwanda ICSP Final Evaluation Report September 2015 Page 126 of 405 125 Kaduha MUGANO GITWA KABUHORO 678 145,967 126 Kaduha MUGANO GITWA KIRENZI 421 146,388 127 Kaduha MUGANO GITWA KIRENZI II 290 146,678 128 Kaduha MUGANO GITWA NYAKIBINGO 409 147,087 129 Kaduha MUGANO GITWA RUTABO 535 147,622 130 Kaduha MUGANO GITWA RYAMIGABO 442 148,064 131 Kaduha MUGANO RUHINGA CYIBANDE 370 148,434 132 Kaduha MUGANO RUHINGA CYINZIRA 476 148,910 133 Kaduha MUGANO RUHINGA GITARAMA 571 149,481 134 Kaduha MUGANO RUHINGA KABUYE 666 150,147 135 Kaduha MUGANO RUHINGA KARAMBI 378 150,525 150,435 30 136 Kaduha MUGANO RUHINGA UWINYANA 646 151,171 137 Kaduha MUGANO SOVU KIGARAMA 844 152,015 138 Kaduha MUGANO SOVU NZIRANZIZA 720 152,735 139 Kaduha MUGANO SOVU RUGARAMA I 638 153,373 140 Kaduha MUGANO SOVU RUGARAMA II 772 154,145 141 Kaduha MUGANO SOVU RUHANGA 814 154,959 142 Kaduha MUGANO SUTI CYABUTSE 413 155,372 155,372 Rwanda ICSP Final Evaluation Report September 2015 Page 127 of 405 Annex 5. Consent Form for KPC Respondents Instruction If the respondent does not read, this form is to be read aloud by someone other than the interviewer, preferably by a community health worker. Introduction You are invited to participate in a survey to learn more about the knowledge and practices of mothers of children under age five months in this community. This consent form will give you the information you will need to understand why this survey is being done and why you are being invited to participate. It will also describe what you will need to do to participate and any known risks, inconveniences or discomforts that you may have while participating. We encourage you to take some time to think this over and to discuss it with your family or friends. For this survey, we will interview approximately 600 mothers of children under five years. Why is this survey being done? World Relief has a project that has been helping to train community health workers to assess and treat children under five in this community. The purpose of the survey is to help us understand the health status of this community and how sick children are cared for. What are the survey procedures? What will I be asked to do? The questions in the survey are about your home, your health, and the health of your child under 2 years or one of your children 6-59 months who has been sick in the past 2 weeks. The survey will last about 20 minutes. I will ask to look quickly inside your house. What are the risks or inconveniences of the survey? There is a risk that some of the questions may make you feel uncomfortable. I want you to know that anything you tell me is completely confidential. We will not use your name in any of our materials or reports. We will not talk about particular children or families, but only about the situation overall in your district. No one will know who gave what answers. What are the benefits of the survey? Your answers will be put together with the answers from many other families in this community and will help us find out the best ways to help families like you lead healthier, happier lives. Will I receive payment for participation? You will not be paid to be in this survey. Are there costs to participate? There are no costs to you to participate. How will my personal information be protected? If you agree to participate, all information about you will be kept as private as possible. No personal information such as your name will be reported. Your name is not written anywhere on the forms containing your responses. Can I stop being in this survey and what are my rights? You do not have to be in this survey if you do not want to. If you agree to be in the survey, but later change your mind, you may contact us. You also may choose to skip any questions that you do not wish to answer. There are no penalties or consequences of any kind if you decide that you do not want to participate. Who do I contact if I have questions about the survey? We will be happy to answer any questions you have about this survey. If you have further questions about this survey, want to voice concerns or complaints about the research, or if you have a research-related problem, you may contact Melene Kabadege, research team member, at telephone number 250788306586. Or, if you have questions about the research, you may call the Innovation CSP office in Nyamagabe District at telephone number 0788307570. Rwanda ICSP Final Evaluation Report September 2015 Page 128 of 405 If you would like to discuss your rights as a research participant, discuss problems, concerns or questions; obtain information; or offer input with an informed individual who is unaffiliated with the specific research, you may also contact the Rwanda National Ethics Committee by calling Dr. Justin Wane, Chairperson of the ethics committee, at 0788500499 or Dr. Emmanuel Nkeramihigo, Secretary of the Ethics Committee, at 0788557273. I will provide you a copy of this information sheet with the contact information should you have any other questions. Comments/Questions: ________________________________________________________________________ Are you willing to participate? Interviewer circle: YES NO Documentation of Consent: This consent document has been read and explained to me and I have decided that I will participate in the survey described above. Its purpose, what I will be asked to do and all possible risks and inconveniences have been explained to me. I understand that I can withdraw at any time. My signature or thumb print also indicates that I have received a copy of the contact information. ____________________________________________ _____________ Respondent Date ____________________________________________ _____________ Guardian (If respondent is under 21) Date ____________________________________________ _____________ Person Obtaining Consent Date Additional and Replacement Documentation Protocal 129 Annex 6. Year 4 KPC Survey Questionnaire with Translation World Relief Rwanda Tangiraneza Innovation Child Survival Project, 2015 1. RESPONDENT IDENTIFICATION/ UMWIRONDORO W’USUBIZA 0) Hospital catchment area / Aho ibitaro bikorera Kigeme…………….. 1 Kaduha……………. 2 i1) Cluster No. / Nimero y’itsinda |___|___| i2) Household No. / Nimero y’urugo |___|___|___|___| i4) Interviewer Name/ Amazina y’ubaza ______________________________ i5) Sector/ Umurenge i6) Cell/ Akagali i7) Village/ Umudugudu i8) Health center/ Ikigo Nderabuzima i9) Date of Interview/ Itariki y’ibazwa 2015 - ___ ___ - ___ ___ MM - DD i10) Was consent received? Ubazwa yabyemeye? Yes/ Yego……………………………….1  i12 No/ Oya…………………………………..2 i11) If no, why not? Unavailable/ Ntaboneka………………..1 End/ Iherezo Additional and Replacement Documentation Protocal 130 Niba ari Oya, kubera iki? Unwilling/ Ntameze neza……………….2 End/ Iherezo Child not Home/ Umwana ntahari……3 End/ Iherezo Other/ Ibindi…………………….…………4 End/ Iherezo ________________________________ (Specify/ Sobanura) i12) What are the name, sex, and date of birth of your youngest child that is still alive? Umwana wawe muto ufite yitwa nde? Yavutse ryari? Igitsina cye ni ikihe? i12a) NAME OF THE CHILD LESS THAN 24 MONTHS AMAZINA Y’UMWANA URI MUNSI Y’AMEZI 24 ____________________________________________ i12b) SEX OF CHILD (1=MALE, 2=FEMALE/ IGITSINA CY’UMWANA( 1=GABO, 2=GORE)……1……..2 i12c) DATE OF BIRTH IGIHE YAVUKIYE ___ ___ ___ ___/___ ___/ ___ ___ Y Y Y Y / M M / D D i12d) AGE OF THE CHILD (IN MONTHS) |___|___| IMYAKA Y’UMWANA (MU MEZI) i13) Ask the mother: What is your name? / Baza umubyeyi w’umwana: Witwa nde? ____________________________________________ Additional and Replacement Documentation Protocal 131 i14) Ask the mother: What is your age in years? / Baza umubyeyi w’umwana: Ufite imyaka ingahe? |___|___| i15) Are you the biological mother of the child? / Ni wowe wabyaye uyu mwana? YES/ YEGO………………………..1 NO/ OYA…...………………….…...0 i16) Time interview began / Isaha ibazwa ryatangiriye AM/ Mbere ya saasita ___ ___:___ ___ PM/ Nyuma ya saasita ___ ___:___ ___ SECTION I: SOCIO-DEMOGRAPHICS / IGICE CYA 1: IMIBEREHO RUSANGE INSTRUCTIONS: Ask the questions exactly as they are written. Do not read responses unless directed to do so. Words in Italics are instructions for the interviewer and should not be read aloud. Follow skip patterns as directed. Write answers in the box unless otherwise directed. AMABWIRIZA: Baza ibibazo nkuko byanditse. Irinde kumu somera ibisubizo. Amagambo yanditse mu buryo buberamye ni amabwiriza y’ubaza ntabwo ugomba kuyasomera ubazwa. Aho ugomba gu simbuka hasimbuke. Andika igisubizo mu kazu kabugenewe. # Questions Ibibazo Responses Ibisubizo bishoboka Skip Simbu ka Ans wer/I gisu bizo atan ze 1. Have you ever attended school? Mwaba mwarageze mu ishuri? Yes/ Yego……….....……….1 No/ Oya…………….......…....2 Don’t know/ Simbizi………88 3 3 Additional and Replacement Documentation Protocal 132 2. If yes, then ask: What is the highest grade or level of school you have completed? Niba ari yego, mubaze uti: Warangije ayahe mashuri? None/ Did not complete primary Ntayo/Ntiyarangije amashuri abanza.................................................0 Primary/ Amashuri abanza ……….....1 Secondary/ Amashuri yisumbuye.….2 Past Secondary/ Amashuri makuru…3 Other/Ibindi……………………….……….4 ________________________________ (Specify/ Sobanura) 3. How many people live in your household? Muri uru rugo mubamo muri bangahe? Number/ Umubare………………….…|___|___| Don’t know/ Simbizi…………………….....88 Additional and Replacement Documentation Protocal 133 4. a 4b . 4c . What is your ubudehe category according to the participatory poverty assessment as defined by MINALOC? Read options if needed. Mwashyizwe mu kihe cyiciro cy’ubudehe nyuma y’ubushakashatsi bwakozwe na MINALOC kubijanye n’ubukire cyangwa ubukene? Musomere ibyiciro niba atabizi If the category is unknown, the interviewer should check the list at the health center so that data is entered for every household. If there is debate, use the category assigned by MINALOC. Niba ubazwa atazi icyiciro arimo, ubaza ajye kureba kuri lisiti yo ku Kigo Nderabuzima iriho ibyiciro by’ingo zose, Niba ubazwa ajya impaka ku cyiciro yashyizwemo, koresha icyiciro kiri ku ilisiti ya MINALOC Are you using health insurance? Ese waba uri mu bwisungane mu kwivuza? If yes: Can I see your member card? Niba ari yego, nshobora kureba ikarita yawe y’ubwisungane mu kwivuza? 1. Umutindi nyakujya (those in abject poverty)…………1 2. Umutindi (the very poor)…..........2 3. Umukene (the poor) …….………..3 4. Umukene wifashije (the resourceful poor..………...…4 5. Umukungu (the food rich)…….....5 6. Umukire (the money rich).……….6 Simbizi (don’t know).………..…88 (Source: Government of Rwanda Poverty Reduction- Strategy Paper,June 2002 – p.15.) Yes/ Yego………………………………1 No/ Oya……………………….………...0 Card available/ Ikarita irahari….…….1 No card/ Ikarita ntayo afite…….……..0 5 SECTION II: MATERNAL AND NEWBORN CARE/ IGICE CYA KABIRI KWITA K’UMUBYEYI NURUHINJA Additional and Replacement Documentation Protocal 134 # Questions Ibibazo Responses/ Ibisubizo bishoboka Skip Simb uka Answ er/Igi subiz o atanz e 5. How long should you wait after the birth of your child before you try to become pregnant again? Urateganya kuzakurikiza Kanaka (Izina ry’umwana muto) amaze igihe kingana iki avutse? LESS THAN 2 YEARS MUNSI Y’IMYAKABIRI..……...1 2 TO 5 YEARS HAGATI Y’IBIRI N’ITANU….…..2 MORE THAN 5 YEARS HEJURU Y’IMYAKA ITANU…...3 I WII NEVER GET PREGNANT SINZONGERA KUBYARA………4 DON’T KNOW SIMBIZI……………….………. 88 6. What are the risks of getting pregnant too soon after the birth of a child? Ni izihe ngorane zishobora kuboneka mugihe umubyeyi akurikije hakiri kare? DO NOT READ RESPONSES. RECORD ALL THAT ARE MENTIONED. IRINDE KUMUSOMERA IBISUBIZO. ANDIKA IBYO AGUSUBIJE BYOSE. BABY BORN TOO SMALL….……A UMWANA AVUKANA IBIRO BIDASHYITSE BABY BORN TOO EARLY………..B UMWANA AVUKA ATAGEJEJE KU GIHE MOTHER CAN DIE……………..…..C UMUBYEYI ASHOBORA GUPFA MOTHER CAN HAVE Additional and Replacement Documentation Protocal 135 MISCARRIAGE…………….D UMUBYEYI ASHOBORA GUKURAMO INDA MOTHER CAN SUFFER ANEMIA…………….…...E UMUBYEYI ASHOBORA KUBURA AMARASO OTHER / IBINDI...............................X ______________________________ (SPECIFY/ SOBANURA) 7. Are you currently doing something or using any method to delay or avoid getting pregnant? Hari uburyo ukoresha ngo wirinde gusama? YES/ YEGO…….…………...……………………1 NO/ OYA…………...………………..…………….0 9 8. Which method are you (or your husband/ partner) using? Ni ubuhe buryo ukoresha (cyangwa umugabo wawe)? DO NOT READ RESPONSES. CODE ONLY ONE RESPONSE. IRINDE KUMUSOMERA IBISUBIZO. SHYIRA AKAMENYETSO KUCYO AKUBWIYE. IF MORE THAN ONE METHOD IS MENTIONED, ASK, / NIBA AKUBWIYE UBURYO BURENZE BUMWE, MUBAZE UTI FEMALE STERILIZATION KWIFUNGISHA BURUNDU KU MUGORE …..….1 MALE STERILIZATION KWIFUNGISHA BURUNDU KU MUGABO……………………………………..………..2 PILL/ IBININI….……………………………………….3 IUD/ AGAPIRA MU MUMURA……….……………..4 INJECTABLES URUSHINGE.….……………………………………..…5 IMPLANTS/ AGAPIRA MU KABOKO.............……6 Additional and Replacement Documentation Protocal 136 What is your MAIN method that you (or your husband/ partner) use to delay or avoid getting pregnant?” Ni ubuhe buryo, wowe cyangwa umugabo wawe mukoresha kurusha ubundi kugirango wirinde gusama? IF REPONDENT MENTIONS BOTH CONDOMS AND STANDARD DAYS METHOD, CODE “12” FOR STANDARD DAYS METHOD. AGAKINGIRIZO N’UBURYO BWA KAMERE SHYIRA AKAMENYETSO KURI “12” IF RESPONDENT MENTIONS BREASTFEEDING, CODE “15” FOR OTHER AND RECORD BREASTFEEDING./NIBA AVUZE UBURYO BWO KONSA SHYIRA AKAMENYETSO KURI “15 “KANDI UBYANDIKE NO MUMAGAMBO IF RESPONDENT MENTIONS ABSTINENCE OR ISOLATION, CODE “15” FOR OTHER AND RECORD RESPONSE IN SPACE PROVIDED. NIBA AVUZE UBURYO BWO KWIFATA SHYIRA AKAMENYETSO KURI “15” KANDI UBYANDIKE NO MUMAGAMBO. CONDOM AGAKINGIRIZO K’ABAGABO ……………………..7 FEMALE CONDOM AGAKINGIRIZO K’ABAGORE……………..….…….8 DIAPHRAGM AGAPIRA KO KU NKONDO Y’UMURA….…….…..9 FOAM/JELLYAMAVUTA…….…………………..…10 LACTATIONAL AMEN. METHOD KONSA GUSA…………………………………….…11 STANDARD DAYS METHOD/ CYCLEBEADS KUBARA IMINSI Y’UBURUMBUKE………….…...12 RHYTHM METHOD (OTHER THAN STANDARD DAYS) UBUNDI BURYO BWO KUBARA…………..……13 WITHDRAWAL/KWIYAKANA…….……………14 OTHER/ IBINDI………………………..……….……….15 _______________________________________ (SPECIFY/ BISOBANURE) 9a. During your pregnancy with (Name), did you see anyone for antenatal care? Mugihe wari utwite Kanaka (Izina ry’ umwana muto) waba warigeze wipimisha inda ? YES/ YEGO………….....……………………1 NO/ OYA……………………..…………...….0 16 Additional and Replacement Documentation Protocal 137 9b. IF YES: Whom did you see? Anyone else? NIBA AVUZE YEGO MUBAZE UTI : Ninde wagusuzumye ? Ntawundi? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN. MUSOBANUZE NEZA WUMVE NIBA YARASUZUMWE N’UMUNTU UBUFITIYE UBUSHOBOZI DOCTOR/MEDICAL ASSISTANT MUGANGA/ UMUFASHA WE………………A NURSE/UMUFOROMO……..……………....B MIDWIFE/ UMUBYAZA…………………….C TRADITIONAL BIRTH ATTENDANT UMUBYAZA WA GIHANGA……………….D OTHER / ABANDI____________________........X (SPECIFY/ BAVUGE) 10. During your pregnancy with (Name), where did you receive antenatal care? Mugihe wari utwite Kanaka ( Izina ry’umwana muto ) ni hehe wipimishirije inda? CIRCLE ALL MENTIONED. SHYIRA AKAZIGA KUGISUBIZO AGUHAYE IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. NIBA ARI KUBITARO, KUKIGO NDERABUZIMA CYANGWA KU IVURIRO RYIGENGA ,ANDIKA UKO HITWA. MUSOBANUZE NEZA KUGIRA NGO WANDIKE IGISUBIZO CY’UKURI _________________________________ (NAME OF PLACE/ IZINA RY’AHO YAPIMISHIRIJE INDA) HOME/ MURUGO YOUR HOME/ IWAWE …………………....A MIDWIFE/TBA HOME/ MURUGO RW’UMUBYAZA……....……....B OTHER HOME/ MURUNDI RUGO............C PUBLIC SECTOR/ IVURIRO RYIGENGA HOSPITAL/ IBITARO …………………...…D HEALTH CENTER IKIGO NDERABUZIMA…………………....E HEALTH POST IVURIRO RYUNGIRIJE …………………....F OUTREACH/ KU MUDUGUDU/ STRATEGIE AVANCEE…………………………………...G OTHER PUBLIC ANDI MAVURIRO YA LETA…..................H (SPECIFY/SOBANURA______________) Additional and Replacement Documentation Protocal 138 PRIVATE HEALTH FACILITY/ AMAVURIRO YIGENGA PRIVATE HOSPITAL IBITARO BYIGENGA ……………………….I PRIVATE CLINIC KIRINIKE YIGENGA …………………..….J OTHER PRIVATE IRINDI VURIRO RYIGENGA……………….....K (SPECIFY/ RIVUGE________________) OTHER/ AHANDI......................................................X (SPECIFY/ HAVUGE_____________) 11. During your pregnancy with (Name), how many months pregnant were you when you first received antenatal care? Mugihe wari utwite kanaka (Izina ry’umwana) wagiye kwipimisha bwa mbere inda ifite amezi angahe? MONTHS/ AMEZI………….… DON’T KNOW/ SIMBIZI…………….88 12. During your pregnancy with (Name), how many times did you receive antenatal care?/Mugihe wari utwite kanaka (Izina ry’umwana) wipimishije inda inshuro zingahe ? TIMES/ INSHURO…………..…. DON’T KNOW/ SIMBIZI……………88 13. As part of your antenatal care during this pregnancy, were any of the following done at least once? Hari ibintu by’ingenzi bakorera umugore utwite iyo agiye kwipimisha,inda, muri ibi bikurikira ni iki baba baragukoreye nibura inshuro imwe ? 1. Was your height taken?/ Bagupimye uburerebure? 2. Was your blood pressure measured? Bagufatiye umuvuduko w’amaraso? 3. Did you give a urine sample?/ Wigeze utanga ikizami cy’inkali? 4. Did you give a blood sample?/Hari ikizami cy’amaraso wigeze utanga? YES/YEGO NO/OYA A. HEIGHT/ UBUREBURE……….1 …….0 B. BP/ UMUVUDUKO W’AMARASO. .1 ……..0 C. URINE/ INKARI………………….1 …….0 D. BLOOD/ AMARASO……………1 ..…….0 14 During (any of) your antenatal care visits, were you told about the signs of pregnancy complications? Mugihe wajyaga kwipimisha inda bigeze bakubwira ibimenyetso mpuruza kumugore YES/ YEGO…………………………..…1 NO/ OYA……………………………..….0 DON’T KNOW/ SIMBIZI……………....88 Additional and Replacement Documentation Protocal 139 utwite ? 16 16 15. Were you told where to go if you had any of these complications? Bigeze bakubwira aho wajya mugihe ubonye kimwe muri ibyo bimenyetso? YES/ YEGO………………………….…1 NO/ OYA…………………………….….0 DON’T KNOW/ SIMBIZI…………….88 16. During pregnancy, woman may encounter severe problems or illnesses and should go or be taken immediately to a health facility. Iyo umugore atwite ashobora guhura n’ibibazo cyangwa se uburwayi bishobora gutuma yihutira kujya kwa muganga. What types of symptoms would cause you to seek immediate care at a health facility (right away)? Ni ibihe bimenyetso by’uburwayi bishobora kugutera kwihutira kujya kwa muganga mu gihe utwite? ASK: Anything else? BAZA UTI: Nta bindi? DO NOT READ RESPONSES. RECORD ALL THAT ARE MENTIONED. IRINDE KUMUSOMERA IBISUBIZO, SHYIRA AKAMENYETSO KU BISUBIZO AGUHAYE BYOSE. VAGINAL BLEEDING KUVIRA KU NDA………………...…….A FAST/DIFFICULT BREATHING/ GUHUMEKA BIMUGOYE………….....B FEVER/ UMURIRO…….…………..….C SEVERE ABDOMINAL PAIN/ KUBABARA MU NDA CYANE……….D HEADACHE/BLURRED VISION KURIBWA UMUTWE/ KUTABONA NEZA…………………………………….E CONVULSIONS/ KUGAGARA…..………….…………...F FOUL SMELLING DISCHARGE/FLUID FROM VAGINA KUZANA IBINTU BY’URUZI BINUKA………………………………....G BABY STOPS MOVING INDA NTIYONKA…………………...….H LEAKING BROWNISH/GREENISH FLUID FROM THE VAGINA KUZANA IBINTU BY’URUZI BISA N’IKIGINA CYANGWA ICYATSI KIBISI…………………..I OTHER / IBINDI …………………….......X ______________________________ (SPECIFY/ BISOBANURE) 17. During your pregnancy with (Name of the child) did you receive an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth? Mugihe wari utwite kanaka (Izina ry’umwana) wigeze ubona urukingo ku kaboko rukingira umwana tetanus(agakwega) kugagara? YES/ YEGO……………………….……1 NO/ OYA ..………………….………….0 19 19 Additional and Replacement Documentation Protocal 140 DON’T KNOW/ SIMBIZI………………88 18. While pregnant with (name of the child), how many times did you receive such an injection? Igihe wari utwite kanaka (Izina ry’umwana muto) urwo rukingo warutewe inshuro zingahe? ONE/ RIMWE………………………...….1 TWO/ KABIRI………….……..…………2 THREE OR MORE INCURO 3 CYANGWA ZIRENGA……3 DON’T KNOW/ SIMBIZI…………..…..88 19. Did you receive any tetanus toxoid injection at any time before that pregnancy, including during a previous pregnancy or between pregnancies? Mbere yo gutwita (Izina ry’umwana muto) wigeze uhabwa urukingo rwa tetanus ushyizemo mu gihe wari utwite iyabanjirije iy’uyu mwana cyangwa se mu gihe cyo hagati y’izo nda? YES/ YEGO……………..………….……1 NO/OYA………………………………...0 DON’T KNOW/ SIMBIZI……..……….88 21 21 20. Before the pregnancy with (Name of the child), how many times did you receive a tetanus injection? Mbere yo gutwita kanaka (izina ry’umwana muto) urwo rukingo warutewe inshuro zingahe? ONE/ RIMWE………………………...….1 TWO/ KABIRI……………………………2 THREE OR MORE INCURO 3 CYANGWA ZIRENGA……3 DON’T KNOW/ SIMBIZI………………..8 21 If biological mother (i15) ask: During your pregnancy with (Name), were you given or did you buy any iron tablets/syrup? Mubaze iki kibazo niba ariwe wabyaye uyu mwana (i15): Mu gihe wari utwite (izinary’umwana muto) wigeze uhabwa cyangwa ugura ibinini/umushongi bya feri byongera amaraso? SHOW TABLETS/ BIMWEREKE YES/ YEGO……………...………….1 NO/ OYA…………………………….0 DON’T KNOW/ SIMBIZI...……….88 29 29 29 22 During the whole pregnancy, for how many days did you take the tablets/syrup? If the answer is not numeric, probe for the approximate number of days. Igihe wari utwite, ibyo binini bya feri wabifashe mu minsi ingahe? Niba igisubizo aguhaye Atari umubare, komeza umubaze agereranye mu mibare. DAYS/ IMINSI……………..…|___|___| DON’T KNOW/ SIMBIZI……….….888 23. Who assisted with the delivery of (Name)? Ni nde wakubyaje kanaka(izina ry’umwana muto) ? DOCTOR/ DOGITERI…………...……..A NURSE/ UMUFOROMO ……..….........B MIDWIFE/ UMUBYAZA…..…..……….C Additional and Replacement Documentation Protocal 141 Anyone else?/Ntawundi PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED. KOMEZA UMUBAZE KUGIRA NGO UMENYE NIBA YARABYAJWE N’UMUNTU WABIHUGURIWE IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY. NIBA AVUZE KO NTAWE, KOMEZA UMUBAZE UMENYE NIBA HARI UMUNTU MUKURU WARI UHARI MU GIHE YABYARAGA. AUXILIARY MIDWIFE/ UMUFASHA W’UMUBYAZA…….............................D OTHER HEALTH STAFF W/ MIDWIFERY SKILLS UNDI MUFOROMO UZI KUBYAZA …E TRAINED TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA WAHUGUWE.........................F TRAINED COMMUNITY HEALTH WORKER/UMUJYANAMA W’ UBUZIMA WAHUGUWE……………....G TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA UTARAHUGUWE………………...…….H COMMUNITY HEALTH WORKER UMUJYANAMA W’UBUZIMA UTARAHUGUWE……………………....I RELATIVE/FRIEND/ UWO MUGIRA ICYO MUPFANA/INSHUTI/ UMUTURANYI ………………………….J NO ONE/ NTA N’UMWE.……………...Y 24. Was (NAME) dried (wiped) immediately after birth before the placenta was delivered? Nyuma y’uko kanaka(Izina ry’umwana) avuka,yaba yarahanaguwe, agafubikwa ako kanya nyuma yo kuvuka mbere yuko iyanyuma isohoka? YES/YEGO………………………………1 NO/ OYA………………………………...0 DON’T KNOW/ SIMBIZI………….….88 25. Was (NAME) wrapped in a warm cloth or blanket immediately after birth before the placenta was delivered? Kanaka (Izina) yaba yarafubitswe mubintu bishyushye (Imyenda cg ikiringiti) akimara kuvuka? YES/YEGO……...………………………1 NO/ OYA………………………………...0 DON’T KNOW/ SIMBIZI……………. 88 26. After (Name) was born, did any health care provider or traditional birth attendant check on (Name’s) health? Nyuma yo kuvuka kwa, Kanaka hari ibindi uwagufashije/uwafashije nyina amubyara yaba yarakoreye uwo mwana mu rwego rwo kwita ku buzima bwe? YES/YEGO………………………………1 NO/ OYA………………….……………...0 DON’T KNOW/SIMBIZI………………..88 29 27. How many hours, days or weeks after the birth of (Name) did the first check take place? Kanaka (amazina) yaba yarasuzumwe nyuma y’igihe kingana iki amaze kuvuka? IF LESS THAN ONE DAY, CIRCLE 0 AND RECORD HOURS; IF ONE TO SIX DAYS CIRCLE 1 AND RECORD DAYS; IF MORE HOURS / AMASAHA 0 DAYS/ IMINSI 1 WEEKS/ IBYUMWERU 2 Additional and Replacement Documentation Protocal 142 THAN 6 DAYS CIRCLE 2 AND RECORD WEEKS. NIBA ARI MUNSI Y’UMUNSI UMWE SHYIRA AKAMENYETSO KURI “0” KANDI WANDIKE “Amasaha”, NIBA ARI HAGATI Y’IMINSI UMWE KUGERA KURI ITANDATU SHYIRA AKAMENYETSO KURI RIMWE WANDIKE “Iminsi”, NIBA ARI HEJURU Y’IMINSI ITANDATU SHYIRA AKAMENYETSO KURI 2 KANDI WANDIKE IBYUMWERU. DON’T KNOW/ SIMBIZI…………..…88 28. Who checked on (Name’s) health at that time? Muri icyo gihe ninde wasuzumye uko ubuzima bwe bumeze? Anyone else?/Ntawundi? PROBE FOR THE MOST QUALIFIED PERSON AND RECORD ALL MENTIONED.KOMEZA UMUBAZE WUMVE KO ARI UMUNTU UBIFITIYE UBUMENYI WAMUSUZUMYE KANDI ABO AKUBWIRA BOSE UBANDIKE. DOCTOR/ DOGITERI…………...……..A NURSE/ UMUFOROMO……...............B MIDWIFE/ UMUBYAZA…….......…….C AUXILIARY MIDWIFE/ UMUFASHA W’UMUBYAZA……....…D OTHER HEALTH STAFF WITH MIDWIFERY SKILLS. / UNDI MUFOROFO UZI KUBYAZA …………E TRAINED TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA WAHUGUWE………………............….F TRAINED COMMUNITY HEALTH WORKER/ UMUJYANAMA W’UBUZIMA WAHUGUWE .....................................G TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA UTARAHUGUWE………...........……..H COMMUNITY HEALTH WORKER/ UMUJYANAMA W’UBUZIMA UTARAHUGUWE……………………...I RELATIVE/FRIEND/ UWO MUGIRA ICYO MUPFANA/ INSHUTI/ UMUTURANYI………………………...J NO ONE/ NTA N’UMWE …………….Y SECTION III: BREASTFEEDING AND CHILD NUTRITION / KONSA NO KUGABURIRAUMWANA 29 Did you ever breastfeed (NAME)? Wigeze wonsa (izinary’umwana muto)? YES/ YEGO....................................... 1 NO/ OYA ......................................... 0 36 30 How long after birth did you first put (NAME) to the breast? IF LESS THAN 1 HOUR, CIRCLE ‘000’ HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. Less than 1 hour / lgihe kitageze ku isaha ………….0 0 0 or / cyangwa Additional and Replacement Documentation Protocal 143 Ukimara kubyara kanaka (izinary’umwana muto) wamwonkeje bwa mbere amaze igihe kingana iki avutse? NIBA ARI MUNSI Y’ISAHA IMWE SHYIRA AKAZIGA KURI 000,NIBA ARI MUNSI Y’AMASAHA 24, ANDIKA UMUBARE W’AMASAHA, NIBA ARI HEJURU Y’AMASAHA 24, ANDIKA IMINSI. Hours / Amasaha……………... |___|___| or / cyangwa Days / Iminsi …………………...|___|___| 31 During the first three days after delivery, did you give (NAME) the liquid that came from your breasts? Mu minsi itatu ya mbere umaze kubyara, waba waronkeje ( IZINA RY’UMWANA MUTO)? YES/ YEGO....................................... 1 NO / OYA ......................................... 0 DON’T KNOW/ SIMBIZI.................... 88 32 During the first three days after delivery, was (NAME) given anything to drink other than breast milk? Mu minsi itatu ya mbere umaze kubyara, hari ikinyobwa wahaye kanaka kitari amashereka? YES/ YEGO....................................... 1 NO / OYA ......................................... 0 DON’T KNOW/ SIMBIZI ................... 88  34  34 33 What else was (NAME) given to drink during the first three days? Ni ibihe binyobwa bindi wahaye (IZINA RY’UMWANA MUTO) mu minsi itatu ya mbere? Anything else? Nta kindi? DO NOT READ THE LIST NTUMUSOMERE IBISUBIZO. RECORD ALL MENTIONED BY CIRCLING LETTER FOR EACH ONE MENTIONED MILK (OTHER THAN BREAST MILK) AMATA (ATARI AMASHEREKA……A PLAIN WATER / AMAZI……...…......B SUGAR OR GLUCOSE WATER / AMAZI ARIMO ISUKARI………..…….C HOME REMEDY/ IMITI YATEGURIWE MU RUGO ITARI IYO KWA MUGANGA………………………………D SUGAR-SALT-WATER SOLUTION / AMAZI ARIMO UMUNYU N’ISUKARI…………………………….…E FRUIT JUICE/ Additional and Replacement Documentation Protocal 144 SHYIRA AKAZIGA KUCYO AKUBWIYE UMUTOBE W’IMBUTO …………….....F INFANT FORMULA / AMATA Y’ABANA YO MU BIKOMBE…………………..….G TEA / ICYAYI………………………….....H HONEY/ UBUKI …………………………I OTHER/ IBINDI…………………….……X ________________________________ (SPECIFY/ SOBANURA) 34 Was (NAME) breastfed yesterday during the day or at night? (Izinary’umwana muto) waramwonkeje ejo kumanywa cyangwa nijoro? YES/ YEGO ...................................... 1 NO / OYA .......................................... 0 DON’T KNOW / SIMBIZI .................. 88 36 35 35 35 Sometimes babies are fed breast milk in different ways, for example by spoon, cup or bottle. This can happen when the mother cannot always be with her baby. Sometimes babies are breastfed by another woman, or given breast milk from another woman by spoon, cup or bottle or some other way. This can happen if a mother cannot breastfeed her own baby. Did (NAME) consume breast milk in any of these ways yesterday during the day or at night? Rimwe na rimwe abana bahabwa amashereka mu buryo butandukanye, urugero: kukayiko, mu gikombe cg mu icupa. Ibyo bishobora kuba iyo umubyeyi adashoboye kuba ari kumwe n’umwana we. Bishobora no kuba iyo umubyeyi adashobora konsa umwana we. Mbese (KANAKA) yaba yarahawe amashereka ejo kumanywa cg nijoro hakoreshejwe bumwe muri ubwo buryo maze kukubwira? YES/ YEGO ...................................... 1 NO / OYA .......................................... 0 DON’T KNOW / SIMBIZI................... 88 Additional and Replacement Documentation Protocal 145 36 Now I would like to ask you about some medicines and vitamins that are sometimes given to infants. Was (NAME) given any vitamin drops or other medicines as drops yesterday during the day or night? Ubu ndashaka kukubaza ibyerekeranye n’imiti cyangwa amavitamini ajya ahabwa abana. Ese (KANAKA) yaba yarahawe ibitonyanga bya vitamin cyangwa indi miti ejo ku manywa cg nijoro? YES/ YEGO ...................................... 1 NO / OYA .......................................... 0 DON’T KNOW / SIMBIZI . 88 37 Was (NAME) given ORS yesterday during the day or at night? Haba hari uruvange rw’imyunyu n’isukari(SRO) waba warahaye (izinary’umwanamuto) ejo kumanywa cg nijoro? YES/ YEGO ...................................... 1 NO / OYA .......................................... 0 DON’T KNOW / SIMBIZI................... 88 38 Did (NAME) drink anything from a bottle with a nipple yesterday or last night? (Izinary’umwana muto) yaba yaranywesheje bibero ejo kumanywa cyangwa iri joro? YES/ YEGO ...................................... 1 NO / OYA .......................................... 0 DON’T KNOW / SIMBIZI................... 88 Read out Q.39 below. Read the list of liquids one by one and mark ‘yes’ or ‘no’, accordingly. After you have completed the list, follow by asking Q. 40. [See far right hand column for those items (40B, 40C, and/or 40F) where the respondent replied ‘YES’.] Soma ibibazo biri hasi, Birebana n’ikibazo cya 39. Soma urutonde rw’ibinyobwa kimwe kimwe ushyireho yego cyangwa oya, nyuma yo kurangiza urutonde, komeza ubaze ikibazo cya 40 [reba ibyanditse iburyo ( 40B, na 40C/cyangwa 40F) aho igisubizo ari ‘YEGO’]. No. QUESTIONS AND FILTERS/ IBIBAZO CODING CATEGORIES/ IBISUBIZO BITEGEREJWE QUESTIONS AND CODING CATEGORIES/ IBIBAZO N’IBISUBIZO BITEGEREJWE 39 Next I would like to ask you about some liquids YES YEGO NO OYA DK SINZI 40 READ QUESTION 40 FOR ITEMS B, C Additional and Replacement Documentation Protocal 146 that (Name) may have had yesterday during the day or at night. Did (Name) have any (ITEM FROM LIST)? READ THE LIST OF LIQUIDS STARTING WITH ‘PLAIN WATER.’ Noneho ndifuza kukubaza ibinyobwa waba wahaye umwana wawe ejo kumanywa cg nijoro. Hari ibyo waba wamuhaye? (IBIRI KU ILISTI) SOMA URUTONDE RW’IBINYOBWA UHEREYE KU “AMAZI GUSA”. AND F, IF CHILD CONSUMED THE ITEM. RECORD 88 for DON’T KNOW. How many times yesterday during the day or at night did (Name) consume any (ITEM FROM LIST)? SOMA IKIBAZO CYA 40 KU BISUBIZO B, C NA F, NIBA UMWANA YARABINYOYE. WANDIKE 88 AHO YASHUBIJE SIMBIZI. Ibi binyobwa kanaka (izinary’umwanamuto) yabifashe inshuro zingahe ku munsi haba ku manywa cyangwa nijoro? A Plain water? Amazi ? 1 0 88 B Infant formula such as Kigozi, Rinda and others? Amata y’abana yo mu bikombe nka Kigozi, Rinda n’andi? 1 0 88 B. TIMES/ Inshuro I__I__I C Milk such as tinned, powdered or fresh animal milk? Amata yo mu dukarito, ay’ifu cyangwa inshyushyu( y’inka, ihene)? 1 0 88 C. TIMES/ Inshuro I__I__I D Juice or juice drinks? Umutobe w’ibitoke cyangwa ubundi bwoko bw’imitobe? 1 0 88 E Clear broth? Isupu imeze nk’amazi? 1 0 88 Additional and Replacement Documentation Protocal 147 F Yogurt? Yawurute? 1 0 88 F. TIMES/ InshuroI__I__I G Thin porridge? Igikoma kidafashe? 1 0 88 H Any other water-based liquids such as (insert local) sorghum juice? Ibindi binyobwa nk’ umusururu ? 1 0 88 I Any other liquids? Ibindi binyobwa? 1 0 88 41 Please describe everything that (NAME) ate yesterday during the day or night, whether at home or outside the home. 1. Think about when (Name) first woke up yesterday. Did (NAME) eat anything at that time? IF YES: Please tell me everything (NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. IF NO, CONTINUE TO QUESTION b). 2. What did (NAME) do after that? Did (NAME) eat anything at that time? IF YES: please tell me everything (NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. REPEAT QUESTION b) ABOVE UNTIL RESPONDENT SAYS THE CHILD WENT TO SLEEEP UNTIL THE NEXT DAY. 3. IF RESPONDENT MENTIONS MIXED DISHES LIKE A PORRIDGE, SAUCE OR STEW, PROBE: What ingredients were in that (MIXED DISH)? PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. AS THE RESPONDENT RECALLS FOODS, UNDERLINE THE CORRESPONDING FOOD AND CIRCLE ‘1’ IN THE COLUMN NEXT TO THE FOOD GROUP. IF THE FOOD IS NOT LISTED IN ANY OF THE FOOD GROUPS BELOW WRITE THE FOOD IN THE BOX LABELLED ‘OTHER FOODS.’ IF FOODS ARE USED IN SMALL AMOUNTS FOR SEASONING OR AS A CONDIMENT, INCLUDE THEM UNDER THE CONDIMENTS FOOD GROUP. ONCE THE RESPONDENT FINISHES RECALLING FOODS EATEN, READ EACH FOOD GROUP WHERE ‘1’ WAS NOT CIRCLED, ASK THE FOLLOWING QUESTION AND CIRCLE ‘1’ IF RESPONDENT SAYS YES, ‘0’ IF NO AND ‘8’ IF DON’T KNOW: Yesterday during the day or night, did (NAME) drink/eat any (FOOD GROUP ITEMS)? Mwatubwira ibiribwa (IZINA RY’UMWANA MUTO) yagaburiwe ejo hashize kumanywa na nijoro murugo cyangwa Additional and Replacement Documentation Protocal 148 ahandi 1. Tekereza mugihe (kanaka) yamaragakubyuka ,hari icyo kurya yaba yarahawe? NIBA ARI YEGO watubwira buri kimwe cyose yaba yarariye muri icyo gihe? KOMEZA UMUBAZE UTI: Nta kindi? KUGEZA UBWO ASUBIZA KO NTA KINDI. NIBA NTACYO, KOMEZA KUKIBAZO CYA b). 2. Nyuma yibyo (kanaka) yakoze iki? Hari ikintu (Kanaka) yariye muri icyo gihe? NIBA ARI YEGO: watubwira buri kimwe cyose yaba yarariye? KOMEZA UMUBAZE UTI: Nta kindi? KUGEZA UBWO ASUBIZA KO NTA KINDI. SUBIRAMO IKIBAZO CYA b) CYO HARUGURU KUGEZA UBWO UBAZWA AKUBWIRA KO UMWANA YAGIYE KURYAMA AGAKANGUKA K’UWUNDI MUNSI. 3. NIBA AGUSHUBIJE IBYO KURYA BIVANGAVANZE NK’IGIKOMA, ISOSI CYANGWA IBINDI BIRYO BITETSE, KOMEZA UMUBAZE UTI: Ni ibihe biribwa byari muri iyo MVANGE y’ibiryo? KOMEZA UMUBAZE UTI: Nta cyindi yariye? KUGEZA UBWO ASUBIZA KO NTA KINDI. UKO USUBIZA AGENDA YIBUKA IBIRYO UMWANA YARIYE, UGENDE USHYIRAHO IKIMENYETSO KUCYO BIHUJE KANDI UZENGURUTSE AKAZIGA KURI”1” MU KUMBA KEGEREYE ITSINDA RY”IBIRIBWA. NIBA IBIRYO AVUZE BITARI KU ILISITI IRI HASI HANO, IBIRYO AVUZE UBYANDIKE AHAGENEWE “IBINDI BIRYO” NIBA HARI IBIRIBWA BYAKORESHEJWE MU KURYOSHYA IBIRYO NK’IBIRUNGO, UBISHYIRE AHAGENEWE ITSINDA RY’IBIRUNGO. MU GIHE USUBIZA ARANGIJE KUVUGA IBIRYO BYOSE UMWANA YARIYE< SOMA BURI KICIRI CY’IBIRYO AHO UTIGEZE USHYIRA AKAZIGA KURI “1” , UBAZE IKIBAZO GIKURIKIRA HANYUMA USHYIRE AKAZIGA KURI “1” NIBA ASHUBIJE YEGO, KURI “0” NIBA ASHUBIJE OYA, KURI “88” NIBA ASHUBIJE SIMBIZI: Ejo kumanywa cyangwa nijoro, ese (Kanaka) yaba yarariye ibiryo biri muri ibi biryo ngiye kukubaza (IBIRYO MU BYICIRO)? OTHER FOODS: PLEASE WRITE DOWN OTHER FOODS IN THIS BOX THAT RESPONDENT MENTIONED BUT ARE NOT IN THE LIST BELOW IBINDI BIRIBWA: ANDIKA IBINDI BIRIBWA YAVUZE BITAGARAGARA KURUTONDE RWO HASI. NO. QUESTIONS AND FILTERS/ IBIBAZO CODING CATEGORIES/ IBISUBIZO BITEGEREJWE YES/ YEGO NO/ OYA DK/ SIMBIZI A Thicker porridge, bread, rice, noodles, or other foods made from grains 1 0 88 Additional and Replacement Documentation Protocal 149 Igikoma gifashe, umugati, umuceri, amakaroni, cyangwa ibindi biribwa bikomoka kubinyampeke B Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside Ibihaza, karoti, ibijumba by’ umuhondo cyangwa bya orange 1 0 88 C White potatoes, white yams, cassava, or any other foods made from roots Ibirayi, ibikoro, imyumbati, cyangwa ibindi biribwa bikomoka kubinyabijumba. 1 0 88 D Any dark or green leafy vegetables Imboga z’icyatsi kibisi cyane, Imboga rwatsi 1 0 88 E Ripe mangoes, ripe papayas or ripe guava Imyembe ihishije,ipapayi ihishije, cyangwe amapera ahishije 1 0 88 F Any other fruits or vegetables (such as avocado) Hari izindi mbuto cyangwa imboga uha umwana zitavuzwe haruguru (nka avoka) 1 0 88 G Liver, kidney, heart or other organ meats Umwijima, impyiko, umutima, cyangwa izindi nyama zo munda 1 0 88 H Any meat, such as beef, pork, lamb, goat, chicken or duck Izindinyama / Iz’inka, ingururube, intama, ihene, inkoko cyangwa imbata 1 0 88 I Eggs / Amagi 1 0 88 J Fresh or dried fish, shellfish or seafood Amafi mabisi cyangwa yumye,isambaza ,injanga/indagara 1 0 88 K Any foods made from beans, peas, lentils, nuts or seeds Ibindi biribwank’ibishyimbo, amashaza, lantiye, ubunyobwa 1 0 88 L Cheese, yogurt, or other milk products foromage,yawurute,cyangwa ibindi bikomoka ku mata 1 0 88 M Any oil, fats or butter, or foods made with any of these Andi mavuta,ibinure cyangwa mayonese, cyangwa ibiribwa bikomoka kubyo 1 0 88 Additional and Replacement Documentation Protocal 150 tuvuze. N Any sugary foods such as chocolates, sweets, candies, pastries cakes or biscuits Ibindi biribwa birimo isukari nka shokora, bombo, shikareti, gato cyangwa biswi 1 0 88 O Condiments for flavor, such as chilies, spices, herbs or fish powder ibiribwaby’ibirungo nk’urusenda, utundi twatsi, ifu y’indagara 1 0 88 P Grubs, snails or insects inswa ,isenani cyangwa utundi dusimba duto tuguruka 1 0 88 Q Foods made with red palm oil, red palm nut or red palm nut pulp sauce Ibiribwa byatekeshejwe amamesa 1 0 88 R Other foods not recorded on the list Ibindi biryo bitavuzwe haruguru 1 0 88 Check categories A-Q / GENZURA IBYICIRO A-Q IF ALL “NO” or “DK”  GO TO 42 IF AT LEAST ONE “YES”  GO TO 43 NIBA BYOSE ARI “OYA” CYANGWA “SIMBIZI” JYA KURI 42 NIBA BYIBUZE KIMWE MURI BYO ARI “YEGO” JYA KURI 43 42 Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night? IF ‘YES’ PROBE: What kind of solid, semi-solid, or soft foods did (NAME) eat? Ese (KANAKA) yigeze arya ibiryo bikomeye , bidakomeye cyane cyangwa byoroshye ejocyangwa ijoro ryakeye? NIBA ARI YEGO KOMEZA UBAZE UTI: Ni ubuhe bwoko YES/ YEGO ……………………...1 NO / OYA ……………………......0 DON’T KNOW/ SIMBIZI……….88 GO BACK TO Q41 AND RECORD FOODS EATEN THEN CONTINUE. 44 44 Additional and Replacement Documentation Protocal 151 bw’ ibiryo bikomeye , bidakomeye cyane cyangwa byoroshye yafashe? Subira kukibazo cya 41 umusubiriremo byabibazo nyuma ukomeze 43 How many times did (NAME) eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night? Such as pureed cassava, potatoes, avocado or other pureed foods? WE WANT TO FIND OUT HOW MANY TIMES THE CHILD ATE ENOUGH TO BE FULL. SMALL SNACKS AND SMALL FEEDS SUCH AS ONE OR TWO BITES OF MOTHER’S OR SISTER’S FOOD SHOULD NOT BE COUNTED. LIQUIDS DO NOT COUNT FOR THIS QUESTION. DO NOT INCLUDE THIN SOUPS OR BROTH, WATERY GRUELS, OR ANY OTHER LIQUID. USE PROBING QUESTIONS TO HELP THE RESPONDENT REMEMBER ALL THE TIMES THE CHILD ATE YESTERDAY Ibiryo bikomeye ,bidakomeye cyane cyangwa ibindi biryo byoroshye ariko bitarink’amazi yabifashe inshuro zingahe ejo kumanywa cyangwa nijoro? Urugero: Ese mwamuhaye inombe y’imyumbati, y’ibijumba? Y’avoka? Cyangwa inombe y’ibindi biryo? TURIFUZA KUMENYA UMUBARE W’INSHURO UMWANA AGABURIRWA KUGEZA AHAZE. NTUBARIREMO UTWO GUHUGENZA UMWANA N’UTUNDI TUNTU DUTO ASHOBORA GUHABWA NA NYINA CYANGWA BAKURU BE. IBINYOBWA NTIBIBARWA MURI IKI KIBAZO. NTUBARIREMO AMASUPU AMEZE NK’AMAZI N’IBINDI BIRYO BIMEZE NK’AMAZI CYANGWA BINYOBWA. KOMEZA UMUBAZE KUGIRA NGO UMUFASHE KWIBUKA INSHURO ZOSE UMWANA YAGABURIWE UMUNSI W’EJO. No. OF TIMES/ INSHURO………………...|___|___| DON’T KNOW/ SIMBIZI ……….88 44 (If yes to 41 or 42) At what age did (NAME) begin eating solid, semi-solid, or soft foods? Age (months)/ Additional and Replacement Documentation Protocal 152 (NIBA ARI YEGO)( kanaka) yanganaga iki mutangira kumuha ibiryo bikomeye cyangwa bidakomeye cyane cyangwa byoroshye? Imyaka mumezi………….|___|___| DON'T KNOW/ SIMBIZI………………….…….88 44a (If yes to 41 or 42) Does (NAME) eat from his/her own separate bowl/cup? (Niba ari yego) Ese (Izina ry”umwana) yaba arira cyangwa agaburirwa ku gasahane/ mu gakombe ke? YES/ YEGO……….…………..…..1 NO/ OYA…………….…………..…0 45 Are you or someone in your family helping (NAME) eat? (ie. physically feeding them) Ujya ufasha (IZINA RY’UMWANA MUTO) kurya cyangwa hari undi wo mu muryango umufasha? YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 46b 46a IF NO: At what age did (NAME) start eating by himself/herself? NIBA ARI OYA: ni ku yahe mezi izina ry’umwana muto ) yatangiye kwigaburira ubwe? Age (months)/ Imyaka mumezi………....|___|___| DON'T KNOW/ SIMBIZI……………………….….88 46b Do you encourage (NAME) to eat/feed (including when you breastfeed)? Mbese ujya ushishikariza (IZINA RY’UMWANA) kurya (no mu gihe umwonsa)? YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 47. Has (NAME) ever received a vitamin A dose (like this/any of these)? Kanaka (IZINA RY’UMWANA MUTO) yigeze ahabwa ikinini cya Vitamini A? SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS MWEREKE IKININI CYA VITAMINI A GISANZWE GIKORESHWA YES/ YEGO...................................... 1 NO/ OYA ........................................ 0 DON’T KNOW/ SIMBIZI .................. 88 49 49 48. If Yes, did (NAME) receive a vitamin A dose within the last 6 months? Niba ari Yego kanaka( izina ry’umwana muto) hari ubwo yahawe akanini ka Vitamini A mu mezi atandatu ashize YES/ YEGO ..................................... 1 NO/ OYA .......................................... 0 DON’T KNOW/ SIMBIZI................... 88 Additional and Replacement Documentation Protocal 153 49. Has (NAME) taken any drug for intestinal worms in the past 6 months? Kanaka (izinary’umwana Muto) yaba hari utunini tw’inzoka zomunda yahawe mu mezi atandatu ashize? Show example of drug for worms Mwereke urugero rw’ibinini by’inzoka YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 DON’T KNOW / SIMBIZI……….88 49a Has (NAME) ever received any MNP packets, like these? Kanaka (izinary’umwana Muto) yaba hari udupaki twa Ongera intungamubiri nk’utu yahawe? YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 DON’T KNOW / SIMBIZI……….88 50 50 49b. If yes, did (NAME) receive it in the last 3 months? Niba ari Yego kanaka( izina ry’umwana muto) hari ubwo yahawe Ongera intungamubiri mu mezi atatu ashize? YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 DON’T KNOW / SIMBIZI……….88 SECTION IV: INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS/ UBUVUZIBUKOMATANIJEBW’INDWARAZ’ABANA 1. DANGER SIGNS/IBIMENYETSO MPURUZA 50. Sometimes children get sick and need to receive care or treatment for illnesses. What are the signs of illness that would indicate your child needs treatment? Rimwe na rimwe abana bajya barwara bagakenera ubufasha cyangwa kuvurwa, ni ibihe bimenyetso byakwereka ko umwana wawe urwaye akeneye kuvuzwa? RECORD ALL MENTIONED. ANDIKA IBYO AKUBWIYE BYOSE. Don’t Know/ Simbizi …………...….A Looks Unwell Or Not Playing Normally/Kwigunga cg kudakina n’abandi............................................B Not Eating Or Drinking/Ntabasha kurya/kunywa……………………....C Lethargic Or Difficult To Wake Gucika intege bikabije…......................D High Fever/ Umuriro mwinshi….….E Fast Or Difficult Breathing/ Guhumeka Additional and Replacement Documentation Protocal 154 insigane cg bimugoye...........................F Vomits Everything/ Kuruka ibintu byose …………………………….G Convulsions/ Kugagara…..……….H Gets worse despite home care Kurushaho kuremba .…………... I Looks dehydrated (dry mouth or no tears)/Amazi yamushizemo (iminwa yumye, cg nta turira)…………………....J Other/ Ibindi ____________________K (Specify/ Sobanura) 2. CONTROL OF MALARIA/GUKURIKIRANA MALARIYA 51. Has (Name) been ill with fever at any time in the last 2 weeks? Kanaka ( izina ry’umwana muto ) yigeze agira umuriro mubyumweru bibiri bishize? YES/ YEGO .......................................1 NO/ OYA .......................................... 0 DON’T KNOW/ SIMBIZI ..................... 88 57 57 52. Did you seek advice or treatment for (NAME’S) fever? Waba waragiriwe inama cyangwa waravuje kanaka (izina ry’umwana muto) igihe yari afite umuriro? YES/ YEGO........................................1 NO/ OYA ........................................... 0 57 53 Where did you first go for advice or treatment for fever? Nihe wabanje kujya kugisha inama cyangwa kumuvuza? Hospital/ Ku bitaro bikuru ……......01 Health Center Ku kigo nderabuzima………..……..02 Health Post/ Poste de Sante ….......03 Community Health Worker Umujyamana w’ubuzima binome...04 Traditional Practitioner Additional and Replacement Documentation Protocal 155 Umuvuzi wa gihanga………………05 Shop/ Mu Isoko………………….….06 Pharmacy/ Farumasi………..……...07 Friend/Relative Inshuti/Abavandimwe ………………08 Other/ Ahandi_________________09 (Specify/ Sobanura) 54. How long after you noticed (NAME’S) fever did you seek treatment? Wamuvuje amaze igihe kingana iki afashwe n’umuriro? Same Day/ Uwo munsi……………...0 Next Day/ Umunsi ukurikiyeho……1 Two Days/ Nyuma y’iminsi 2………2 Three Or More Days/ Nyuma y’iminsi 3/irenga ……..……3 Don’t Know/ Simbizi ……………...88 55. At any time during the illness, did (Name) take any drugs for the fever? Hari imiti y’umuriro Kanaka (Izina ry’umwana) yahawe mu gihe yari arwaye? YES/ YEGO .......................................…….1 NO/ OYA ........................................... …….0 DON’T KNOW/ SIMBIZI……..……..88 57 57 56. Which medicines were given to (NAME) for his/her fever? Ni iyihe miti yahawe kubera impanvu z’umuriro? CIRCLE ALL MEDICINES THAT WERE GIVEN. SHYIRA AKAZIGA KU MUTI WOSE AKUBWIYE KO YAHAWE IF MOTHER IS UNABLE TO RECALL DRUG NAME(S), ASK HER TO SHOW THE DRUG(S) TO YOU. IF SHE IS UNABLE TO SHOW YOU THEM, SHOW HER TYPICAL ANTI-MALARIALS AND HAVE HER IDENTIFY WHICH WERE GIVEN. ANTI-MALARIAL DRUGS/IMITI IRWANYA MALARIYA A. Coartem/ Primo……0 1 2 3 88 B. Quinine/kinini………..0 1 2 3 88 Other Drugs/ Indi miti C. Paracetamol Parasitamolu………....0 1 2 3 88 D. Unknown Drug/ Ntuzwi…0 1 2 3 88 Additional and Replacement Documentation Protocal 156 NIBA UMUBYEYI ADASHOBOYE KUKUBWIRA IYO MITI, MUSABE AYIKWEREKE, NIBA ADASHOBOYE KUYIKWERERA MWEREKE IMITI YA MALARIYA ITANDUKANYE AKWEREKE IYO YAKORESHEJE. FOR EACH ANTI-MALARIAL MEDICINE ASK: KURI BURI MUTI WA MALARIYA, MUBAZE UTI: How long after the fever started did (NAME) start taking the medicine? Yatangiye kuwufata amaze igihe kingana iki afashwe n’umuriro? CIRCLE THE APPROPRIATE CODE/ SHYIRA AKAZIGA KU GISUBIZO AKUBWIYE .CODES/ KODE: SAME DAY/UWO MUNSI= 0 NEXT DAY AFTER THE FEVER UMUNSI UKURIKIYEHO = 1 TWO DAYS AFTER THE FEVER NYUMA Y’IMINSI 2 = 2 THREE OR MORE DAYS AFTER THE FEVER NYUMA Y’IMINSI 3 CYANGWA IRENGA = 3 DON’T KNOW/ SIMBIZI =88 E. Other/ Undi_________0 1 2 3 88 _______________________________ (Specify/ Sobanura) 57. Does your household have any mosquito nets that can be used while sleeping? Mu rugo rwawe mufite inzitiramibu mukoresha? YES/ YEGO........................................1 NO/ OYA .......................................... 0 62 58. Who slept under a bed net last night? Ni bande baraye mu nzitiramibu iri joro ryakeye? RECORD ALL MENTIONED SHYIRA IKIMENYETSO KU BO AKUBWIYE IF ANYONE OTHER THAN THE CHILD OF INTEREST IS No One/ Nta numwe…………..…… 0 Child (Name)/ Umwana…..………...1 Nyina w’umwana……………………..2 Other/ Undi………………………..…..3 62 59 Additional and Replacement Documentation Protocal 157 MENTIONED, CIRCLE “OTHER.” NIBA HARI ABANDI BAYIRAYEMO BATARI UWO MWANA, SHYIRA IKIMENYETSO KURI “ABANDI” 59. Which brand of bed net did (Name) sleep under last night? Ni ubuhe bwoko bw’inzitiramibu kanaka (amazina y’umwana) yarayemo iri joro ryakeye? READ THE PIECE OF PAPER ON THE BEDNET WHICH SHOWS THE BRAND OF THIS BEDNET SOMA KU GAPAPURO KARI KU NZITIRAMIBU GASOBANURA UBWOKO BWAYO BRAND OPTIONS NEED TO MATCH WHAT IS LOCALLY AVAILABLE IN EACH CATEGORY. THE PURPOSE OF THIS QUESTION IS TO IDENTIFY WHAT TYPE OF NET IS BEING USED BURI BWOKO BWOKO KURI IYI LISTI BUGOMBA GUHUZWA N’UBWOKO BW’ INZITIRAMIBU BUBONEKA MURI AKO GACE. IMPAMVU Y’IKI KIBAZO NI UKUGIRA NGO TUMENYE NEZA UBWOKO BW’INZITIRAMIBU BUKORESHWA LONG LASTING NET/ INZITIRA MIBU IKORANYWE UMUTI Permanet…………………..….1 Olyset…..……………………..2 Netprotect………………….…3 DON’T KNOW/ SIMBIZI …..88 PRETREATED NETS/ INZITIRAMIBU IKARISHYWA No tag/Nta gapapuro………...4 DON’T KNOW/ SIMBIZI …….88 OTHER NET (UNTREATED)/ IZINDI NZITIRAMIBU ZIDAKARISHIJE OTHER NET/ IZINDI………...…5 Specify/ Sobanura ……………6 DON’T KNOW/ SIMBIZI …....88 62 62 62 60. Was the bed net that (Name) slept under last night ever soaked or dipped in a liquid treated to repel mosquitoes or bugs? Inzitiramibu kanaka (amazina y’umwana) yarayemo iri joro yigeze ikarishywa? YES/ YEGO .......................................1 NO/ OYA .......................................... 0 DON’T KNOW/ SIMBIZI .... …….88 62 62 61. How long ago was the net last soaked or dipped in a liquid MONTHS/ AMEZI I___I___I Additional and Replacement Documentation Protocal 158 treated to repel mosquitoes or bugs? Iyo nzitiramibu imaze igihe kingana iki ikarihijwe? IF LESS THAN ONE MONTH AGO, RECORD 00 MONTHS. NIBA IMAZE IGIHE KIRI MUNSI Y’UKWEZI KUMWE, ANDIKA AMEZI 00 IF LESS THAN 2 YEARS AGO, RECORD MONTHS AGO. PROBE FOR EXACT NUMBER OF MONTHS. NIBA ICYO GIHE KIRI MUNSI Y’IMYAKA IBIRI, ANDIKA UMUBARE W’AMEZI ASHIZE. KOMEZA UMUBAZE UMENYE NEZA UMUBARE W’AMEZI ASHIZE. MORE THAN 2 YEARS AGO/ HEJURU Y’IMYAKA IBIRI …………2 DON’T KNOW/ SIMBIZI………….…88 3. PNEUMONIA/GUKURIKIRANA UMUSONGA 62. Has (Name) had an illness with a cough that comes from the chest at any time in the last two weeks? Kanaka (Amazina y’umwana) yaba yarigeze arwara inkorora no kubabara mu gatuza igihe icyo aricyo cyose mu byumweru bibiri bishize? YES/ YEGO……………………...........1 NO/ OYA..............................….0 DON’T KNOW/ SIMBIZI …...88 66 66 63. When (Name) had an illness with a cough, did s/he have trouble breathing or breath faster than usual with short, fast breath? Mu gihe kanaka (izina ry’umwana muto) yari arwaye inkorora, yahumekaga insigane cyangwa yahumekaga bimugoye? YES/ YEGO........................................1 NO/ OYA ..........................................0 DON’T KNOW/ SIMBIZI ………………..88 66 66 64. Did you seek advice or treatment for the cough/fast breathing? Wigeze usaba inama cyangwa ushaka umuti w’ inkorora, guhumeka insigane cyangwa guhumeka bimugoye? YES/ YEGO........................................1 NO/ OYA .........................................0 66 65. Who gave you advice or treatment? Anyone else? Record all mentioned. Ninde waba yarakugiriye inama cyangwa akaguha umuti? Ntawundi? ANDIKA ABO Doctor/ Dogiteri………………………….A Nurse/ Umuforomo……………………….B Community Health Worker Additional and Replacement Documentation Protocal 159 AKUBWIYE BOSE. Umujyanama w’ubuzima (binome)…....C Other/Undi_______________________D Sobanura 4. CONTROL OF DIARRHEAL DISEASES/GUKURIKIRANA INDWARA Z’IMPISWI 66. Has (NAME) had diarrhea in the last 2 weeks? Kanaka ( izina ry’umwana muto ) yigeze arwara impiswi mu byumweru bibiri bishize Bavugako umwana arwaye impiswi iyo agiye ku musarane inshuro zirenze 3 ku munsi kandi yituma umusarani w’amazi. YES/ YEGO .......................................1 NO/ OYA ...........................................0 DON’T KNOW/ SIMBIZI …………………...88 76 76 67. What was given to treat the diarrhea? Ni iki wamuhaye kugira ngo impiswi ihagarare ? Anything else?/Ntakindi ? If answer pill or syrup, show local packaging for zinc and ask if the child received this medicine. Niba ari ibinini cg imiti y’amazi, mwereke ibinini bya zinc noneho umubaze niba umwana yarahawe iyo miti. RECORD ALL MENTIONED. ANDIKA IBYO AVUZE BYOSE. NOTHING/ NTACYO……………………………….A FLUID FROM ORS PACKET/ URUVANGE RW’IMYUNYU……………………………………....B HOME-MADE FLUID/ IBYO KUNYWA BITEGURIWE IMUHIRA ………………………..…C PILL OR SYRUP,ZINC/ IKININI,UMUTI W’ AMAZI, ZINC ……………………………………...D PILL OR SYRUP, NOT ZINC/ IBININI,UMUTI W’AMAZI NTA ZINC…………………………….….E INJECTION/ URUSHINGE…………………………F (IV) INTRAVENOUS/ SERUMU…………….…….G HOME REMEDIES/ HERBAL MEDICINES/ IMITI Y’IBYATSI……………………………………….…...H OTHER/ IBINDI_________________________ X (SPECIFY/ BISOBANURE) 68. If the child is exclusively breastfed (only taking breastmilk), ask only this question and then Less than usual/Nkeya k’ubusanzwe...A Additional and Replacement Documentation Protocal 160 skip to Q 71 Niba umwana yonka gusa baza gusa iki kibazo noneho uhite ujya ku kibazo cya 71 When (name of child) was sick, was s/he offered more breastmilk than usual, about the same amount, or less than usual? Mu gihe Kanaka (izina ry’umwana muto) yari arwaye, yonkejwe inshuro nyinshi kuruta ubusanzwe, zingana cyangwa nkeya kubusanzwe? Same amount/ Zingana …………………B More than usual/ Ziruta ubusanzwe ….C 69. When (NAME) had diarrhea, was he/she offered less than usual to drink, about the same amount, or more than usual to drink? Mu gihe Kanaka (izina ry’umwana muto) yari arwaye impiswi, yahawe ibinyobwa bike, bingana cyangwa biruta ibyo yarasanzwe anywa? Less than usual/Nkeya k’ubusanzwe...A Same amount/ Zingana …………………B More than usual/ Ziruta ubusanzwe …..C 70. When (name of child) was sick, was s/he offered more than usual to eat, about the same amount, or less than usual to eat? Mu gihe Kanaka (izina ry’umwana muto) yari arwaye impiswi, yahawe ibyo kurya bike, bingana cyangwa biruta ibyo yarasanzwe arya? Less than usual/Nkeya k’ubusanzwe...A Same amount/ Zingana …………………B More than usual/ Ziruta ubusanzwe ….C 71. Was s/he given any of the following to drink at any time s/he started having diarrhea? Mugihe Kanaka yari atangiye kugira impiswi hari ibyo wamuhaye muri ibi binyobwa bikurikira: Read the choices to the mother and circle all mentioned: Bimusomere maze ushyire akaziga kubyo akubwiye byose A fluid made from a special packet called (local name for ORS packet) Uruvange rw’imyunyu (SRO)……………..…...A Cereal based ORT (rice water, maize water) Amazi avura impiswi (Amazi y’umuceri)........B Other home available fluids/ Ibindi binyobwa byateguriwe imuhira ………..C Bisobanure 72. Did you seek advice or treatment from someone outside of the home for (NAME’S) diarrhea? YES/ YEGO................................. 1 NO/ OYA ..................................... 2 75 Additional and Replacement Documentation Protocal 161 Igihe Kanaka yari arwaye impiswi,wigeze ushaka inama cyangwa umuti hanze y’urugo? 73. Where did you first go for advice or treatment? 3 Washakiye inama cyangwa wamuvurije he bwa mbere? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. NIBA AHO YAKUYE IMITI ARI KUBITARO,KU KIGO NDERABUZIMA CG MU IVURIRO RYIGENGA , ANDIKA IZINA RYAHO. _____________________________________ _________________________ (NAME OF PLACE/ IZINA RY’AHO HANTU) HEALTH FACILITY/ AMAVURIRO HOSPITAL/ IBITARO BIKURU ……………….01 HEALTH CENTER/ IKIGO NDERABUZIMA ………………………..02 HEALTH POST/ IVURIRO RYUNGIRIJE POSTE DE SANTE…………….……………………………03 CHW / UMUJYANAMA W’UBUZIMA ……….06 OTHER HEALTH FACILITY/ IRINDI VURIRO _____________________________________07 (SPECIFY/RISOBANURE) OTHER SOURCE/ AHANDI YAKUYE IMITI TRADITIONAL PRACTITIONER UMUVUZI WA GIHANGA…………………....08 SHOP/ MU IDUKA.…………………….…..…09 PHARMACY/ FARUMASI………………..…10 FRIEND/RELATIVE INSHUTI CG UMUVANDIMWE ……..…….12 OTHER/ ABANDI____________________88 (SPECIFY/ BAVUGE) 74. Who decided that you should go there for RESPONDENT/ USUBIZA……………………. A Additional and Replacement Documentation Protocal 162 (NAME’S) diarrhea? Ninde wafashe icyo cyemezo cyo kumujyanayo (kumuvuza)? RECORD ALL MENTIONED. ANDIKA IBYO AKUBWIYE BYOSE. HUSBAND/PARTNER/ UMUGABO………… ..B RESPONDENT’S MOTHER/ NYINA W’USUBIZA………………………………………. C MOTHER-IN-LAW NYIRABUKWE W’USUBIZA … ………………..D FRIENDS/NEIGHBORS INSHUTI/ABATURANYI ……………………….E OTHER/ABANDI______________________ X (SPECIFY/ BASOBANURE) 75. Since (NAME) has been recovering from diarrhea, did you give him/her less than usual to eat, about the same to eat, or more than usual to eat? Mugihe umwana yari akimara gukiruka impiswi, mbese mwamuhaye ibyo kurya bike, bingana cyangwa byinshi kuruta ibyo yari asanzwe ahabwa? LESS/ BIKE……………………………………1 SAME/ BINGANA……………………………..2 MORE/ BIRUTA…………………………..……3 STILL HAS DIARRHEA/ ARACYAHITWA ... 4 DON’T KNOW/ SIMBIZI………………………88 SECTION V: WATER & SANITATION / AMAZI N’ISUKURA 76. Do you treat your water in any way to make it safer for drinking? Hari uburyo mukoresha mu gutu nganya amazi yokunywa? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0  78 77. IF YES: What do you usually do to the water to make it safer to drink? Niba ariYego: ubikora ute ngo wize reko amazi ari meza Let It Stand And Settle/ Sedimentation kuyatereka akiyungurura……….A Strain It Through Cloth Kuyayunguruza agatambaro……………………...B Additional and Replacement Documentation Protocal 163 yokunyobwa? (ONLY CHECK MORE THAN ONE RESPONSE, IF SEVERAL METHODS ARE USUALLY USED TOGETHER, FOR EXAMPLE, CLOTH FILTRATION AND CHLORINE) SHYIRA IKIMENYETSO KU GISUBIZO KIRENZE KIMWE NIBA AKORESHA UBWO BURYO BWOSE ICYARIMWE, URUGERO: KUYAYUNGURURA UKORESHEJE CHLORINE CYANGWA AGATAMBARO. Boil/ kuyateka………………………………………..C Add Bleach/Chlorine Kuyashyiramo sur’eau/kolorine………………….D Water Filter (Ceramic, Sand, Composite) Kuyayunguruza filitire(iyakizungu, amakara, umucanga…………………..….……………………..E Solar Disinfection/ Kwica udukoko ukoresheje izuba………………...F Don’t Know/ simbizi…………………………….….G Other/ Ikindi______________________________H (Specify/ Sobanura) 78. When do you wash your hands? Ni ryari ukaraba intoki? DO NOT PROMPT. CIRCLE ALL MENTIONED. NTUMUHAGARIKE, KOMEZA WUMVE IBYO AKUBWIRA USHYIRE AKAMENYETSO KU BYO AKUBWIRA BYOSE. Never / nta narimwe …………..……………………….A Before Food Preparation / Mbere yogutegura amafunguro.………………………………………….….B Before Feeding Child / Mbere yo konsa/ mbereyo kugaburira umwana………………………………..…C After Defecation/Visiting The Toilet / Nyuma yo ku kuva ku musarane …………………………………...D After attending to a child who has defecated/soiled / Nyuma yo gutunganya/guhanagura umwana umaze kwituma…………………………….……………………E Other/ Ikindi ihe.____________________________F (Specify/ Sobanura) 81 79 Can you show me where you usually wash your hands and Inside/Near Toilet Facility/ Additional and Replacement Documentation Protocal 164 what you use to wash hands? Mushobora kunyereka aho mukarabira intoki n’icyo mukoresha mukaraba intoki? ASK TO SEE AND OBSERVE MUSABE ABIKWEREKE NAWE WITEGEREZE. Mu musarane imbere cyangwa hafi yawo…….….1 Inside/Near Kitchen/Cooking Place/ mu gikoni, Iruhande rwacyo/ aho batekera……………….…. 2 Elsewhere In Yard Ahantu aho ari ho hose mu rugo………………....3 Outside Yard/ inyumay’urugo………….…....…….4 No Specific Place Nta mwanya wihariye uhari…………………….…..5 No Permission To See Ntakwemereye kuhareba …………………….……8 80a. OBSERVATION ONLY: Is there soap or detergent or locally used cleansing agent? This item should be either in place or brought by the interviewee within one minute. If the item is not present within one minute check none, even if brought out later. (ONLY CHECK MORE THAN ONE IF SEVERAL CLEANING AGENTS ARE USED) ITEGEREZE GUSA: Hari isabune cyangwa ibindi bikoreshwa mu gukaraba intoki? Soap/ Isabune isanzwe………………….…………A Detergent/ Isabune y’ifu nka omo………………..B Ash/ Ivu…………………………………………….…C Mud/Sand/ Icyondo/ Akabuye………………….…D None/ Ntanakimwe………………………………....E Other/ Ikindi______________________________F (Specify/ Sobanura) Additional and Replacement Documentation Protocal 165 Icyo gikoresho gishobora kuba gihari cyangwa kikazanwa n’umubyeyi mu gihe cy’umunota umwe gusa. Niba kitabonetse mu munota umwe, kibarwa nk’ikidahari. (SHYIRA IKIMENYETSO KU GIKORESHO CYOSE YIFASHISHA AKARABA INTOKI ) 80b OBSERVATION ONLY: Specify what kind of hand washing facility is used, if any? (ONLY CHECK MORE THAN ONE IF SEVERAL FACILITIES ARE USED) ITEGEREZE GUSA: Bakoresha ibihe bikoresho bakaraba? (SHYIRA IKIMENYETSO KU GIKORESHO CYOSE YIFASHISHA AKARABA INTOKI ) Tippy tap / Kandagira ukarabe ……………………A Basin/ Ibase…………………………………….…… B Jerry can / jug: injerekani / ijage…………………C Pan / pot / : Isafuliya/ Inkono ……………………D Sink / Lavabo ……………………………………...E None/ Nta nakimwe ……………………………..…F Other/ Ikindi_____________________________G (Specify/ Sobanura) 80c. (If pan, pot, bowl, or basin) What else, if anything, are you using this receptacle for other than Nothing else/ Ntakindi……………………………A Additional and Replacement Documentation Protocal 166 hand washing? (ONLY CHECK MORE THAN ONE IF SEVERAL ARE PRACTICED) (Niba ari isafuliya,inkono cyangwa ibase ) mubaze undi murimo akoresha ibi bikoresho utari gukaraba intoki? (SHYIRA IKIMENYETSO KU BYO AKUBWIYE BYOSE) Food preparation/ Gutegura Amafunguro……B Laundry/ Kumesa………………….……………..C Other/ Ibindi____________________________D (Specify/ Sobanura) 81. What kind of toilet facility do you have? Can I see it? Umusarane mukoresha umeze ute? Nshobora kuwureba ? No toilet facility/ Nta musarane ………………….1 Open latrine/ Umusarane udapfundikiye ………2 Closed latrine/ umusarane upfundikiye……..….3 Flush toilet/ umusarane wa kizungu…………..…4 No permission to see/ ntiyakwemereye kureba….5 82. The last time (NAME) passed stools, where were the feces disposed of? Igihe cyashize (izina ry’umwana) amaze kwituma umwanda we wawushyize he? Probe to find the location. Komeza umubaze wumve aho yaba ashyira Disposed into a latrine or toilet facility Yawushyize mu musarane ………………………....1 Disposed into a garbage/ trash bin yawushyize mu kintu kijyamo imyanda cyangwa ahagenewe imyanda…………………....….2 Dug and buried – near the house or in the yard?/ Yawushyize iruhande rw’inzu cyangwa kure Additional and Replacement Documentation Protocal 167 umwanda w’umwana. yayo ……………………………………………………...3 Dug and buried – far from the house or yard?/ Yawushyize cyangwa yawutabye kure yinzu cyangwa ahandi..........................................................4 Did not bury – near the house or yard / Ntiyawutabye hafi yinzu cyangwa ahandi……………………………………….………..…...5 Did not bury – far from the house or yard / Ntiyawutabye kure yinzu cyangwa ahandi …….....6 Don’t know/ Simbizi……………………..……............7 Other/ Ahandi______________________________8 (Specify/ Sobanura) SECTION VI: IMMUNIZATION/ IKINGIRA 83. Did you receive a card or child health booklet where (name of child’s) vaccinations and Vitamin A doses can be written down? If so, can I see the card? Ese ufite igipande kanaka(izina ry’umwana) yakingiriweho, yanahereweho vitamine A? Niba gihari wakinyereka? Yes, interviewer sees the card Yego, ubaza abonye igipande ……………….A Yes, but card is missing or lost Yego, ariko igipande ntagihari ……………….B No, never had a card Oya, nta gipande afite.…………………………..C Don’t know / Simbizi …………….…………....…D 86 86 86 84. Copy the following vaccination dates from the card or booklet. If vaccines are not recorded in the child booklet, fill in 99/99/9999 / Reba ku gipande wandike amatariki yaboneyeho buri rukingo, niba bitanditse ku gipande andika 99/99/9999 IF ALL VACCINES ARE RECORDED ON THE CHILD HEALTH CARD OR BOOKLET, GO TO QUESTION 93/ NIBA INKINGO ZOSE ZANDITSE KU GIPANDE, JYA KU KIBAZO CYA 93 Date of Immunization/ Itariki y’ikingira DAY/U MUNSI MONT H/UK WEZI YEAR/UMW AKA BCG/ IGITUNTU Additional and Replacement Documentation Protocal 168 POLIO 0 / IMBASA 0 (POLIO GIVEN AT BIRTH OR BEFORE 6 WEEKS URUKINGO RW’IMBASA RUTANZWE UMWANA AKIVUKA CYANGWA MBERE Y’IBYUMWERU BIBIRI) POLIO 1/ IMBASA1 POLIO 2/ IMBASA2 POLIO 3/ IMBASA3 PENTA-1 PENTA-2 PENTA-3 PINEMOKOKE1 PINEMOKOKE2 PINEMOKOKE3 Rotavirus/IMPISWI1 Rotavirus/IMPISWI2 Rotavirus/IMPISWI3 Measles/ Iseru1 Measles/ Iseru2 Vitamin A (most recent dose Akanini aherutse kubona) Vitamin A (previous dose Akanini kabanjirije agaheruka) 85. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations given during immunization campaigns? Kanaka hari urundi rukingo yaba yarahawe Yes/ Yego .........................................1 No/ Oya.............................................0 Don’t Know/ Simbizi..................... 88 93 93 Additional and Replacement Documentation Protocal 169 rutari kugipande, ushyizemo n’izo yaherewe mu ikingira rusange? 86. Please tell me if (NAME) received any of the following vaccinations: Ndabasaba kumbwira niba (KANAKA ) yarahawe izi nkingo zikurikira: BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar? Urukingo rw’igituntu, rumwe bakingira umwana kukaboko cg ku rutugu rukamusigiraho inkovu? Yes/ Yego ........................................ 1 No/ Oya ............................................ 0 Don’t Know/ Simbizi ...................... 88 87. Polio vaccine, that is, drops like these, in the mouth? Urukingo rw’imbasa/ Igitonyanga baha umwana mukanwa? SHOW THE EXAMPLE OF POLIO DROPS MWEREKE URUGERO RW’ IGITONYANGA. Yes/ Yego ........................................ 1 No/ Oya ............................................ 0 Don’t Know/ Simbizi ...................... 88 90 90 88. When was the first polio vaccine received? [In the first two weeks after birth or later? Niryari umwana yahawe urukingo rwa mbere rw’imbasa?(Mu byumweru bibiri bya mbere amaze kuvuka cg nyuma yabyo) First Two Weeks After Birth Mubyumweru bibiri bya mbere avutse ……1 Later/ Nyuma yaho……………………………..2 Don’t Know/ Simbizi……………………………88 89. How many times was the polio vaccine received? Urukingo rw’imbasa yarubonye inshuro zingahe? Number Of Times/ Incuro ........... Don’t Know/ Simbizi…………………………88 90. DTP vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops? Urukingo batera ku kibero akenshi batangira rimwe n’urw’imbasa Yes/ Yego ........................................ 1 No/ Oya ............................................ 0 92 92 Additional and Replacement Documentation Protocal 170 yararuhawe? Don’t Know/ Simbizi ...................... 88 91. How many times? Yaruhawe inshuro zingahe? Number Of Times/ Incuro............ Don’t Know/ Simbizi…………………………88 92a. Did (name of child) ever receive an injection in the arm to prevent Measles? Ese Kanaka (Izina ry’umwana muto) yaba yarakingiwe urukingo rw’iseru? Yes/ Yego ........................................ 1 No/ Oya ............................................ 0 Don’t Know/ Simbizi………………..88 92b. Did (name of child) ever receive a dose of vitamin A? Ese Kanaka (Izina ry’umwana muto) yaba yarahawe ikinini cya Vitamini A? Yes/ Yego ........................................ 1 No/ Oya ............................................ 0 Don’t Know/ Simbizi ………………88 93 93 92c. When was the last dose of vitamin A? Ikinini cya vitamin A aherutse kugihabwa ryari? Less than 6 months/ Amezi 6 ntarashira……1 More than 6 months/ Amezi 6 ararenga……2 Don’t Know/ Simbizi…………………..………88 SECTION VII: ANTHROMPOMETRICS/ IBIPIMO 93 May I weigh (name of child)? Nshobora gupima (izinary’umwana muto) ibiro? Measure twice. If difference in weight is more than 0.5 KG, measure a third time. Pima umwana inshuro ebyiri ,niba ikinyuranyo cy’ibiro by’umwana ari inusu( 500 grs) ongera umupime bwa gatatu Yes/ Yego ……………….1st __________ Kilograms/ Ibiro 2nd __________ Kilograms/ Ibiro 3rd __________ Kilograms/ Ibiro No/ Oya…………….0 Additional and Replacement Documentation Protocal 171 94 May I use MUAC Tape with (name of child)? Nshobora gupima umuzenguruko w’ikizigira (izinary’umwanamuto)? Measure twice. If difference in length is more than 0.5 CM, measure a third time. Pima umwana inshuro ebyiri ,niba ikinyuranyo cy’umuzenguruko w’ikizigira by’umwana ari 0.5 cm ongera umupime bwa gatatu Yes / Yego……………1st ____________ cm/ santimetero 2nd ____________ cm/ santimetero 3rd ____________ cm/ santimetero No/ Oya…………….0 95. May I measure length for (name of child)? Nshobora gupima uburebure bw’umwana? Measure twice. If difference in length is more than 0.5 CM, measure a third time. Pima umwana inshuro ebyiri ,niba ikinyuranyo cy’uburebure bw’umwana ari 0.5 cm ongera umupime bwa gatatu Yes / Yego……………1st ____________ cm/ santimetero 2nd ____________ cm/ santimetero 3rd ____________ cm/ santimetero No/ Oya…………….0 95a. Check if (name of child) has oedema in both feet / Suzuma urebe niba (Izina ry’umwana muto) yaba afite edeme ku maguru yombi. Yes/ Yego……………………………………………..1 No/ Oya………………………………………………..0 96 May I use MUAC Tape with you? Nshobora gupima umuzenguruko w’ikizigira cy’akaboko kawe? Measure twice. If difference in length is more than 0.5 CM, measure a third time. Pima umubyeyi inshuro ebyiri ,niba ikinyuranyo cy’umuzenguruko w’ikizigira cy’umubyeyi ari 0.5 Yes / Yego…………..1st ____________ cm/ santimetero 2nd ____________ cm/ santimetero 3rd ____________ Additional and Replacement Documentation Protocal 172 cm ongera umupime bwa gatatu cm/ santimetero No/ Oya…………….0 SECTION VIII: BEHAVIOR CHANGE COMMUNICATION/IKIGANIRO KIGAMIJE GUHINDURA IMYITWARIRE 97. In the past 6 months, have you participated in a week-long training on child feeding and food preparation? Mu mezi 6 ashije , waba warigeze witabira inyigisho zimara icyumweru zijyanye no kugaburira umwana no gutegura amafunguro mu mudugudu? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0 DON’T KNOW / SIMBIZI……..........88  101  101 98. IF YES: How many times? NIBA ARI YEGO: wazigiyemo inshuro zingahe ? Once/ Rimwe………………………………1 Twice/ Kabiri…………………………....…2 Three or more/ Gatatu cyangwa karenga…………………………………….3 99. When was the most recent time you participated in such a week-long training? Ni ryari uherutse gukurikirana izo nyigisho zimara icyumweru? Month/Ukwezi ______________________ Year/ Umwaka ______________________ 100. The most recent time, how many of the days did you participate? Izo uherutse wazitabiriye iminsi ingahe? Number / Umubare………………|___|___| Don’t know/ Simbizi………………..…88 No response/ Nta gisubizo………….99 Additional and Replacement Documentation Protocal 173 101. Did you receive a visit related to health in the past month? Hari uwaba yaragusuye mu byerekeranye n’ubuzima mu kwezi gushize? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0 DON’T KNOW / SIMBIZI……..........88 101a. If yes, who visited you? Niba ari yego ni nde? Do not prompt; Circle all that apply. Wimuca mu ijambo andika ibyo akubwiye aho bigomba kujya. Care group member/ Uri mu itsinda ry’ubuzima (care group)……………….A Health facilities staff/ Umukozi w’ivuriro………………………..B Local government staff/ Umuyobozi mu nzego z’ibanze………..C Others?/ Abandi?__________________D (Specify/ Sobanura) 102 If yes, can you tell me what the purpose of the visit was? Niba ari yego, wambwira icyamugenzaga? Do not prompt; Circle all that apply. Wimuca mu ijambo andika ibyo akubwiye aho bigomba kujya. 1. FOLLOW UP ON SICK CHILD GUKURIKIRANA UMWANA URWAYE.....A 2. PROVIDE HEALTH EDUCATION ON MALARIA PREVENTION GUTANGA INYIGISHO ZO KWIRINDA MALARIYA................................................B 3. PROVIDE HEALTH EDUCATION ON DIARRHEA PREVENTION GUTANGA INYIGISHO ZO KWIRINDA IMPISWI.....................................................C 4. PROVIDE HEALTH EDUCATION ON PNEUMONIA GUTANGA INYIGISHO KUNDWARA Y’UMUSONGA..........................................D 5. PROVIDE HEALTH EDUCATION ON NUTRITION GUTANGA INYIGISHO KU MIRIRE..........E 6. PROVIDE HEALTH EDUCATION ON IMMUNIZATION GUTANGA INYIGISHO KU IKINGIRA.......F 7. OTHER/ IKINDI: ____________________ (Specify/ Sobanura) Additional and Replacement Documentation Protocal 174 103. Did you receive any health information from a CHW in the last month? If yes, where did you receive that health information? Hari inyigisho wigeze uhabwa n’umujyanama w’ubuzima muri uku kwezi gushize? Niba ari yego, izo nyigisho waziboneyehe? 1. Home visit Mu isura ry’ingo…………………..A 2. Community Meeting/Mu nama y’umudugudu cg iy’Akagali………B 3. Health Facility Ku Kigo Nderabuzima………………C 4. Growth Monitoring and Counseling Mu gihe cyo gukurikirana imikurire y’abana mu Akagali…………………..D 5. Nutrition Week/ Mu cyumweru cy’Imirire……………………………….E 6. Other/Ahandi.....................................F ________________________________ (Specify/Sobanura) 7. Did not receive any health information from a CHW last month. Ntabwo yigeze ahabwa inyigisho z’ubuzima n’Umujyanama w’ubuzima mu kwezi gushize………………….…………….G 104. Did you receive any health information from a church in the last month? If yes, what was the information? Hari inyigisho ku buzima wigeze uhabwa mu rusengero (mu kiliziya) mu kwezi gushize? Niba ari yego, izo nyigisho zari izihe? 1. Ante-Natal Care or Post-Natal Care/ Kwita k’umugore utwite cyangwa Umubyeyi umaze kubyara n’uruhinja ………………………..……..A 2. Pneumonia/Umusonga ……………….B 3. Water treatment/Isuku y’amazi ……C 4. Hand Washing/Gukaraba intoki …..D 5. Diarrhea/Impiswi ………………………E 6. Breastfeeding/Konsa …………………F 7. Nutrition/Imirire ………………………..G 8. Other/Ibindi? ………………..………….H 9. Did not receive any health information from a church in the last month/ Ntabwo yigeze ahabwa inyigisho z’ubuzima mu rusengero/ Kiliziya mu kwezi gushize……………………………I 105a. Do you own a kitchen garden? /Mbese ufite akarima k’igikoni mu rugo iwawe? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0 Additional and Replacement Documentation Protocal 175 105b. If “Yes”, do you sell the vegetables or eat the vegetables, or both? Niba ari “Yego”, mbese ujya ugurisha umusaruro w’imboga zivuye mu karima k’igikoni? Cyangwa murazirya mu rugo, Cyangwa urazigurisha izindi ukazirya? A. Sell/ Kuzigurisha…………….……………..A B. Eat/Kuzirya ………………………………….B C. Sell and Eat/ Kuzigurisha no kuzirya ……C 105c. If you sell some or all of the vegetables (if 105b: A or C), what do you spend the money on? Iyo ugurishije umusaruro muke cyangwa wose (iki kibazo kibaze uwashubije 105b: A cg C), amafaranga avuyemo uyakoresha iki? A. Food / Kugura ibiryo …………………….A B. Healthcare/Kwivuza ………………………B C. Other (specify)/ Ibindi (bisobanure) ____________________________________ C 105d If you eat some or all of the vegetables (if 105b: B or C), who in the household eats the vegetables? Iyo muriye imboga zivuye mu karima kanyu k’igikoni (iki kibazo kibaze uwashubije 105b: B cg C), mu rugo rwawe nibande barya kuri izo mboga)? A. Children/ Abana……………………………A B. Adults/ Abantu bakuru……………………B C. Children and Adults /Abana n’abakuru ..C 106. Do you raise small animals at home?/ Mbese hari amatungo magufi woroye mu rugo rwawe? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0 106b. If “Yes”, do you sell the animals or eat the animals, or both?/ Niba ari “Yego”, mbese ujya ugurisha umusaruro w’amatungo magufi? Cyangwa murayarya mu rugo, Cyangwa urayagurisha andi ukayarya? A. Sell/ Kuyagurisha…………….……………..A B. Eat/Kuyarya ………………………………….B C. Sell and Eat/ Kuyagurisha no kuyarya…..C 106c. If you sell some or all of the animals (if 106b: A or C), what do you spend the money on? Iyo ugurishije umusaruro muke cyangwa wose (iki kibazo kibaze uwashubije 106b: A cg C), amafaranga avuyemo uyakoresha iki? D. Food / Kugura ibiryo …………………….A E. Healthcare/Kwivuza ………………………B F. Other (specify)/ Ibindi (bisobanure) ____________________________________ C Additional and Replacement Documentation Protocal 176 106d. If you eat some or all of the animals (if 106b: B or C), who in the household eats the animals?/ Iyo muriye ibikomoka kuri ayo matungo mworoye (iki kibazo kibaze uwashubije 106b: B cg C), mu rugo rwawe nibande barya ibikomoka kuri ayo matungo ( cg ibiyakomokaho)? D. Children/ Abana……………………………A E. Adults/ Abantu bakuru……………………B F. Children and Adults /Abana n’abakuru ..C Time interview ended/ Igihe ibazwa ryarangiriye AM Mbere ya saasita ___ ___:___ ___ PM Nyuma ya saasita ___ ___:___ ___ Thank you. Murakoze Additional and Replacement Documentation Protocal 177 Annex 7. Sampled Villages in Nyamagabe District Kigeme Clusters Hospita l Sector Cell Village Population Cluste r 70 Kigeme GASAKA REMERA GITWA 196 1 78 Kigeme Kamegeli Kamegeli Kinyovu 817 2 87 Kigeme Kamegeli Kizi Kinyana 541 3 96 Kigeme Kibilizi Bugarama Kabarera 383 4 10 6 Kigeme Kibilizi Bugarura Uwinyana 670 5 11 4 Kigeme Kibilizi Karambo Kavumu 770 6 12 2 Kigeme Kibilizi Ruhunga Ruhurura 757 7 13 0 Kigeme KITABI KAGANO KINTOBO 931 8 13 6 Kigeme KITABI MUJUGA GASASA 790 9 14 2 Kigeme KITABI MUKUNGU GAHIRA 573 10 14 9 Kigeme KITABI SHABA MUGANZA 872 11 15 6 Kigeme KITABI UWINGUGU RUHANGA 756 12 16 4 Kigeme MBAZI MUTIWINGOM A KABERE 529 13 17 4 Kigeme MBAZI NGARA GASHARU 642 14 18 5 Kigeme TARE BUHORO RYARUBONDO 558 15 19 4 Kigeme TARE GATOVU KIGUSA 2,903 16 20 2 Kigeme TARE KAGANZA RUGANZA 541 17 21 3 Kigeme TARE NYAMIGINA GAKOMA 643 18 22 3 Kigeme UWINKING I BIGUMIRA MAGUMIRA 679 19 23 1 Kigeme UWINKING I KIBYAGIRA BISHYA 841 20 23 9 Kigeme UWINKING I MUDASOMWA KARAMBO 820 21 24 Kigeme UWINKING MUNYEGE MUNYEGE 798 22 Additional and Replacement Documentation Protocal 178 7 I 2 Kigeme CYANIKA GITEGA GASEKE 369 23 14 Kigeme CYANIKA KARAMA MUGAMBA 611 24 25 Kigeme CYANIKA KIYUMBA NYARUCYAMU 361 25 34 Kigeme CYANIKA NYANZA MIRAMA 728 26 44 Kigeme CYANIKA NYANZOGA NYAMIRAMA 325 27 51 Kigeme GASAKA NGIRYI KIBANDA 797 28 57 Kigeme GASAKA NYABIVUMU GASHARU 567 29 63 Kigeme GASAKA NYAMUGARI KIGARAMA 940 30 Cumulative Population 163,670 Kaduha Clusters Hospital Sector Cell Village Population Cluster 143 Kaduha MUGANO SUTI GASIZA 244 1 153 Kaduha MUSANGE GASAVE Kabingo 516 2 162 Kaduha MUSANGE JENDA Nyakirambi 633 3 172 Kaduha MUSANGE MASANGANO Mubuga 559 4 181 Kaduha MUSANGE NYAGISOZI Kibaga 508 5 193 Kaduha MUSEBEYA NYARURAMBI Gatiti 541 6 205 Kaduha MUSEBEYA RUNEGE Bigugu 434 7 217 Kaduha MUSEBEYA SEKERA Masinde 650 8 226 Kaduha MUSHUBI BUTETERI MUGUNDA 376 9 237 Kaduha MUSHUBI CYOBE NYAKABINGO 646 10 246 Kaduha MUSHUBI GASHWATI RUCUNDA 711 11 257 Kaduha NKOMANE MUSARABA RUSOYO 360 12 268 Kaduha NKOMANE NKOMANE MUGARI 796 13 274 Kaduha NKOMANE NYARWUNGO NYARUHOMBO 249 14 5 Kaduha BURUHUKIRO BYIMANA BISHYIGA 597 15 15 Kaduha BURUHUKIRO GIFURWE UWANKIRIYE 442 16 21 Kaduha BURUHUKIRO KIZIMYAMURIRO MUJERENGE 835 17 29 Kaduha BURUHUKIRO MUNINI RUKWANDU 540 18 37 Kaduha GATARE BOKOPFU KARUMBI 641 19 44 Kaduha GATARE GATARE UWISURI 882 20 53 Kaduha GATARE RUGANDA MASANGANO 525 21 62 Kaduha KADUHA KAVUMU BIZIGURO 599 22 71 Kaduha KADUHA MURAMBI KASEMANYANA 542 23 79 Kaduha KADUHA MUSENYI MUNINI 462 24 Additional and Replacement Documentation Protocal 179 88 Kaduha KADUHA NYABISINDU KIVUMU 720 25 97 Kaduha KIBUMBWE BWENDA MUNYINYA 784 26 106 Kaduha KIBUMBWE GAKANKA NYARUBUYE 468 27 117 Kaduha KIBUMBWE NYAKIZA MURAMBI 527 28 124 Kaduha MUGANO GITONDORO MASO 579 29 135 Kaduha MUGANO RUHINGA KARAMBI 378 30 Cumulative Population 150,525 Additional and Replacement Documentation Protocal 180 Annex 8. Indicator Tabulation Plan-Year 4 KPC Demographic Information Numerator Denominator Mother’s Age Mean Median See demographic data All mothers Mother’s Education Any education Each level of education See Q1 and Q2 All mothers Household size Mean Median See Q3 Poverty Level (Ubudehe) Percent according to each level See Q4 Children 0-23 months Health Insurance (Mutuelle) Percent Yes (Conf Int) Percent No (Conf Int) See Q4b Children 0-23 months Health Insurance Card Percent Yes (Conf Int) Percent No (Conf Int) See Q4b & 4C Q4b=1 Nutrition and Breastfeeding (40% Level of Effort) Indicator Numerator Denominator (1) Early initiation of breastfeeding: Percentage of children 0-23 months who were put to the breast within one hour of birth. (OR, Key Indicator MNC) (Q30 = 00 for HOURS) Children 0-23 months Living with their biological mothers Ever-breastfed (Q29=1) Children 0-23 months (2) Prelacteal feeds: Percentage of children 0-23 months given liquids prior to the initiation of breastfeeding. (Q29=1) AND (Q32 = 1) Children 0-23 months ever breastfed; (Q.29=1) (3) Colostrum: Percentage of children 0-23 months who were breastfed during the first three days of life. (Q31 = 1) Children 0-23 months (4) Exclusive breastfeeding: Percentage of children age 0-5 months who were exclusively (AGE 0-5 m) AND (Q34=1 OR Q35=1) AND Infants 0-5 months Additional and Replacement Documentation Protocal 181 breastfed during the last 24 hours. (RC6, OR) (39A-39I all =0) AND (41A-41Q all =0) EBF disaggregation by age groups (recommended by WHO, if sufficient sample size) AGE ___ AND (Q34=1 OR Q35=1) AND (39A-39I all =0) AND (41A-41Q all =0) Infants 0-1 months Infants 2-3 months Infants 4-5 months Infants 0-3 months Continued breastfeeding 6-23 months Q34=1 Children 6-23 months Continued breastfeeding 1 year Q34=1 AND Age 12-15m Children 12-15 months Continued breastfeeding 2 years Q34=1 AND Age 20-23m Children 20-23 months (5)Infant and Young Child Feeding: Percent of infants and young children age 6-23 months fed according to minimum acceptable diet (apart from breast milk). Breastfed children 6–23 months of age who had at least the minimum dietary diversity and the minimum meal frequency during the previous day AND Non-breastfed children 6–23 months of age who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day. Continued breastfeeding or feeding of milk or milk products; Feeding solid/semi-solid food the minimum number of times per day according to age and breastfeeding status; Related sub-indicators relate to the frequency; Feeding the minimum number of food groups per day according to breastfeeding status.) The IYCF indicator also allows for the calculation of consumption of food by type (rich in iron, vitamin A, animal protein) and frequency. MCHIP has given WR permission to use the WHO indicator definition and tabulation plan, which differs slightly from the USAID 2008 Rapid CATCH guidance. (Modified from RC7, OR) (5a) Minimum Dietary Diversity (OR) AGE 6-23m AND 7 Food Group Score ≥4 Children 6-23 months Food Groups 1. Grains, roots and tubers 2. Legumes and nuts 3. Dairy products (milk, yogurt, cheese) 4. Flesh foods (meat, fish ,poultry and liver/organ meats) 5. Eggs 6. Vitamin-A rich fruits and vegetables 7. Other fruits and vegetables Construct 7 food group score as follows: Begin with 0. For each of the 7 food groups, add a point if consumed. Food Group 1 Add 1 point if: Q39G=1 OR Q41A=1 OR 41C=1 Food Group 2 Add 1 point if: Q41K=1 Food Group 3 Add 1 point if: Q39B=1 OR Q39C=1 OR 39F=1 OR 41L=1 Additional and Replacement Documentation Protocal 182 Food Group 4 Add 1 point if: Q41G=1 OR Q41H=1 OR 41J=1 Food Group 5 Add 1 point if: Q41I-1 Food Group 6 Add 1 point if: Q41B=1 OR Q41D=1 OR Q41E=1 OR Q41Q=1 Food Group 7 Add 1 point if: Q41F=1 Suggested disaggregation for Minimum Dietary Diversity, if sample size permits 6-11 months 12-17 months 18-23 months (5b) Minimum Meal Frequency (OR) Proportion of BF and non-BF children 6- 23 m who receive solid, semi-solid, or soft foods the minimum number of times or more the previous day Breastfeeding and non￾breastfeeding children 6-23 months (Q34=1 OR Q35=1) AND AGE 6-8 mo. AND Q43≥2 OR (Q34=1 OR Q35=1) AND AGE 9-23 mo. AND Q43≥3 OR (Q34=0 AND Q35=0) AND AGE 6-23mo. AND ((Q40B+Q40C+Q40F+Q43)≥4) • For BF children, the minimum number of times varies with age (2 times if 6-8 mos.; 3 times if 9-23 mos.). • For non-BF children, the number of times does not vary by age (4 times for all non-BF children 6-23 mos.) • Q11B,C,F (dairy products) only count toward the numerator for the non-BF children. Children 6-23 months (5c) Minimum Acceptable Diet Proportion of children 6-23 months who receive a minimum acceptable diet (apart from breastmilk). (OR) BF children 6-23 months who had at least the minimum dietary diversity and min meal frequency during previous day. AND Non-BF children who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the min meal frequency during previous day. Breastfed children 6-23 mo. AND Non-BF children 6-23 months • Each BF child who scored positively for diversity and positively for meal frequency will score positively for M.A.D. • NOTE: For non-BF children, the dietary diversity component of the indicator is scored differently than for “minimum dietary diversity” indicator. In this case, it is based on a 6-food group score, as explained Additional and Replacement Documentation Protocal 183 below. Calculation of 6 food-group score for non-breastfed children (no dairy group this time) 1. Grains, roots and tubers 2. Legumes and nuts 3. Flesh foods (meat, fish ,poultry and liver/organ meats) 4. Eggs 5. Vitamin-A rich fruits and vegetables 6. Other fruits and vegetables To construct score for non-BF children, start with 0 and add 1 point for each group that was consumed. Food Group 1 Add 1 point if: Q39G=1 OR Q41A=1 OR 41C=1 Food Group 2 Add 1 point if: Q41K=1 Food Group 3 Add 1 point if: Q41G=1 OR Q41H=1 OR 41J=1 Food Group 4 Add 1 point if: Q41I-1 Food Group 5 Add 1 point if: Q41B=1 OR Q41D=1 OR Q41E=1 OR Q41Q=1 Food Group 6 Add 1 point if: Q41F=1 Calculation of Minimum Acceptable Diet Indicator (Q34=1 OR Q35=1) AND AGE 6-8 mos. AND 7 food group score ≥4 AND Q43≥2 OR (Q34=1 OR Q35=1) AND AGE 9-23 mos AND 7 good group score≥4 AND Q43≥3 OR (Q34=0 AND Q35=0) AND AGE 6-23 mos. AND ((Q39B + Q39C+Q39F)≥2 AND 6 food group score ≥4 AND ((Q39B+Q39C+Q39F+Q43)≥4) Children 6-23 months Consumption of iron-rich foods (did not ask about fortified foods) Children 6-23 months who received an iron rich (non-fortified) food the previous day. AGE 6-23 mos. AND Q41G=1 OR Q41H=1 OR Q41J =1 Children 6-23 months (6) Age appropriate introduction of semi-solid foods: Proportion of infants 6–8 months of age who receive solid, semi-solid or soft foods (OR) AGE 6-8 mos AND Q42=1 (Infants 6–8 months of age who received solid, semi￾solid or soft foods during the previous day) Infants 6-8 months (7)Responsive feeding: Caregiver All Children 6-23 months AND Additional and Replacement Documentation Protocal 184 actively involved in feeding child 6-23months (OR) 1) Frequency of children 6-23 months who consume soft, semi￾solid or solid foods who are self￾feeding. 1a) Mean age at which child started to self-feed. 2) Frequency of children 6-23 months who consume soft, semi￾solid or solid foods who are being assisted with feeding 3) Proportion of all mothers of children age 0-23months who report encouraging their child to either breastfeed or eat soft, semi-solid foods. Please see notes below. 1) Proportion of those who consumed soft, semi-solid foods yesterday who are self-feeding: Q42=1 AND Q45=0 1a) Mean age at which child started to self-feed. Mean, min, max, SD of Q46a 2) Proportion of those who consumed soft, semi-solid foods yesterday who are being assisted with feeding. Q42=1 AND Q45=1 Q42=1 3) Q46B=1 All children 0-23 months NOTES on RESPONSIVE FEEDING: The adequacy of complementary feeding (adequacy in short for timely, adequate, safe and appropriate) not only depends on the availability of a variety of foods in the household, but also on the feeding practices of caregivers. Feeding young infants requires active care and stimulation, where the caregiver is responsive to the child clues for hunger and also encourages the child to eat. This is also referred to as active or responsive feeding. The guidelines advise caregivers to recognize children’s signals of hunger and satiety, not to force children to eat, and to regard mealtimes as a period of learning and love. Guidelines for responsive feeding have expanded to include the promotion of self-feeding through finger foods, attending to the child throughout the meal, and strategies to respond to food refusal. These feeding recommendations, disaggregated by child age, include topics such as breast-feeding on demand, being responsive to cues of hunger and satiety during complementary feeding, introducing and encouraging use of finger foods, and increasing the infant’s exposure to food variety and tastes. The recommendations for responsive feeding on the growth card for the WHO Growth Standards are age-based and include adaptations from the PAHO/WHO (9) guidelines: “Do not force her to eat” and “remove distractions,” the longest list of recommendations so far. Two new recommendations were “use a separate plate/bowl” (1–2 y) and “give realistic portions depending on her age, size, and activity level” (2–5 y). Additional and Replacement Documentation Protocal 185 (8) Underweight: Percentage of children 0-23 months who are underweight (-2 SD for the median weight for age, according to WHO reference population) (RC 18, OR) (Q93= 1) AND (Kilos ≤ -2 SD for median wt for age) Children 0-23 months (9)Wasted: Percentage of children 0-23 months who are underweight for height (-2SD for the median height for age, according to WH0 reference population) (OR) Disaggregate by moderate (≤- 2SD and >-3SD) and severe wasting(≤ -3SD) (Q93= 1 AND Q95=1) AND Weight for length ≤ -2SD Children 0-23 months (10)Stunted: Percentage of children 0-23 months who are under height/length for age (- 2SD for the median height for age, according to WHO reference population) (OR) Disaggregate stunting by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) Q95=1 AND Length for Age≤ -2SD Children 0-23 months (11) Acute Malnutrition: Percent of children 6-23 months and percent of mothers of children 0- 23 months acutely malnourished as measured by MUAC (OR) References for children 6-23 m: SAM: <110 mm and/or edema (Q95A) MAM: ≥110 mm and < 125 mm At risk: ≥125 and <135 Reference for women: SAM <18.5 cm For children 6-23 months: Q94=1 AND AGE 6-23m AND MUAC <125mm For mothers: Q96=1 AND All Biological Mothers AND MUAC <21 cm Children 6-23 months Biological Mothers Additional and Replacement Documentation Protocal 186 MAM≥18.5 cm and <21.0 cm Disaggregate by at risk, moderate and severe acute malnutrition. For SAM: Q94=1 AND AGE 6-23m AND MUAC <110mm OR Q95A=1 (11.5) Micronutrient Powder supplementation: Percent of children age 6-23 months who received packets of micronutrient powder (MNP) in the last 3 months: mother’s recall. (Q49A=1) AND (Q49B=1) Children 6-23 months (12) Vitamin A Supplementation in the last 6 months: Percentage of children age 6-23 months who received a dose of Vitamin A in the last 6 months: card verified or mother’s recall. (RC 8, OR) [(Q47 =1) AND (Q49=1)] OR [(Q83=1) AND (Q84Vitamin A Month <> 99 AND Q84Vitamin A Year <> 9999) AND (Date of Interview - Date of VitaminA<=6 months)] OR (Q92b=1 AND Q92c=1) Children 6-23 months Maternal Newborn Care (35% Level of Effort) Indicator Numerator Denominator Additional and Replacement Documentation Protocal 187 (13) Antenatal Care: Percentage of mothers of children age 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child. (RC1) (Q9a=1) AND (Q9b= A, B, or C) AND (Q12 ≥ 4 AND Q12 < 98 ) All Biological Mothers* (*RC uses all mothers, but it doesn’t make sense to include non-biological mothers) ANC first trimester (Q11≤3) All Biological Mothers (14) Maternal TT Vaccination: Percentage of mothers with children age 0-23 months who received at least two Tetanus toxoid vaccinations before the birth of their youngest child. (RC2) (Q18 + Q20 >=2) AND (Q18 <> 9 AND Q18 <> 9) All Biological Mothers (15) Skilled Birth Attendant: Percentage of children age 0-23 months whose births were attended by skilled personnel. (RC3) (Q23 = A, B , C, D or E) All Biological Mothers (16) Post-natal visit to check on newborn within the first 2 days after birth: Percentage of children age 0-23 who received a post-natal visit from an appropriate trained health worker within two days after the birth of the youngest child. (RC4) Number of children age 0-23 months who received a post-natal visit (Q26=1) AND within two days after birth (Q27U = 0) or (Q27U= 1) and (Q27N ≤ 2) AND by an appropriate health worker (Q28= A, B , C, D,E,F,G) U refers to the units of time (hours, days, weeks) and N refers to the corresponding number All Biological Mothers (17) Current Contraceptive Use Among Mothers of Young Children: Percentage of mothers of children age 0-23 months who are using a modern contraceptive method. (Q7 = 1) AND (Q8 = 1 - 12) All Biological Mothers Additional and Replacement Documentation Protocal 188 (RC5) (18) Maternal Iron Supplementation During Pregnancy: Percentage of mothers who received tablets; number of days consumed. (OR) Received tablets: Q21=1 Average number of days consumed: Q21=1 AND Sum of Q22 All Biological Mothers Those who received tablets (Q21=1) Early initiation of breastfeeding of newborns: Percentage of children 0-23 months put to the breast within one hour of delivery (Key Indicator for MNC) Calculation under Nutrition and Breastfeeding Control of Diarrheal Diseases (15% Level of Effort) Indicator Numerator Denominator (19) ORT use: 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. (RC 13) diarrhea in the last two weeks (Q66 = 1) AND who received ORS and/or recommended home fluids (Q67B OR 67C) Children 0-23 months who had diarrhea in prior 2 weeks (Q66=1) (20) Point of Use (POU) water treatment: Percentage of households of children age 0-23 months that treat water effectively. (RC15, OR) (Q76=1) AND (Q77= C, D, E or F) Children 0-23 months (21) Appropriate Hand washing Practices: Percentage of mothers of children age 0-23 months who live in households with soap at the place for hand washing. (RC16, OR) (Q79 ≤4) AND (Q80a=A or B) Children 0-23 months (21a) Exclusive Vessels for Hand Washing: Percentage of mothers of children age 0-23 months who (Q79 ≤4) AND (Q80c=A) Children 0-23 months whose mothers use a pan, pot, bowl or basin for hand washing Additional and Replacement Documentation Protocal 189 live in households with vessels used exclusively for hand washing (Q80b=B or D) Hand Washing at Appropriate times: Percentage of mothers of children age 0-23 months who wash hands with soap at all four key times (Before Food Preparation, Before Feeding Child, After Defecation/Visiting The Toilet, After attending to a child who has defecated/soiled) (Q78=B) AND (Q78=C) AND (Q78=D) AND (Q78=E) Children 0-23 months Latrine/toilet in good condition: Percentage of households of children age 0-23 months that have a toilet facility in appropriate condition Q81=3 or 4 Children 0-23 months (22) Increased fluid intake during diarrheal episode: Percentage of children 0-23 months with diarrhea in the last two weeks who were offered more fluids during the illness. (Key Indicator) (Q68=C) OR (Q69=C) Children 0-23 months who had diarrhea in prior 2 weeks (Q66=1) (23) Continued feeding during a diarrheal episode: Percentage of children 0-23 months with diarrhea in the last two weeks who were offered the same amount or more food during the illness. (Key Indicator) (Q68 = B or C) OR (Q70 = B or C) Children 0-23 months who had diarrhea in prior 2 weeks (Q66=1) (24) Zinc: Percentage of children 0-23 months with diarrhea in the last two weeks who were treated with zinc supplements. (Key Indicator) (Q67=D) Children 0-23 months who had diarrhea in prior 2 weeks (Q66=1) (25) Use of medicine during diarrhea: Percentage of children (Q67 DOES NOT=E,F,H or X) Purpose is to count number of children Children 0-23 months who had Additional and Replacement Documentation Protocal 190 0-23 months with diarrhea in last two weeks who were not treated with antidiarrheals or antibiotics. (Key Indicator) who did NOT receive anything that might have been an antibiotic or anti￾diarrheal (e.g. E, F, or H); If response given for “X” could be an antibiotic or anti-diarrheal, it should also count against inclusion. diarrhea in prior 2 weeks (Q66=1) (26) Safe feces disposal: Percentage of mothers of children 0-23 months who disposed of the youngest child’s feces safely the last time s/he passed stool. (Key Indicator) Safe disposal includes: dropped into toilet facility; water discarded into a toilet facility (except composting toilet); water discarded into sink or tub connected to drainage system (sewer, septic tank or pit). Latrine or toilet facility (Q82=A) Children 0-23 months (27) Two week prevalence of diarrhea: Percentage of children 0-23 months with diarrhea in the previous two weeks (Key Indicator) (Q66 = 1) Children 0-23 months Pneumonia Case Management (10% Level of Effort) Indicator Numerator Denominator (28) Appropriate Care Seeking for Pneumonia: Percentage of children age 0-23 months with chest-related cough and fast and/ or difficult breathing in the last two weeks who were taken to an appropriate health provider. (RC14) Cough and difficult breathing in the last two weeks [(Q62=1) AND (Q63= 1)] AND taken to an appropriate health provider (Q64=1) AND (Q65 = A,B,C) Total number of children age 0- 23 months with chest-related cough in the last two weeks (Q62=1) AND (Q63= 1) (29) Two week prevalence of suspected pneumonia: children 0-23 months with cough and cough and difficult breathing 2 weeks [(Q62=1) AND (Q63= 1)] All children 0-23 months Additional and Replacement Documentation Protocal 191 rapid and/or difficult breathing during two weeks prior to survey Immunization (Not official intervention) Indicator Numerator Denominator (30) Measles vaccination: Percentage of children age 12-23 months who received a measles vaccination (RC9) AGE12-23mos AND (Q83=1) AND (Q84mea1 <> 99 AND Q84mea1not written <> 9999) OR recalled by the mother (Q92a = 1) Children 12-23 months (31) Access to immunization services:Percentage of children aged 12-23 months who received PENTA-1 according to the vaccination card or mother’s recall by the time of the survey (RC10) AGE12-23 mos AND [(Q83=1) AND (Q84PENTA-1M <> 99 AND Q20PENTA-1Y <> 9999)] OR mother’s recall [(Q90=1) AND (Q91>=1)] Children 12-23 months (32) Health System Performance regarding Immunization services: Percentage of children aged 12-23 months who received PENTA-3 according to the vaccination card or mother’s recall by the time of the survey. (RC11) AGE12-23 mos AND [(Q83=1) AND (Q843M <> 99 AND Q84PENTA-3Y <> 9999)] OR Recalled by the mother [(Q90=1) AND (Q91>=3)] Children 12-23 months Malaria (Not official intervention) Indicator Numerator Denominator (33) Treatment of Fever in Malarious Zones 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. (RC12) Children 0-23 m with fever last 2 weeks (Q51 = 1) AND who sought treatment within 24 hours (Q52=1) AND (Q54 = 0 OR Q54=1) AND Was treated with an appropriate anti￾malarial drug Children 0-23 m with fever last 2 weeks (Q51 = 1) Additional and Replacement Documentation Protocal 192 (Q55 = 1) AND ( (Q56A ≤ 1or Q56B ≤ 1) (34) Child sleeps under an insecticide-treated bednet: Percentage of children age 0-23 months who slept under an insecticide-treated bed net (in malaria risk areas, where bed net use is effective) the previous night. (RC17) Has net slept under by child ((Q57 =1) AND (Q58 =1)) AND Net is long-lasting of known brand (Q59<= 3) OR Net treated in last 6 months ((Q59 > 3 and Q59 <> 9) AND (Q60=1) AND (Q61 <=6)) Children 0-23 months Two week prevalence of fever (Q51 = 1) Children 0-23 months Care-seeking for fever Percentage of children age 0-23 months with a febrile episode during the last two weeks who sought treatment from appropriate provider. Q51=1 AND Q52=1 AND Q53=1,2,3 or 4 Q51=1 Process Indicators Indicator Numerator Denominator (35) Contact with CHW: Percent of households with children 0-23 months that received health information from a CHW in the past month, according to location (home visit, community meeting, health facility, Growth Monitoring and Counselling, Nutrition Week, etc.) Contact for any purpose: (Q103=A,B,C,D,E or F) All children 0-23 months (36) CHW Home Visits: Percent of households with children 0-23 months that received a visit from a CHW in the past month, according to reported purpose (follow up on sick child, provide health education on malaria, provide health education on diarrhea, provide health Visit for any purpose: (Q102=A,B,C,D,E,F or G) All children 0-23 months Visit for sick child or follow up: (Q102=A) All children 0-23 months Visit for education (1 or more topics) (Q102=B,C,D,E or F) All children 0-23 months Visit for education by topic Frequencies for each topic: (Q102 =B) Those children visited for education Additional and Replacement Documentation Protocal 193 education on pneumonia, provide health education on nutrition, provide health education on immunization.) (OR) (Q102 =C) (Q102=D) (Q102=E) (Q102=F) (Q102=B,C,D,E or F) (Q102=B,C,D,E or F) (Q102=B,C,D,E or F) (Q102=B,C,D,E or F) (Q102=B,C,D,E or F) (37)Participation in Nutrition Weeks: Percentage of mothers with children 0-23 months who participated in “Nutrition Week” intervention at least once in the prior 6 months for 4 or more days. (OR) Ever Participated (Q97=1) All children 0-23 months Number of times (Q98=1) (Q98=2) (Q98≥3) All children 0-23 months All children 0-23 months All children 0-23 months % Participation in last 6 months (Q99 Month & Year < 6 months from survey) All children 0-23 months %Participation in last 12 months (Q99 Month & Year <12 months from survey) All children 0-23 months Duration of participation (% of participants who reported participation according to number of days) One day: (Q100=1) Two days: (Q100=2 Three days: (Q100=3) Four days: (Q100=4) Five days: (Q100=5) Six or more days: (Q100≥6) Reported number of days Q100 >=1 AND Q100<8 Q100 >=1 AND Q100<8 Q100 >=1 AND Q100<8 Q100 >=1 AND Q100<8 Q100 >=1 AND Q100<8 Q100 >=1 AND Q100<8 Participated at least 4 days in a Nutrition Week held in the past six months (Q99 Month & Year < 6 months from survey) All children 0-23 months Additional and Replacement Documentation Protocal 194 AND Q100>=4 (38) Contact with a Modified Care Group Member: Percent of households with children 0-23 months that received a visit from a CHW in the past month, according to reported purpose (follow up on sick child, provide health education on malaria, provide health education on diarrhea, provide health education on pneumonia, provide health education on nutrition, provide health education on immunization.) Visit for any purpose: Q101=A AND (Q102=A,B,C,D,E,F or G) All children 0-23 months Visit for education (1 or more topics) Q101=A AND (Q102=B,C,D,E or F) All children 0-23 months Visit for education by topic Frequencies for each topic: Q101=A AND (Q102 =B) Q101=A AND (Q102 =C) Q101=A AND (Q102=D) Q101=A AND (Q102=E) Q101=A AND (Q102=F) Those children visited for education (Q102=B,C,D,E or F) (Q102=B,C,D,E or F) (Q102=B,C,D,E or F) (Q102=B,C,D,E or F) (Q102=B,C,D,E or F) (39) Churches Providing Health Information: Percent of households with children 0-23 months that received health information from a church in the last month Information on any health topic : Q104=A,B,C,D,E,F,G or H Information by topic Frequencies for each topic Q104=A Q104=B Q104=C Q104=D Q104=E Q104=F Q104=G Q104=H All Children 0-23 months Those who received information (Q104=A,B,C,D,E,F,G or H) (Q104=A,B,C,D,E,F,G or H) (Q104=A,B,C,D,E,F,G or H) (Q104=A,B,C,D,E,F,G or H) (Q104=A,B,C,D,E,F,G or H) (Q104=A,B,C,D,E,F,G or H) (Q104=A,B,C,D,E,F,G or H) (Q104=A,B,C,D,E,F,G or H) Food Security Indicator Numerator Denominator (40) Kitchen Gardens: Percent of households of children 0-23 months who own a kitchen garden Q105a=1 All children 0-23 months (41) Kitchen Garden used for Q105a=1 All households with a kitchen Additional and Replacement Documentation Protocal 195 feeding children: Percent of households of children 0-23 months with a kitchen garden where children eat the food produced AND Q105b=B or C AND Q105d=A or C garden (Q105a=1) (42) Small animal husbandry: Percent of households of children 0-23 months who raise small animals Q106=1 All children 0-23 months 43) Small animals used for feeding children: Percent of households who raise small animals where children eat the food produced Q106=1 AND Q106b=B or C AND Q106d=A or C All households who raise small animals (Q106=1) (44) Income from kitchen gardens and small animals: Percent of households of children 0-23 months who spend income from kitchen gardens or small animals toward food or health care Income toward food or healthcare {(Q105B=A or C) OR (Q106b=A or C)} AND {(q105C= A or B) OR (Q106c= A or B)} Income toward food {(Q105B=A or C) OR (Q106b=A or C)} AND {(Q105C= A) OR (Q106c= A)} Income toward health care {(Q105B=A or C) OR (Q106b=A or C)} AND {(Q105C= B) OR (Q106c= B)} All children 0-23 months AND {(Q105B=A or C) OR (Q106b=A or C)} Additional and Replacement Documentation Protocal 196 Annex 9. Project Resource Requirements of Year 4 KPC Survey ICSP Year 4 Evaluation Budget - Actual Costs ACTIVITIES Units Quant ity Days Rate TOTAL (RwFrs) I. Household Survey Training of supervisors on HH Survey Supervisors from District Person 1 1 5,000 5,000 Supervisors from I-CSP Person 3 Research Coordinator Person 1 Tea break for Participants 5 1 1,500 7,500 Lunch for Participants Lunch 5 1 3,000 15,000 Water bottle 5 1 400 2,000 29,500 Training of surveyors on HH Survey Enumerators from Health Facilities & Sectors Person 26 3 19,500 1,521,000 Enumerators from I- CSP Person 6 Supervisors from District Person 1 3 5,000 15,000 Supervisors from I-CSP Person 3 Research Coordinator Person 1 Tea break for Participants 37 3 1,500 166,500 Lunch for Participants Lunch 37 3 3,000 333,000 Transport cost for HC & Sector participants Person 26 2 10,000 520,000 Transport cost for participants: field gtest Car 2 1 60,000 120,000 Water bottle 37 3 400 44,400 2,719,900 Household Survey Enumerators from Health Facilities & Sectors Person 26 8 15,000 3,120,000 Transport cost for HC & Sector participants Motobikes 10 8 15,000 1,200,000 Supervisors from District Person 1 8 15,000 120,000 Lunch for Project surveyors Lunch 3 8 2,000 48,000 Overnights for Project surveyors -HH Survey Overnight 6 8 12,000 576,000 Research Coordinator 1 Water bottle 74 8 400 236,800 Community guides person 60 1 3000 180,000 5,480,800 II. Interviews & Focus Group Discussions Training of surveyors on Qualitative research Surveyors from Kaduha Health Facilities & Sectors Person 10 2 19,500 390,000 Surveyors from Kigeme Health Facilities & Sectors Person 10 2 5,000 100,000 Surveyors from ICSP Person 9 Research Coordinator Person 1 Tea break for Participants 30 2 1,500 90,000 Lunch for Participants Lunch 30 2 3,000 180,000 Transport cost for HC & Sector participants Person 20 2 10,000 400,000 Water bottle 30 2 400 24,000 Additional and Replacement Documentation Protocal 197 1,184,000 Data collection- Interviews & FGDs Surveyors from Kaduha Health Facilities & Sectors Person 10 4 5,000 200,000 Surveyors from Kigeme Health Facilities & Sectors Person 10 4 5,000 200,000 Lunch for Project surveyors Lunch 9 1 2,000 18,000 Research Coordinator Person 1 Water bottle 30 6 400 72,000 Refreshment for FGD participants person 120 1 3,000 360,000 850,000 Supplies & Logistics flipchart pc 3 1 6,000 18,000 markers pc 2 1 3,500 7,000 pens pc 50 1 100 5,000 folders and Note books pc 50 1 3,500 175,000 vehicle rental- HH survey veh 2 8 100,000 1,600,000 vehicle rental-QA veh 2 6 100,000 1,200,000 phone cards card 50 1 2,000 100,000 Renewal fees 1 1 425,000 425,000 3,530,000 Total 13,794,200 Rwanda ICSP Final Evaluation Report September 2015 Page 198 of 997 Annex 10. Year 4 KPC Raw Data for each question INNOVATION CHILD SURVIVAL TANGIRANEZA PROGRAM NYAMAGABE DISTRICT WRR YEAR 3 KPC RAW DATA SORT CASES BY HospitalCatchment. SPLIT FILE LAYERED BY HospitalCatchment. FREQUENCIES VARIABLES=MotherConsent /ORDER=ANALYSIS. i10) Was consent received? Statistics MotherConsent Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 MotherConsent HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 360 100,0 100,0 100,0 Kaduha Valid Yes 360 100,0 100,0 100,0 FREQUENCIES VARIABLES=SexChild /ORDER=ANALYSIS. Frequencies Sex Child [DataSet1] Statistics SexChild Additional and Replacement Documentation Protocal 199 SexChild HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Male 171 47,5 47,5 47,5 Female 189 52,5 52,5 100,0 Total 360 100,0 100,0 Kaduha Valid Male 173 48,1 48,1 48,1 Female 187 51,9 51,9 100,0 Total 360 100,0 100,0 AGE OF A CHILD UNDER 2 YEARS FREQUENCIES VARIABLES=CalcAgeChild /STATISTICS=STDDEV MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics CalcAgeChild Kigeme N Valid 360 Missing 0 Mean 10,264 Median 10,000 Std. Deviation 6,5347 Kaduha N Valid 360 Missing 0 Mean 10,767 Median 11,000 Std. Deviation 6,5679 CalcAgeChild HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 0 16 4,4 4,4 4,4 1 22 6,1 6,1 10,6 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 Additional and Replacement Documentation Protocal 200 2 16 4,4 4,4 15,0 3 13 3,6 3,6 18,6 4 16 4,4 4,4 23,1 5 7 1,9 1,9 25,0 6 31 8,6 8,6 33,6 7 23 6,4 6,4 40,0 8 14 3,9 3,9 43,9 9 19 5,3 5,3 49,2 10 13 3,6 3,6 52,8 11 23 6,4 6,4 59,2 12 19 5,3 5,3 64,4 13 13 3,6 3,6 68,1 14 8 2,2 2,2 70,3 15 19 5,3 5,3 75,6 16 10 2,8 2,8 78,3 17 12 3,3 3,3 81,7 18 12 3,3 3,3 85,0 19 15 4,2 4,2 89,2 20 12 3,3 3,3 92,5 21 10 2,8 2,8 95,3 22 10 2,8 2,8 98,1 23 7 1,9 1,9 100,0 Total 360 100,0 100,0 Kaduha Valid 0 12 3,3 3,3 3,3 1 16 4,4 4,4 7,8 2 18 5,0 5,0 12,8 3 17 4,7 4,7 17,5 4 16 4,4 4,4 21,9 5 11 3,1 3,1 25,0 6 17 4,7 4,7 29,7 7 13 3,6 3,6 33,3 8 26 7,2 7,2 40,6 9 18 5,0 5,0 45,6 10 14 3,9 3,9 49,4 11 25 6,9 6,9 56,4 12 20 5,6 5,6 61,9 13 15 4,2 4,2 66,1 Additional and Replacement Documentation Protocal 201 14 16 4,4 4,4 70,6 15 16 4,4 4,4 75,0 16 3 ,8 ,8 75,8 17 14 3,9 3,9 79,7 18 16 4,4 4,4 84,2 19 10 2,8 2,8 86,9 20 12 3,3 3,3 90,3 21 8 2,2 2,2 92,5 22 16 4,4 4,4 96,9 23 11 3,1 3,1 100,0 Total 360 100,0 100,0 COMPUTE Cat_age=CalcAgeChild. EXECUTE. RECODE Cat_age (0 thru 5.9=1) (6 thru 23.9=2) INTO Age_Category. EXECUTE. FREQUENCIES VARIABLES=Age_Category /ORDER=ANALYSIS. FREQUENCIES VARIABLES=Age_Category /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics Age_Category Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 Age_Category HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 0_5months 90 25,0 25,0 25,0 6_23 months 270 75,0 75,0 100,0 Total 360 100,0 100,0 Kaduha Valid 0_5months 90 25,0 25,0 25,0 6_23 months 270 75,0 75,0 100,0 Total 360 100,0 100,0 Age Mother Frequencies [DataSet1] Statistics Additional and Replacement Documentation Protocal 202 AgeMother Kigeme N Valid 360 Missing 0 Mean 29,01 Median 28,50 Std. Deviation 6,343 Kaduha N Valid 360 Missing 0 Mean 29,86 Median 30,00 Std. Deviation 6,424 AgeMother HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 16 1 ,3 ,3 ,3 17 1 ,3 ,3 ,6 18 6 1,7 1,7 2,2 19 3 ,8 ,8 3,1 20 14 3,9 3,9 6,9 21 11 3,1 3,1 10,0 22 23 6,4 6,4 16,4 23 27 7,5 7,5 23,9 24 15 4,2 4,2 28,1 25 21 5,8 5,8 33,9 26 21 5,8 5,8 39,7 27 20 5,6 5,6 45,3 28 17 4,7 4,7 50,0 29 15 4,2 4,2 54,2 30 22 6,1 6,1 60,3 31 24 6,7 6,7 66,9 32 21 5,8 5,8 72,8 33 15 4,2 4,2 76,9 34 10 2,8 2,8 79,7 35 18 5,0 5,0 84,7 36 8 2,2 2,2 86,9 37 7 1,9 1,9 88,9 38 5 1,4 1,4 90,3 Additional and Replacement Documentation Protocal 203 39 4 1,1 1,1 91,4 40 8 2,2 2,2 93,6 41 9 2,5 2,5 96,1 42 5 1,4 1,4 97,5 43 5 1,4 1,4 98,9 44 1 ,3 ,3 99,2 45 3 ,8 ,8 100,0 Total 360 100,0 100,0 Kaduha Valid 16 1 ,3 ,3 ,3 17 1 ,3 ,3 ,6 18 6 1,7 1,7 2,2 19 1 ,3 ,3 2,5 20 10 2,8 2,8 5,3 21 8 2,2 2,2 7,5 22 12 3,3 3,3 10,8 23 23 6,4 6,4 17,2 24 18 5,0 5,0 22,2 25 26 7,2 7,2 29,4 26 14 3,9 3,9 33,3 27 18 5,0 5,0 38,3 28 19 5,3 5,3 43,6 29 19 5,3 5,3 48,9 30 34 9,4 9,4 58,3 31 15 4,2 4,2 62,5 32 15 4,2 4,2 66,7 33 17 4,7 4,7 71,4 34 20 5,6 5,6 76,9 35 16 4,4 4,4 81,4 36 9 2,5 2,5 83,9 37 18 5,0 5,0 88,9 38 9 2,5 2,5 91,4 39 5 1,4 1,4 92,8 40 9 2,5 2,5 95,3 41 4 1,1 1,1 96,4 42 1 ,3 ,3 96,7 43 4 1,1 1,1 97,8 44 2 ,6 ,6 98,3 45 1 ,3 ,3 98,6 Additional and Replacement Documentation Protocal 204 46 1 ,3 ,3 98,9 47 2 ,6 ,6 99,4 50 1 ,3 ,3 99,7 61 1 ,3 ,3 100,0 Total 360 100,0 100,0 FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=BiologicalMother /ORDER=ANALYSIS. i15) Are you the biological mother of the child? Frequencies [DataSet1] Statistics BiologicalMother Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 BiologicalMother HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 360 100,0 100,0 100,0 Kaduha Valid No 3 ,8 ,8 ,8 Yes 357 99,2 99,2 100,0 Total 360 100,0 100,0 Q1. Have you ever attended school? FREQUENCIES VARIABLES=q01 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q01 Kigeme N Valid 360 Missing 0 Additional and Replacement Documentation Protocal 205 Kaduha N Valid 360 Missing 0 q01 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 53 14,7 14,7 14,7 Yes 307 85,3 85,3 100,0 Total 360 100,0 100,0 Kaduha Valid No 64 17,8 17,8 17,8 Yes 296 82,2 82,2 100,0 Total 360 100,0 100,0 Q2. If yes, then ask: What is the highest grade or level of school you have completed? Frequencies Statistics q02 Kigeme N Valid 307 Missing 0 Kaduha N Valid 296 Missing 0 q02 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid None/Didnot complete primary school 113 36,8 36,8 36,8 Primary School 172 56,0 56,0 92,8 Secondary School 22 7,2 7,2 100,0 Total 307 100,0 100,0 Kaduha Valid None/Didnot complete primary school 138 46,6 46,6 46,6 Primary School 135 45,6 45,6 92,2 Secondary School 20 6,8 6,8 99,0 Past secondary School 3 1,0 1,0 100,0 Total 296 100,0 100,0 Q3. How many people live in your household? Frequencies [DataSet1] Additional and Replacement Documentation Protocal 206 Statistics q03 Kigeme N Valid 360 Missing 0 Mean 5,18 Median 5,00 Std. Deviation 1,792 Kaduha N Valid 360 Missing 0 Mean 5,05 Median 5,00 Std. Deviation 1,772 q03 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 2 3 ,8 ,8 ,8 3 66 18,3 18,3 19,2 4 81 22,5 22,5 41,7 5 73 20,3 20,3 61,9 6 57 15,8 15,8 77,8 7 36 10,0 10,0 87,8 8 26 7,2 7,2 95,0 9 14 3,9 3,9 98,9 10 1 ,3 ,3 99,2 11 3 ,8 ,8 100,0 Total 360 100,0 100,0 Kaduha Valid 2 4 1,1 1,1 1,1 3 76 21,1 21,1 22,2 4 74 20,6 20,6 42,8 5 83 23,1 23,1 65,8 6 55 15,3 15,3 81,1 7 25 6,9 6,9 88,1 8 29 8,1 8,1 96,1 9 7 1,9 1,9 98,1 10 6 1,7 1,7 99,7 11 1 ,3 ,3 100,0 Total 360 100,0 100,0 Additional and Replacement Documentation Protocal 207 Q4a. What is your ubudehe category according to the participatory poverty assessment as defined by MINALOC? Frequencies [DataSet1] Statistics Q04 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 Q04 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Those in abject poverty 33 9,2 9,2 9,2 The very poor 82 22,8 22,8 31,9 The poor 243 67,5 67,5 99,4 The resourceful poor 2 ,6 ,6 100,0 Total 360 100,0 100,0 Kaduha Valid Those in abject poverty 32 8,9 8,9 8,9 The very poor 83 23,1 23,1 31,9 The poor 241 66,9 66,9 98,9 The resourceful poor 4 1,1 1,1 100,0 Total 360 100,0 100,0 Q4b. If the category is unknown, the interviewer should check the list at the health center so that data is entered for every household. If there is debate, use the category assigned by MINALOC. Frequencies [DataSet1] Statistics Q4b Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 Q4b Additional and Replacement Documentation Protocal 208 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 58 16,1 16,1 16,1 Yes 302 83,9 83,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 61 16,9 16,9 16,9 Yes 299 83,1 83,1 100,0 Total 360 100,0 100,0 Q4c. Are you using health insurance? Member card seen by interviewer Frequencies [DataSet1] Statistics If yes: Can I see your member card? Kigeme N Valid 302 Missing 0 Kaduha N Valid 299 Missing 0 If yes: Can I see your member card? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No card 26 8,6 8,6 8,6 Card availabe 276 91,4 91,4 100,0 Total 302 100,0 100,0 Kaduha Valid No card 6 2,0 2,0 2,0 Card availabe 293 98,0 98,0 100,0 Total 299 100,0 100,0 Q5. How long should you wait after the birth of your child before you try to become pregnant again? USE ALL. COMPUTE filter_$=(BiologicalMother = 1). VARIABLE LABEL filter_$ 'BiologicalMother = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q05 /ORDER=ANALYSIS. Frequencies Additional and Replacement Documentation Protocal 209 [DataSet1] Statistics Q5. How long should you wait after the birth of your child before you try to become pregnant again? Kigeme N Valid 360 Missing 0 Kaduha N Valid 357 Missing 0 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid LESS THAN 2 YEARS 5 1,4 1,4 1,4 2 TO 5 YEARS 88 24,4 24,4 25,8 MORE THAN 5 YEARS 164 45,6 45,6 71,4 I WII NEVER GET PREGNANT 94 26,1 26,1 97,5 DON’T KNOW 9 2,5 2,5 100,0 Total 360 100,0 100,0 Kaduha Valid LESS THAN 2 YEARS 5 1,4 1,4 1,4 2 TO 5 YEARS 95 26,6 26,6 28,0 MORE THAN 5 YEARS 134 37,5 37,5 65,5 I WII NEVER GET PREGNANT 114 31,9 31,9 97,5 DON’T KNOW 9 2,5 2,5 100,0 Total 357 100,0 100,0 Q6. What are the risks of getting pregnant too soon after the birth of a child? FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=Q06A Q06B Q06C Q06D Q06E Q06X /ORDER=ANALYSIS. Frequencies FREQUENCIES VARIABLES=Q06A Q06B Q06C Q06D Q06E Q06X /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics HospitalCatchment BABY BORN TOO SMALL BABY BORN TOO EARLY MOTHER CAN DIE MOTHER CAN HAVE MISCARRIAGE MOTHER CAN SUFFER ANEMIA OTHER Additional and Replacement Documentation Protocal 210 Kigeme N Valid 360 360 360 360 360 360 Missing 0 0 0 0 0 0 Kaduha N Valid 360 360 360 360 360 360 Missing 0 0 0 0 0 0 Frequency Table BABY BORN TOO SMALL HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 249 69,2 69,2 69,2 Yes 111 30,8 30,8 100,0 Total 360 100,0 100,0 Kaduha Valid No 215 59,7 59,7 59,7 Yes 145 40,3 40,3 100,0 Total 360 100,0 100,0 BABY BORN TOO EARLY HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 312 86,7 86,7 86,7 Yes 48 13,3 13,3 100,0 Total 360 100,0 100,0 Kaduha Valid No 262 72,8 72,8 72,8 Yes 98 27,2 27,2 100,0 Total 360 100,0 100,0 MOTHER CAN DIE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 264 73,3 73,3 73,3 Yes 96 26,7 26,7 100,0 Total 360 100,0 100,0 Kaduha Valid No 219 60,8 60,8 60,8 Yes 141 39,2 39,2 100,0 Total 360 100,0 100,0 MOTHER CAN HAVE MISCARRIAGE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 316 87,8 87,8 87,8 Yes 44 12,2 12,2 100,0 Total 360 100,0 100,0 Additional and Replacement Documentation Protocal 211 Kaduha Valid No 262 72,8 72,8 72,8 Yes 98 27,2 27,2 100,0 Total 360 100,0 100,0 MOTHER CAN SUFFER ANEMIA HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 306 85,0 85,0 85,0 Yes 54 15,0 15,0 100,0 Total 360 100,0 100,0 Kaduha Valid No 255 70,8 70,8 70,8 Yes 105 29,2 29,2 100,0 Total 360 100,0 100,0 OTHER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 69 19,2 19,2 19,2 Yes 291 80,8 80,8 100,0 Total 360 100,0 100,0 Kaduha Valid No 143 39,7 39,7 39,7 Yes 217 60,3 60,3 100,0 Total 360 100,0 100,0 Q7. Are you currently doing something or using any method to delay or avoid getting pregnant? USE ALL. COMPUTE filter_$=(BiologicalMother = 1). VARIABLE LABEL filter_$ 'BiologicalMother = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q07 /ORDER=ANALYSIS. Frequencies Statistics Kigeme N Valid 360 Missing 0 Kaduha N Valid 357 Missing 0 Additional and Replacement Documentation Protocal 212 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 62 17,2 17,2 17,2 Yes 298 82,8 82,8 100,0 Total 360 100,0 100,0 Kaduha Valid No 76 21,3 21,3 21,3 Yes 281 78,7 78,7 100,0 Total 357 100,0 100,0 Q8. Which method are you (or your husband/ partner) using? FREQUENCIES VARIABLES=q08 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics Kigeme N Valid 298 Missing 62 Kaduha N Valid 281 Missing 76 Q8. Which method are you (or your husband/ partner) using? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid PILL 48 13,3 16,1 16,1 IUD 3 ,8 1,0 17,1 INJECTABLES 178 49,4 59,7 76,8 IMPLANTS 16 4,4 5,4 82,2 MALE CONDOM 17 4,7 5,7 87,9 FEMALE CONDOM 1 ,3 ,3 88,3 DIAPHRAGM 2 ,6 ,7 88,9 LACTATIONAL METHOD 5 1,4 1,7 90,6 STANDARD DAYS METHOD/ CYCLEBEADS 14 3,9 4,7 95,3 RHYTHM METHOD (OTHER THAN STANDARD DAYS) 2 ,6 ,7 96,0 WITHDRAWAL 1 ,3 ,3 96,3 OTHER 11 3,1 3,7 100,0 Total 298 82,8 100,0 Missing System 62 17,2 Total 360 100,0 Additional and Replacement Documentation Protocal 213 Kaduha Valid FEMALE STERILIZATION 2 ,6 ,7 ,7 PILL 53 14,8 18,9 19,6 IUD 3 ,8 1,1 20,6 INJECTABLES 136 38,1 48,4 69,0 IMPLANTS 20 5,6 7,1 76,2 MALE CONDOM 17 4,8 6,0 82,2 LACTATIONAL METHOD 16 4,5 5,7 87,9 STANDARD DAYS METHOD/ CYCLEBEADS 14 3,9 5,0 92,9 WITHDRAWAL 4 1,1 1,4 94,3 OTHER 16 4,5 5,7 100,0 Total 281 78,7 100,0 Missing System 76 21,3 Total 357 100,0 Q9a. During your pregnancy with (Name), did you see anyone for antenatal care? FREQUENCIES VARIABLES=Q9a /ORDER=ANALYSIS. Frequencies Statistics Kigeme N Valid 360 Missing 0 Kaduha N Valid 357 Missing 0 Q9a. During your pregnancy with (Name), did you see anyone for antenatal care? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 4 1,1 1,1 1,1 Yes 356 98,9 98,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 1 ,3 ,3 ,3 Yes 356 99,7 99,7 100,0 Total 357 100,0 100,0 Q9b. IF YES: Whom did you see? Anyone else? Frequency Table GET FILE='C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav'. DATASET NAME DataSet1 WINDOW=FRONT. USE ALL. COMPUTE filter_$=(Q9a = 1). Additional and Replacement Documentation Protocal 214 VARIABLE LABEL filter_$ 'Q9a = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q9bA Q9bB Q9bC Q9bD Q9bX /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics HospitalCatchment Q9bA. DOCTOR/MEDICAL ASSISTANT Q9bB. NURSE Q9bC.MIDWIFE Q9bD. TRADITIONAL BIRTH ATTENDANT Q9bX. OTHER Kigeme N Valid 356 356 356 356 356 Missing 0 0 0 0 0 Kaduha N Valid 356 356 356 356 356 Missing 0 0 0 0 0 Frequency Table Q9bA. DOCTOR/MEDICAL ASSISTANT HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 349 98,0 98,0 98,0 Yes 7 2,0 2,0 100,0 Total 356 100,0 100,0 Kaduha Valid No 350 98,3 98,3 98,3 Yes 6 1,7 1,7 100,0 Total 356 100,0 100,0 Q9bB. NURSE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 6 1,7 1,7 1,7 Yes 350 98,3 98,3 100,0 Total 356 100,0 100,0 Kaduha Valid No 5 1,4 1,4 1,4 Yes 351 98,6 98,6 100,0 Total 356 100,0 100,0 Q9bC.MIDWIFE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 351 98,6 98,6 98,6 Yes 5 1,4 1,4 100,0 Additional and Replacement Documentation Protocal 215 Total 356 100,0 100,0 Kaduha Valid No 356 100,0 100,0 100,0 Q9bD. TRADITIONAL BIRTH ATTENDANT HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 356 100,0 100,0 100,0 Kaduha Valid No 356 100,0 100,0 100,0 Q9bX. OTHER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 356 100,0 100,0 100,0 Kaduha Valid No 356 100,0 100,0 100,0 Q10. During your pregnancy with (Name), where did you receive antenatal care? FREQUENCIES VARIABLES=Q10A Q10B Q10C Q10D Q10E Q10F Q10G Q10H Q10I Q10J Q10K Q10X /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics HospitalCatchment Q10A Q10B Q10C Q10D Q10E Q10F Q10G Q10H Q10I Q10J Q10K Q10X Kigeme N Valid 356 356 356 356 356 356 356 356 356 356 356 356 Missing 0 0 0 0 0 0 0 0 0 0 0 0 Kaduha N Valid 356 356 356 356 356 356 356 356 356 356 356 356 Missing 0 0 0 0 0 0 0 0 0 0 0 0 Frequency Table Q10A YOUR HOME HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 356 100,0 100,0 100,0 Kaduha Valid No 356 100,0 100,0 100,0 Q10B MIDWIFE/TBA HOME HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 356 100,0 100,0 100,0 Kaduha Valid No 356 100,0 100,0 100,0 Q10C OTHER HOME HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 356 100,0 100,0 100,0 Kaduha Valid No 355 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Additional and Replacement Documentation Protocal 216 Q10A YOUR HOME HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 356 100,0 100,0 100,0 Total 356 100,0 100,0 Q10D HOSPITAL HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 348 97,8 97,8 97,8 Yes 8 2,2 2,2 100,0 Total 356 100,0 100,0 Kaduha Valid No 347 97,5 97,5 97,5 Yes 9 2,5 2,5 100,0 Total 356 100,0 100,0 Q10E HEALTH CENTER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 5 1,4 1,4 1,4 Yes 351 98,6 98,6 100,0 Total 356 100,0 100,0 Kaduha Valid No 6 1,7 1,7 1,7 Yes 350 98,3 98,3 100,0 Total 356 100,0 100,0 Q10F HEALTH POST HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 354 99,4 99,4 99,4 Yes 2 ,6 ,6 100,0 Total 356 100,0 100,0 Kaduha Valid No 356 100,0 100,0 100,0 Q10G OUTREACH HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 356 100,0 100,0 100,0 Kaduha Valid No 356 100,0 100,0 100,0 Q10H OTHER PUBLIC HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 355 99,7 99,7 99,7 Additional and Replacement Documentation Protocal 217 Yes 1 ,3 ,3 100,0 Total 356 100,0 100,0 Kaduha Valid No 356 100,0 100,0 100,0 Q10I PRIVATE HOSPITAL HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 355 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 356 100,0 100,0 Kaduha Valid No 356 100,0 100,0 100,0 Q10J PRIVATE CLINIC HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 355 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 356 100,0 100,0 Kaduha Valid No 356 100,0 100,0 100,0 Q10K OTHER PRIVATE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 356 100,0 100,0 100,0 Kaduha Valid No 356 100,0 100,0 100,0 Q10X OTHER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 354 99,4 99,4 99,4 Yes 2 ,6 ,6 100,0 Total 356 100,0 100,0 Kaduha Valid No 355 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 356 100,0 100,0 Q11. During your pregnancy with (Name), how many months pregnant were you when you first received antenatal care? Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav USE ALL. COMPUTE filter_$=(Q9a = 1and q11 < 88). VARIABLE LABEL filter_$ 'Q9a = 1and q11 < 88 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. Additional and Replacement Documentation Protocal 218 FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q11 /STATISTICS=STDDEV MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics Q11.During your pregnancy with (Name), how many months pregnant were you when you first received antenatal care? Kigeme N Valid 356 Missing 0 Mean 3,38 Median 3,00 Std. Deviation 1,048 Kaduha N Valid 352 Missing 0 Mean 3,49 Median 3,00 Std. Deviation 1,075 Q11.During your pregnancy with (Name), how many months pregnant were you when you first received antenatal care? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 1 5 1,4 1,4 1,4 2 32 9,0 9,0 10,4 3 215 60,4 60,4 70,8 4 58 16,3 16,3 87,1 5 28 7,9 7,9 94,9 6 10 2,8 2,8 97,8 7 8 2,2 2,2 100,0 Total 356 100,0 100,0 Kaduha Valid 1 1 ,3 ,3 ,3 2 15 4,3 4,3 4,5 3 227 64,5 64,5 69,0 4 63 17,9 17,9 86,9 5 27 7,7 7,7 94,6 6 8 2,3 2,3 96,9 7 5 1,4 1,4 98,3 Additional and Replacement Documentation Protocal 219 8 6 1,7 1,7 100,0 Total 352 100,0 100,0 Q12. During your pregnancy with (Name), how many times did you receive antenatal care?/ Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics Kigeme N Valid 356 Missing 0 Kaduha N Valid 356 Missing 0 Q12. During your pregnancy with (Name), how many times did you receive antenatal care?/ HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 1 4 1,1 1,1 1,1 2 32 9,0 9,0 10,1 3 103 28,9 28,9 39,0 4 213 59,8 59,8 98,9 5 2 ,6 ,6 99,4 6 2 ,6 ,6 100,0 Total 356 100,0 100,0 Kaduha Valid 1 11 3,1 3,1 3,1 2 17 4,8 4,8 7,9 3 116 32,6 32,6 40,4 4 205 57,6 57,6 98,0 5 5 1,4 1,4 99,4 6 1 ,3 ,3 99,7 9 1 ,3 ,3 100,0 Total 356 100,0 100,0 Q13. As part of your antenatal care during this pregnancy, were any of the following done at least once? FREQUENCIES VARIABLES=q13A q13B q13C q13D /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics HospitalCatchment q13A q13B q13C q13D Kigeme N Valid 356 356 356 356 Additional and Replacement Documentation Protocal 220 Missing 0 0 0 0 Kaduha N Valid 356 356 356 356 Missing 0 0 0 0 Frequency Table q13A HEIGHT HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 43 12,1 12,1 12,1 Yes 313 87,9 87,9 100,0 Total 356 100,0 100,0 Kaduha Valid No 77 21,6 21,6 21,6 Yes 279 78,4 78,4 100,0 Total 356 100,0 100,0 q13B BP HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 8 2,2 2,2 2,2 Yes 348 97,8 97,8 100,0 Total 356 100,0 100,0 Kaduha Valid No 17 4,8 4,8 4,8 Yes 339 95,2 95,2 100,0 Total 356 100,0 100,0 q13C URINE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 101 28,4 28,4 28,4 Yes 255 71,6 71,6 100,0 Total 356 100,0 100,0 Kaduha Valid No 176 49,4 49,4 49,4 Yes 180 50,6 50,6 100,0 Total 356 100,0 100,0 q13D BLOOD HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 8 2,2 2,2 2,2 Yes 348 97,8 97,8 100,0 Total 356 100,0 100,0 Kaduha Valid No 17 4,8 4,8 4,8 Yes 339 95,2 95,2 100,0 Additional and Replacement Documentation Protocal 221 q13A HEIGHT HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 43 12,1 12,1 12,1 Yes 313 87,9 87,9 100,0 Total 356 100,0 100,0 Kaduha Valid No 77 21,6 21,6 21,6 Yes 279 78,4 78,4 100,0 Total 356 100,0 100,0 Q14. During (any of) your antenatal care visits, were you told about the signs of pregnancy complications? Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q14 Kigeme N Valid 356 Missing 0 Kaduha N Valid 356 Missing 0 q14 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 45 12,6 12,6 12,6 Yes 308 86,5 86,5 99,2 Don't know 3 ,8 ,8 100,0 Total 356 100,0 100,0 Kaduha Valid No 51 14,3 14,3 14,3 Yes 305 85,7 85,7 100,0 Total 356 100,0 100,0 Q15. Were you told where to go if you had any of these complications? Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav USE ALL. COMPUTE filter_$=(Q9a = 1 and q14 = 1). VARIABLE LABEL filter_$ 'Q9a = 1 and q14 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. Additional and Replacement Documentation Protocal 222 FREQUENCIES VARIABLES=q15 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q15 Kigeme N Valid 308 Missing 0 Kaduha N Valid 305 Missing 0 q15 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 3 1,0 1,0 1,0 Yes 305 99,0 99,0 100,0 Total 308 100,0 100,0 Kaduha Valid No 4 1,3 1,3 1,3 Yes 301 98,7 98,7 100,0 Total 305 100,0 100,0 Q16. During pregnancy, woman may encounter severe problems or illnesses and should go or be taken immediately to a health facility. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics HospitalCatchment Q16A Q16B Q16C Q16D Q16E Q16F Q16G Q16H Q16I Q16X Kigeme N Valid 360 360 360 360 360 360 360 360 360 360 Missing 0 0 0 0 0 0 0 0 0 0 Kaduha N Valid 360 360 360 360 360 360 360 360 360 360 Missing 0 0 0 0 0 0 0 0 0 0 Frequency Table Q16AVAGINAL BLEEDING HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 69 19,2 19,2 19,2 Yes 291 80,8 80,8 100,0 Total 360 100,0 100,0 Kaduha Valid No 68 18,9 18,9 18,9 Yes 292 81,1 81,1 100,0 Total 360 100,0 100,0 Q16B FAST/DIFFICULT BREATHING Additional and Replacement Documentation Protocal 223 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 335 93,1 93,1 93,1 Yes 25 6,9 6,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 319 88,6 88,6 88,6 Yes 41 11,4 11,4 100,0 Total 360 100,0 100,0 Q16C FEVER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 226 62,8 62,8 62,8 Yes 134 37,2 37,2 100,0 Total 360 100,0 100,0 Kaduha Valid No 172 47,8 47,8 47,8 Yes 188 52,2 52,2 100,0 Total 360 100,0 100,0 Q16D SEVERE ABDOMINAL PAIN HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 175 48,6 48,6 48,6 Yes 185 51,4 51,4 100,0 Total 360 100,0 100,0 Kaduha Valid No 153 42,5 42,5 42,5 Yes 207 57,5 57,5 100,0 Total 360 100,0 100,0 Q16E HEADACHE/BLURRED VISION HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 263 73,1 73,1 73,1 Yes 97 26,9 26,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 267 74,2 74,2 74,2 Yes 93 25,8 25,8 100,0 Total 360 100,0 100,0 Q16F CONVULSIONS HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 343 95,3 95,3 95,3 Additional and Replacement Documentation Protocal 224 Yes 17 4,7 4,7 100,0 Total 360 100,0 100,0 Kaduha Valid No 325 90,3 90,3 90,3 Yes 35 9,7 9,7 100,0 Total 360 100,0 100,0 Q16G FOUL SMELLING DISCHARGE/FLUID FROM VAGINA HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 311 86,4 86,4 86,4 Yes 49 13,6 13,6 100,0 Total 360 100,0 100,0 Kaduha Valid No 275 76,4 76,4 76,4 Yes 85 23,6 23,6 100,0 Total 360 100,0 100,0 Q16H BABY STOPS MOVING HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 276 76,7 76,7 76,7 Yes 84 23,3 23,3 100,0 Total 360 100,0 100,0 Kaduha Valid No 261 72,5 72,5 72,5 Yes 99 27,5 27,5 100,0 Total 360 100,0 100,0 Q16I LEAKING BROWNISH/GREENISH FLUID FROM THE VAGINA HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 330 91,7 91,7 91,7 Yes 30 8,3 8,3 100,0 Total 360 100,0 100,0 Kaduha Valid No 312 86,7 86,7 86,7 Yes 48 13,3 13,3 100,0 Total 360 100,0 100,0 Q16X HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 276 76,7 76,7 76,7 Yes 84 23,3 23,3 100,0 Total 360 100,0 100,0 Additional and Replacement Documentation Protocal 225 Kaduha Valid No 300 83,3 83,3 83,3 Yes 60 16,7 16,7 100,0 Total 360 100,0 100,0 Q17. During your pregnancy with (Name of the child) did you receive an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth? USE ALL. COMPUTE filter_$=(BiologicalMother = 1). VARIABLE LABEL filter_$ 'BiologicalMother = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q17 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q17 Kigeme N Valid 360 Missing 0 Kaduha N Valid 357 Missing 0 q17 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 64 17,8 17,8 17,8 Yes 294 81,7 81,7 99,4 Don't know 2 ,6 ,6 100,0 Total 360 100,0 100,0 Kaduha Valid No 70 19,6 19,6 19,6 Yes 286 80,1 80,1 99,7 Don't know 1 ,3 ,3 100,0 Total 357 100,0 100,0 Q18. While pregnant with (name of the child), how many times did you receive such an injection? USE ALL. COMPUTE filter_$=(q17 = 1). VARIABLE LABEL filter_$ 'q17 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. Additional and Replacement Documentation Protocal 226 FREQUENCIES VARIABLES=q18 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q18 Kigeme N Valid 294 Missing 0 Kaduha N Valid 286 Missing 0 q18 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid One 182 61,9 61,9 61,9 Two 89 30,3 30,3 92,2 Three or more 22 7,5 7,5 99,7 Don't know 1 ,3 ,3 100,0 Total 294 100,0 100,0 Kaduha Valid One 190 66,4 66,4 66,4 Two 84 29,4 29,4 95,8 Three or more 10 3,5 3,5 99,3 Don't know 2 ,7 ,7 100,0 Total 286 100,0 100,0 Q19. Did you receive any tetanus toxoid injection at any time before that pregnancy, including during a previous pregnancy or between pregnancies? USE ALL. COMPUTE filter_$=(BiologicalMother = 1). VARIABLE LABEL filter_$ 'BiologicalMother = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q19 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q19 Kigeme N Valid 360 Missing 0 Kaduha N Valid 357 Missing 0 Additional and Replacement Documentation Protocal 227 q19 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 138 38,3 38,3 38,3 Yes 222 61,7 61,7 100,0 Total 360 100,0 100,0 Kaduha Valid No 127 35,6 35,6 35,6 Yes 230 64,4 64,4 100,0 Total 357 100,0 100,0 Q20. Before the pregnancy with (Name of the child), how many times did you receive a tetanus injection? USE ALL. COMPUTE filter_$=(q19 = 1). VARIABLE LABEL filter_$ 'q19 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q20 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q20 Kigeme N Valid 222 Missing 0 Kaduha N Valid 230 Missing 0 q20 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid One 57 25,7 25,7 25,7 Two 84 37,8 37,8 63,5 Three or more 79 35,6 35,6 99,1 Don't know 2 ,9 ,9 100,0 Additional and Replacement Documentation Protocal 228 Total 222 100,0 100,0 Kaduha Valid One 65 28,3 28,3 28,3 Two 71 30,9 30,9 59,1 Three or more 92 40,0 40,0 99,1 Don't know 2 ,9 ,9 100,0 Total 230 100,0 100,0 Q21. If biological mother (i15) ask: During your pregnancy with (Name), were you given or did you buy any iron tablets/syrup? Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav USE ALL. COMPUTE filter_$=(BiologicalMother = 1). VARIABLE LABEL filter_$ 'BiologicalMother = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q21 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q21 Kigeme N Valid 360 Missing 0 Kaduha N Valid 357 Missing 0 q21 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 38 10,6 10,6 10,6 Yes 322 89,4 89,4 100,0 Total 360 100,0 100,0 Kaduha Valid No 61 17,1 17,1 17,1 Additional and Replacement Documentation Protocal 229 Yes 296 82,9 82,9 100,0 Total 357 100,0 100,0 Q22. During the whole pregnancy, for how many days did you take the tablets/syrup? USE ALL. COMPUTE filter_$=(q21 = 1). VARIABLE LABEL filter_$ 'q21 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q22 /STATISTICS=STDDEV MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q22 Kigeme N Valid 322 Missing 0 Mean 57,05 Median 60,00 Std. Deviation 33,784 Kaduha N Valid 296 Missing 0 Mean 51,50 Median 40,00 Std. Deviation 28,291 q22 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 1 4 1,2 1,2 1,2 2 5 1,6 1,6 2,8 3 5 1,6 1,6 4,3 Additional and Replacement Documentation Protocal 230 4 4 1,2 1,2 5,6 5 2 ,6 ,6 6,2 7 6 1,9 1,9 8,1 10 1 ,3 ,3 8,4 14 1 ,3 ,3 8,7 15 4 1,2 1,2 9,9 20 1 ,3 ,3 10,2 24 1 ,3 ,3 10,6 27 1 ,3 ,3 10,9 30 103 32,0 32,0 42,9 32 1 ,3 ,3 43,2 35 1 ,3 ,3 43,5 40 2 ,6 ,6 44,1 45 4 1,2 1,2 45,3 50 1 ,3 ,3 45,7 60 64 19,9 19,9 65,5 87 1 ,3 ,3 65,8 88 1 ,3 ,3 66,1 90 81 25,2 25,2 91,3 95 1 ,3 ,3 91,6 120 26 8,1 8,1 99,7 130 1 ,3 ,3 100,0 Total 322 100,0 100,0 Kaduha Valid 1 1 ,3 ,3 ,3 7 4 1,4 1,4 1,7 12 2 ,7 ,7 2,4 14 2 ,7 ,7 3,0 15 3 1,0 1,0 4,1 20 2 ,7 ,7 4,7 25 1 ,3 ,3 5,1 30 130 43,9 43,9 49,0 32 1 ,3 ,3 49,3 36 1 ,3 ,3 49,7 40 4 1,4 1,4 51,0 42 2 ,7 ,7 51,7 45 1 ,3 ,3 52,0 56 1 ,3 ,3 52,4 Additional and Replacement Documentation Protocal 231 60 74 25,0 25,0 77,4 70 2 ,7 ,7 78,0 90 60 20,3 20,3 98,3 100 1 ,3 ,3 98,6 120 1 ,3 ,3 99,0 180 3 1,0 1,0 100,0 Total 296 100,0 100,0 Q23. Who assisted with the delivery of (Name)? Frequency Table FREQUENCIES VARIABLES=Q23A Q23B Q23C Q23D Q23E Q23F Q23G Q23H Q23I Q23J Q23Z /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics HospitalCatchment Q23A Q23B Q23C Q23D Q23E Q23F Q23G Q23H Q23I Q23J Q23Z Kigeme N Valid 360 360 360 360 360 360 360 360 360 360 360 Missing 0 0 0 0 0 0 0 0 0 0 0 Kaduha N Valid 357 357 357 357 357 357 357 357 357 357 357 Missing 0 0 0 0 0 0 0 0 0 0 0 Frequency Table Q23A DOCTOR HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 286 79,4 79,4 79,4 Yes 74 20,6 20,6 100,0 Total 360 100,0 100,0 Kaduha Valid No 303 84,9 84,9 84,9 Yes 54 15,1 15,1 100,0 Total 357 100,0 100,0 Q23B NURSE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 90 25,0 25,0 25,0 Yes 270 75,0 75,0 100,0 Total 360 100,0 100,0 Kaduha Valid No 80 22,4 22,4 22,4 Additional and Replacement Documentation Protocal 232 Yes 277 77,6 77,6 100,0 Total 357 100,0 100,0 Q23C MIDWIFE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 334 92,8 92,8 92,8 Yes 26 7,2 7,2 100,0 Total 360 100,0 100,0 Kaduha Valid No 348 97,5 97,5 97,5 Yes 9 2,5 2,5 100,0 Total 357 100,0 100,0 Q23D AUXILIARY MIDWIFE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 356 98,9 98,9 98,9 Yes 4 1,1 1,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 357 100,0 100,0 100,0 Q23E OTHER HEALTH STAFF W/ MIDWIFERY SKILLS HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 360 100,0 100,0 100,0 Kaduha Valid No 357 100,0 100,0 100,0 Q23F TRAINED TRADITIONAL BIRTH ATTENDANT HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 360 100,0 100,0 100,0 Kaduha Valid No 356 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 357 100,0 100,0 Q23G TRAINED COMMUNITY HEALTH WORKER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 358 99,4 99,4 99,4 Yes 2 ,6 ,6 100,0 Total 360 100,0 100,0 Kaduha Valid No 355 99,4 99,4 99,4 Yes 2 ,6 ,6 100,0 Total 357 100,0 100,0 Additional and Replacement Documentation Protocal 233 Q23H RADITIONAL BIRTH ATTENDANT HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 360 100,0 100,0 100,0 Kaduha Valid No 357 100,0 100,0 100,0 Q23I COMMUNITY HEALTH WORKER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 360 100,0 100,0 100,0 Kaduha Valid No 356 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 357 100,0 100,0 Q23J RELATIVE/FRIEND HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 357 99,2 99,2 99,2 Yes 3 ,8 ,8 100,0 Total 360 100,0 100,0 Kaduha Valid No 353 98,9 98,9 98,9 Yes 4 1,1 1,1 100,0 Total 357 100,0 100,0 Q23Y NO ONE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 354 98,3 98,3 98,3 Yes 6 1,7 1,7 100,0 Total 360 100,0 100,0 Kaduha Valid No 339 95,0 95,0 95,0 Yes 18 5,0 5,0 100,0 Total 357 100,0 100,0 Q24. Was (NAME) dried (wiped) immediately after birth before the placenta was delivered? Frequencies USE ALL. COMPUTE filter_$=(BiologicalMother = 1). VARIABLE LABEL filter_$ 'BiologicalMother = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). Additional and Replacement Documentation Protocal 234 FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q24 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q24 Kigeme N Valid 360 Missing 0 Kaduha N Valid 357 Missing 0 q24 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 2 ,6 ,6 ,6 Yes 358 99,4 99,4 100,0 Total 360 100,0 100,0 Kaduha Valid No 8 2,2 2,2 2,2 Yes 347 97,2 97,2 99,4 Don't know 2 ,6 ,6 100,0 Total 357 100,0 100,0 Q25. Was (NAME) wrapped in a warm cloth or blanket immediately after birth before the placenta was delivered? [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav SAVE OUTFILE='C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav' /COMPRESSED. FREQUENCIES VARIABLES=q25 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q25 Kigeme N Valid 360 Missing 0 Kaduha N Valid 357 Missing 0 q25 Additional and Replacement Documentation Protocal 235 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 3 ,8 ,8 ,8 Yes 355 98,6 98,6 99,4 Don't know 2 ,6 ,6 100,0 Total 360 100,0 100,0 Kaduha Valid No 17 4,8 4,8 4,8 Yes 338 94,7 94,7 99,4 Don't know 2 ,6 ,6 100,0 Total 357 100,0 100,0 Q26. After (Name) was born, did any health care provider or traditional birth attendant check on (Name’s) health? FREQUENCIES VARIABLES=q26 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q26 Kigeme N Valid 360 Missing 0 Kaduha N Valid 357 Missing 0 q26 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 360 100,0 100,0 100,0 Kaduha Valid No 6 1,7 1,7 1,7 Yes 351 98,3 98,3 100,0 Total 357 100,0 100,0 Q27. How many hours, days or weeks after the birth of (Name) did the first check take place? CROSSTABS /TABLES=q27u BY Q27n /FORMAT=AVALUE TABLES /CELLS=COUNT /COUNT ROUND CELL. Crosstabs [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Case Processing Summary HospitalCatchment Cases Valid Missing Total N Percent N Percent N Percent Additional and Replacement Documentation Protocal 236 Kigeme q27u * Q27n 360 100,0% 0 ,0% 360 100,0% Kaduha q27u * Q27n 351 100,0% 0 ,0% 351 100,0% q27u * Q27n Crosstabulation Count HospitalCatchment Q27n 0 1 2 3 4 6 9 Total Kigeme q27u Hours 308 34 8 3 2 1 356 Days 0 3 1 0 0 0 4 Total 308 37 9 3 2 1 360 Kaduha q27u Hours 326 12 3 3 1 1 346 Days 0 1 2 1 0 0 4 Weeks 0 0 1 0 0 0 1 Total 326 13 6 4 1 1 351 Q28. Who checked on (Name’s) health at that time? USE ALL. COMPUTE filter_$=(q26 = 1). VARIABLE LABEL filter_$ 'q26 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q28A Q28B Q28C Q28D Q28E Q28F Q28G Q28H Q28I Q28J Q28Y /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics HospitalCatchment Q28A Q28B Q28C Q28D Q28E Q28F Q28G Q28H Q28I Q28J Q28Y Kigeme N Valid 360 360 360 360 360 360 360 360 360 360 360 Missing 0 0 0 0 0 0 0 0 0 0 0 Kaduha N Valid 351 351 351 351 351 351 351 351 351 351 351 Missing 0 0 0 0 0 0 0 0 0 0 0 Frequency Table Q28A DOCTOR HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 302 83,9 83,9 83,9 Yes 58 16,1 16,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 313 89,2 89,2 89,2 Yes 38 10,8 10,8 100,0 Total 351 100,0 100,0 Additional and Replacement Documentation Protocal 237 Q28B NURSE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 74 20,6 20,6 20,6 Yes 286 79,4 79,4 100,0 Total 360 100,0 100,0 Kaduha Valid No 35 10,0 10,0 10,0 Yes 316 90,0 90,0 100,0 Total 351 100,0 100,0 Q28C MIDWIFE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 338 93,9 93,9 93,9 Yes 22 6,1 6,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 348 99,1 99,1 99,1 Yes 3 ,9 ,9 100,0 Total 351 100,0 100,0 Q28D AUXILIARY MIDWIFE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 355 98,6 98,6 98,6 Yes 5 1,4 1,4 100,0 Total 360 100,0 100,0 Kaduha Valid No 350 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 351 100,0 100,0 Q28E OTHER HEALTH STAFF WITH MIDWIFERY SKILLS HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 360 100,0 100,0 100,0 Kaduha Valid No 351 100,0 100,0 100,0 Q28F TRAINED TRADITIONAL BIRTH ATTENDANT HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 359 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 360 100,0 100,0 Kaduha Valid No 350 99,7 99,7 99,7 Additional and Replacement Documentation Protocal 238 Yes 1 ,3 ,3 100,0 Total 351 100,0 100,0 Q28G TRAINED COMMUNITY HEALTH WORKER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 351 97,5 97,5 97,5 Yes 9 2,5 2,5 100,0 Total 360 100,0 100,0 Kaduha Valid No 346 98,6 98,6 98,6 Yes 5 1,4 1,4 100,0 Total 351 100,0 100,0 Q28H TRADITIONAL BIRTH ATTENDANT HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 360 100,0 100,0 100,0 Kaduha Valid No 351 100,0 100,0 100,0 Q28I COMMUNITY HEALTH WORKER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 360 100,0 100,0 100,0 Kaduha Valid No 351 100,0 100,0 100,0 Q28J RELATIVE/FRIEND HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 360 100,0 100,0 100,0 Kaduha Valid No 351 100,0 100,0 100,0 Q28Y NO ONE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 359 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 360 100,0 100,0 Kaduha Valid No 350 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 351 100,0 100,0 Q29. Did you ever breastfeed (NAME)? Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav USE ALL. COMPUTE filter_$=(BiologicalMother = 1). VARIABLE LABEL filter_$ 'BiologicalMother = 1 (FILTER)'. Additional and Replacement Documentation Protocal 239 VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q29 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q29 Kigeme N Valid 360 Missing 0 Kaduha N Valid 357 Missing 0 q29 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 4 1,1 1,1 1,1 Yes 356 98,9 98,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 1 ,3 ,3 ,3 Yes 356 99,7 99,7 100,0 Total 357 100,0 100,0 Q30. How long after birth did you first put (NAME) to the breast? USE ALL. COMPUTE filter_$=(q29 = 1). VARIABLE LABEL filter_$ 'q29 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. CROSSTABS /TABLES=q30u BY q30n /FORMAT=AVALUE TABLES /CELLS=COUNT ROW /COUNT ROUND CELL. Case Processing Summary HospitalCatchment Cases Valid Missing Total N Percent N Percent N Percent Kigeme q30u * q30n 356 100,0% 0 ,0% 356 100,0% Kaduha q30u * q30n 356 100,0% 0 ,0% 356 100,0% q30u * q30n Crosstabulation HospitalCatchment q30n 0 1 2 3 4 5 6 7 8 15 18 20 Total Kigeme q30u Less Count 312 0 0 0 0 0 0 0 312 Additional and Replacement Documentation Protocal 240 than 1 hour % within q30u 100,0% ,0% ,0% ,0% ,0% ,0% ,0% ,0% 100,0% Hours Count 0 20 7 5 2 3 2 0 39 % within q30u ,0% 51,3% 17,9% 12,8% 5,1% 7,7% 5,1% ,0% 100,0% Days Count 0 1 3 0 0 0 0 1 5 % within q30u ,0% 20,0% 60,0% ,0% ,0% ,0% ,0% 20,0% 100,0% Total Count 312 21 10 5 2 3 2 1 356 % within q30u 87,6% 5,9% 2,8% 1,4% ,6% ,8% ,6% ,3% 100,0% Kaduha q30u Less than 1 hour Count 296 0 0 0 0 0 0 0 0 0 0 0 296 % within q30u 100,0% ,0% ,0% ,0% ,0% ,0% ,0% ,0% ,0% ,0% ,0% ,0% 100,0% Hours Count 0 23 14 11 2 1 1 1 1 1 1 1 57 % within q30u ,0% 40,4% 24,6% 19,3% 3,5% 1,8% 1,8% 1,8% 1,8% 1,8% 1,8% 1,8% 100,0% Days Count 0 1 1 1 0 0 0 0 0 0 0 0 3 % within q30u ,0% 33,3% 33,3% 33,3% ,0% ,0% ,0% ,0% ,0% ,0% ,0% ,0% 100,0% Total Count 296 24 15 12 2 1 1 1 1 1 1 1 356 % within q30u 83,1% 6,7% 4,2% 3,4% ,6% ,3% ,3% ,3% ,3% ,3% ,3% ,3% 100,0% Q31. During the first three days after delivery, did you give (NAME) the liquid that came from your breasts? Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav USE ALL. COMPUTE filter_$=(q29 = 1). VARIABLE LABEL filter_$ 'q29 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q31 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q31 Kigeme N Valid 356 Additional and Replacement Documentation Protocal 241 Missing 0 Kaduha N Valid 356 Missing 0 q31 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Non 4 1,1 1,1 1,1 Yes 352 98,9 98,9 100,0 Total 356 100,0 100,0 Kaduha Valid Non 1 ,3 ,3 ,3 Yes 355 99,7 99,7 100,0 Total 356 100,0 100,0 Q32. During the first three days after delivery, was (NAME) given anything to drink other than breast milk? FREQUENCIES VARIABLES=q32 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q32 Kigeme N Valid 356 Missing 0 Kaduha N Valid 356 Missing 0 q32 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 350 98,3 98,3 98,3 Yes 6 1,7 1,7 100,0 Total 356 100,0 100,0 Kaduha Valid No 355 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 356 100,0 100,0 Q33. What else was (NAME) given to drink during the first three days? USE ALL. COMPUTE filter_$=(q32 = 1). VARIABLE LABEL filter_$ 'q32 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q33A Q33B Q33C Q33D Q33E Q33F Q33G Q33H Q33I Q33X Additional and Replacement Documentation Protocal 242 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics HospitalCatchment Q33A Q33B Q33C Q33D Q33E Q33F Q33G Q33H Q33I Q33X Kigeme N Valid 6 6 6 6 6 6 6 6 6 6 Missing 0 0 0 0 0 0 0 0 0 0 Kaduha N Valid 1 1 1 1 1 1 1 1 1 1 Missing 0 0 0 0 0 0 0 0 0 0 Frequency Table Q33A MILK (OTHER THAN BREAST MILK) HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 4 66,7 66,7 66,7 Yes 2 33,3 33,3 100,0 Total 6 100,0 100,0 Kaduha Valid No 1 100,0 100,0 100,0 Q33B PLAIN WATER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 3 50,0 50,0 50,0 Yes 3 50,0 50,0 100,0 Total 6 100,0 100,0 Kaduha Valid Yes 1 100,0 100,0 100,0 Q33C SUGAR OR GLUCOSE WATER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 6 100,0 100,0 100,0 Kaduha Valid No 1 100,0 100,0 100,0 Q33D HOME REMEDY HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 6 100,0 100,0 100,0 Kaduha Valid No 1 100,0 100,0 100,0 Q33E SUGAR-SALT-WATER SOLUTION HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 6 100,0 100,0 100,0 Kaduha Valid No 1 100,0 100,0 100,0 Q33F FRUIT JUCE HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 6 100,0 100,0 100,0 Kaduha Valid No 1 100,0 100,0 100,0 Q33G INFANT FORMULA Additional and Replacement Documentation Protocal 243 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Non 5 83,3 83,3 83,3 Yes 1 16,7 16,7 100,0 Total 6 100,0 100,0 Kaduha Valid Non 1 100,0 100,0 100,0 [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Q33H TEA HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 6 100,0 100,0 100,0 Kaduha Valid No 1 100,0 100,0 100,0 Q33I HONEY HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 4 66,7 66,7 66,7 Yes 2 33,3 33,3 100,0 Total 6 100,0 100,0 Kaduha Valid No 1 100,0 100,0 100,0 Q33X OTHER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 6 100,0 100,0 100,0 Kaduha Valid No 1 100,0 100,0 100,0 Q34. Was (NAME) breastfed yesterday during the day or at night? USE ALL. COMPUTE filter_$=(q29 = 1). VARIABLE LABEL filter_$ 'q29 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q34 /ORDER=ANALYSIS. Frequencies Statistics q34 Kigeme N Valid 356 Missing 0 Kaduha N Valid 356 Missing 0 q34 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 23 6,5 6,5 6,5 Yes 333 93,5 93,5 100,0 Additional and Replacement Documentation Protocal 244 Total 356 100,0 100,0 Kaduha Valid No 13 3,7 3,7 3,7 Yes 343 96,3 96,3 100,0 Total 356 100,0 100,0 Q35. Did (NAME) consume breast milk in any of these ways yesterday during the day or at night? USE ALL. COMPUTE filter_$=(q34 = 0). VARIABLE LABEL filter_$ 'q34 = 0 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q35 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q35 Kigeme N Valid 23 Missing 0 Kaduha N Valid 16 Missing 0 q35 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 17 73,9 73,9 73,9 Yes 6 26,1 26,1 100,0 Total 23 100,0 100,0 Kaduha Valid No 14 87,5 87,5 87,5 Yes 2 12,5 12,5 100,0 Total 16 100,0 100,0 Q36. Now I would like to ask you about some medicines and vitamins that are sometimes given to infants. Was (NAME) given any vitamin drops or other medicines as drops yesterday during the day or night? [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav FREQUENCIES VARIABLES=q36 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q36 Kigeme N Valid 360 Additional and Replacement Documentation Protocal 245 Missing 0 Kaduha N Valid 360 Missing 0 q36 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 327 90,8 90,8 90,8 Yes 33 9,2 9,2 100,0 Total 360 100,0 100,0 Kaduha Valid No 337 93,6 93,6 93,6 Yes 20 5,6 5,6 99,2 Don't Know 3 ,8 ,8 100,0 Total 360 100,0 100,0 Q37. Was (NAME) given ORS yesterday during the day or at night? FREQUENCIES VARIABLES=q37 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q37 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q37 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 348 96,7 96,7 96,7 Yes 12 3,3 3,3 100,0 Total 360 100,0 100,0 Kaduha Valid No 352 97,8 97,8 97,8 Yes 8 2,2 2,2 100,0 Total 360 100,0 100,0 Q38. Did (NAME) drink anything from a bottle with a nipple yesterday or last night? FREQUENCIES VARIABLES=q38 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q38 Kigeme N Valid 360 Missing 0 Additional and Replacement Documentation Protocal 246 Kaduha N Valid 360 Missing 0 q38 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 344 95,6 95,6 95,6 Yes 16 4,4 4,4 100,0 Total 360 100,0 100,0 Kaduha Valid No 347 96,4 96,4 96,4 Yes 13 3,6 3,6 100,0 Total 360 100,0 100,0 Q39. Next I would like to ask you about some liquids that (Name) may have had yesterday during the day or at night. Did (Name) have any (ITEM FROM LIST)? USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q39a /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q39a Kigeme N Valid 270 Missing 0 Kaduha N Valid 270 Missing 0 q39a Plain Water HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 228 84,4 84,4 84,4 Yes 42 15,6 15,6 100,0 Total 270 100,0 100,0 Kaduha Valid No 209 77,4 77,4 77,4 Yes 61 22,6 22,6 100,0 Total 270 100,0 100,0 Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC DATASET 04222015.sav Statistics q39b Kigeme N Valid 270 Additional and Replacement Documentation Protocal 247 Missing 0 Kaduha N Valid 270 Missing 0 q39b Infant formula such as Kigozi, Rinda and others? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 266 98,5 98,5 98,5 Yes 4 1,5 1,5 100,0 Total 270 100,0 100,0 Kaduha Valid No 265 98,1 98,1 98,1 Yes 5 1,9 1,9 100,0 Total 270 100,0 100,0 Statistics q39b2 Infant formula such as Kigozi, Rinda and others? Times Kigeme N Valid 4 Missing 0 Mean 2,00 Median 2,00 Std. Deviation ,816 Kaduha N Valid 5 Missing 0 Mean 2,80 Median 2,00 Std. Deviation 1,095 q39b2 Infant formula such as Kigozi, Rinda and others? Times HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Once 1 25,0 25,0 25,0 Two times 2 50,0 50,0 75,0 Three times 1 25,0 25,0 100,0 Total 4 100,0 100,0 Kaduha Valid Two times 3 60,0 60,0 60,0 Four times 2 40,0 40,0 100,0 Total 5 100,0 100,0 Statistics q39c Kigeme N Valid 270 Missing 0 Kaduha N Valid 270 Additional and Replacement Documentation Protocal 248 Statistics q39b Kigeme N Valid 270 Missing 0 Kaduha N Valid 270 Missing 0 q39c Milk such as tinned, powdered or fresh animal milk? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 231 85,6 85,6 85,6 Yes 39 14,4 14,4 100,0 Total 270 100,0 100,0 Kaduha Valid No 222 82,2 82,2 82,2 Yes 48 17,8 17,8 100,0 Total 270 100,0 100,0 Statistics q39c3 Kigeme N Valid 39 Missing 0 Mean 2,54 Median 3,00 Std. Deviation 1,295 Kaduha N Valid 48 Missing 0 Mean 2,58 Median 2,50 Std. Deviation 1,088 q39c3 Milk such as tinned, powdered or fresh animal milk? TIMES HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Once 10 25,6 25,6 25,6 Twice 9 23,1 23,1 48,7 Three times 13 33,3 33,3 82,1 Four times 5 12,8 12,8 94,9 Six times 2 5,1 5,1 100,0 Total 39 100,0 100,0 Kaduha Valid Once 7 14,6 14,6 14,6 Twice 17 35,4 35,4 50,0 Three times 16 33,3 33,3 83,3 Additional and Replacement Documentation Protocal 249 Four times 6 12,5 12,5 95,8 Five times 1 2,1 2,1 97,9 Six times 1 2,1 2,1 100,0 Total 48 100,0 100,0 q39d Juice or juice drinks? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 260 96,3 96,3 96,3 Yes 10 3,7 3,7 100,0 Total 270 100,0 100,0 Kaduha Valid No 255 94,4 94,4 94,4 Yes 15 5,6 5,6 100,0 Total 270 100,0 100,0 q39e Clear broth? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 226 83,7 83,7 83,7 Yes 44 16,3 16,3 100,0 Total 270 100,0 100,0 Kaduha Valid No 211 78,1 78,1 78,1 Yes 59 21,9 21,9 100,0 Total 270 100,0 100,0 q39f Yogurt? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 266 98,5 98,5 98,5 Yes 4 1,5 1,5 100,0 Total 270 100,0 100,0 Kaduha Valid No 267 98,9 98,9 98,9 Yes 3 1,1 1,1 100,0 Total 270 100,0 100,0 q39f3 Yogurt? Times HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 3 2 50,0 50,0 50,0 4 2 50,0 50,0 100,0 Total 4 100,0 100,0 Kaduha Valid 2 1 33,3 33,3 33,3 3 2 66,7 66,7 100,0 Total 3 100,0 100,0 q39g Thin porridge? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Additional and Replacement Documentation Protocal 250 Kigeme Valid No 94 34,8 34,8 34,8 Yes 176 65,2 65,2 100,0 Total 270 100,0 100,0 Kaduha Valid No 168 62,2 62,2 62,2 Yes 102 37,8 37,8 100,0 Total 270 100,0 100,0 q39h Any other water-based liquids such as (insert local) sorghum juice? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 245 90,7 90,7 90,7 Yes 25 9,3 9,3 100,0 Total 270 100,0 100,0 Kaduha Valid No 250 92,6 92,6 92,6 Yes 20 7,4 7,4 100,0 Total 270 100,0 100,0 q39i Any other liquids? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 256 94,8 94,8 94,8 Yes 14 5,2 5,2 100,0 Total 270 100,0 100,0 Kaduha Valid No 260 96,3 96,3 96,3 Yes 10 3,7 3,7 100,0 Total 270 100,0 100,0 Q41. Please describe everything that (NAME) ate yesterday during the day or night, whether at home or outside the home. q41a. Thicker porridge, bread, rice, noodles, or other foods made from grains HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 212 58,9 58,9 58,9 Yes 148 41,1 41,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 158 43,9 43,9 43,9 Yes 202 56,1 56,1 100,0 Total 360 100,0 100,0 q41b. Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 296 82,2 82,2 82,2 Yes 64 17,8 17,8 100,0 Total 360 100,0 100,0 Kaduha Valid No 264 73,3 73,3 73,3 Yes 96 26,7 26,7 100,0 Additional and Replacement Documentation Protocal 251 q41a. Thicker porridge, bread, rice, noodles, or other foods made from grains HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 212 58,9 58,9 58,9 Yes 148 41,1 41,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 158 43,9 43,9 43,9 Yes 202 56,1 56,1 100,0 Total 360 100,0 100,0 q41c. White potatoes, white yams, cassava, or any other foods made from roots HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 227 63,1 63,1 63,1 Yes 133 36,9 36,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 187 51,9 51,9 51,9 Yes 173 48,1 48,1 100,0 Total 360 100,0 100,0 q41d. Any dark or green leafy vegetables HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 189 52,5 52,5 52,5 Yes 171 47,5 47,5 100,0 Total 360 100,0 100,0 Kaduha Valid No 144 40,0 40,0 40,0 Yes 216 60,0 60,0 100,0 Total 360 100,0 100,0 q41e. Ripe mangoes, ripe papayas or ripe guava HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 329 91,4 91,4 91,4 Yes 31 8,6 8,6 100,0 Total 360 100,0 100,0 Kaduha Valid No 325 90,3 90,3 90,3 Yes 34 9,4 9,4 99,7 8 1 ,3 ,3 100,0 Total 360 100,0 100,0 q41f. Any other fruits or vegetables (such as avocado) HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 301 83,6 83,6 83,6 Yes 59 16,4 16,4 100,0 Total 360 100,0 100,0 Kaduha Valid No 257 71,4 71,4 71,4 Yes 103 28,6 28,6 100,0 Total 360 100,0 100,0 q41g. Liver, kidney, heart or other organ meats Additional and Replacement Documentation Protocal 252 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 358 99,4 99,4 99,4 Yes 2 ,6 ,6 100,0 Total 360 100,0 100,0 Kaduha Valid No 359 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 360 100,0 100,0 q41h. Any meat, such as beef, pork, lamb, goat, chicken or duck HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 357 99,2 99,2 99,2 Yes 3 ,8 ,8 100,0 Total 360 100,0 100,0 Kaduha Valid No 354 98,3 98,3 98,3 Yes 6 1,7 1,7 100,0 Total 360 100,0 100,0 q41i. Eggs HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 349 96,9 96,9 96,9 Yes 11 3,1 3,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 334 92,8 92,8 92,8 Yes 26 7,2 7,2 100,0 Total 360 100,0 100,0 q41j. Fresh or dried fish, shellfish or seafood HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 334 92,8 92,8 92,8 Yes 26 7,2 7,2 100,0 Total 360 100,0 100,0 Kaduha Valid No 276 76,7 76,7 76,7 Yes 84 23,3 23,3 100,0 Total 360 100,0 100,0 q41k. Any foods made from beans, peas, lentils, nuts or seeds HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 180 50,0 50,0 50,0 Yes 180 50,0 50,0 100,0 Total 360 100,0 100,0 Kaduha Valid No 157 43,6 43,6 43,6 Yes 203 56,4 56,4 100,0 Total 360 100,0 100,0 q41l. Cheese, yogurt, or other milk products HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 360 100,0 100,0 100,0 Additional and Replacement Documentation Protocal 253 Kaduha Valid No 357 99,2 99,2 99,2 Yes 3 ,8 ,8 100,0 Total 360 100,0 100,0 q41m. Any oil, fats or butter, or foods made with any of these HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 346 96,1 96,1 96,1 Yes 14 3,9 3,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 350 97,2 97,2 97,2 Yes 10 2,8 2,8 100,0 Total 360 100,0 100,0 q41n. Any sugary foods such as chocolates, sweets, candies, pastries cakes or biscuits HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 320 88,9 88,9 88,9 Yes 40 11,1 11,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 309 85,8 85,8 85,8 Yes 51 14,2 14,2 100,0 Total 360 100,0 100,0 q41o. Condiments for flavor, such as chilies, spices, herbs or fish powder HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 326 90,6 90,6 90,6 Yes 34 9,4 9,4 100,0 Total 360 100,0 100,0 Kaduha Valid No 313 86,9 86,9 86,9 Yes 47 13,1 13,1 100,0 Total 360 100,0 100,0 q41p. Grubs, snails or insects HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 360 100,0 100,0 100,0 Kaduha Valid No 360 100,0 100,0 100,0 q41q. Foods made with red palm oil, red palm nut or red palm nut pulp sauce HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 271 75,3 75,3 75,3 Yes 89 24,7 24,7 100,0 Total 360 100,0 100,0 Kaduha Valid No 214 59,4 59,4 59,4 Yes 146 40,6 40,6 100,0 Total 360 100,0 100,0 q41r. Other foods not recorded on the list HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 317 88,1 88,1 88,1 Additional and Replacement Documentation Protocal 254 Yes 43 11,9 11,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 353 98,1 98,1 98,1 Yes 7 1,9 1,9 100,0 Total 360 100,0 100,0 q41s.At least one Yes ? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 97 26,9 26,9 26,9 Yes 263 73,1 73,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 94 26,1 26,1 26,1 Yes 266 73,9 73,9 100,0 Total 360 100,0 100,0 Q42. Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night? USE ALL. COMPUTE filter_$=(q41s = 0). VARIABLE LABEL filter_$ 'q41s = 0 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q42 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q42 Kigeme N Valid 97 Missing 0 Kaduha N Valid 94 Missing 0 q42 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 0 97 100,0 100,0 100,0 Kaduha Valid 0 94 100,0 100,0 100,0 Q43. How many times did (NAME) eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night? FREQUENCIES VARIABLES=q43 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q43 Kigeme N Valid 263 Additional and Replacement Documentation Protocal 255 Missing 0 Mean 2,71 Median 3,00 Std. Deviation 1,063 Kaduha N Valid 266 Missing 0 Mean 2,99 Median 3,00 Std. Deviation ,998 Q43 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Once 30 11,4 11,4 11,4 2 times 78 29,7 29,7 41,1 3 times 114 43,3 43,3 84,4 4 times 27 10,3 10,3 94,7 5 times 8 3,0 3,0 97,7 6 times 5 1,9 1,9 99,6 7 times 1 ,4 ,4 100,0 Total 263 100,0 100,0 Kaduha Valid Once 14 5,3 5,3 5,3 2 times 60 22,6 22,6 27,8 3 times 128 48,1 48,1 75,9 4 times 48 18,0 18,0 94,0 5 times 12 4,5 4,5 98,5 6 times 3 1,1 1,1 99,6 8 times 1 ,4 ,4 100,0 Total 266 100,0 100,0 Q44. If yes to 41 or 42) At what age did (NAME) begin eating solid, semi-solid, or soft foods? FREQUENCIES VARIABLES=q44 /STATISTICS=STDDEV MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q44 Kigeme N Valid 263 Missing 0 Mean 6,18 Median 6,00 Std. Deviation 1,388 Kaduha N Valid 266 Additional and Replacement Documentation Protocal 256 Missing 0 Mean 6,03 Median 6,00 Std. Deviation ,713 q44 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 0 month 5 1,9 1,9 1,9 2 months 3 1,1 1,1 3,0 3 months 3 1,1 1,1 4,2 4 months 7 2,7 2,7 6,8 5 months 8 3,0 3,0 9,9 6 months 157 59,7 59,7 69,6 7 months 50 19,0 19,0 88,6 8 months 21 8,0 8,0 96,6 9 months 8 3,0 3,0 99,6 10 months 1 ,4 ,4 100,0 Total 263 100,0 100,0 Kaduha Valid 2 months 1 ,4 ,4 ,4 3 months 3 1,1 1,1 1,5 4 months 1 ,4 ,4 1,9 5 months 13 4,9 4,9 6,8 6 months 222 83,5 83,5 90,2 7 months 22 8,3 8,3 98,5 8 months 2 ,8 ,8 99,2 9 months 1 ,4 ,4 99,6 12 months 1 ,4 ,4 100,0 Total 266 100,0 100,0 Q44a. (If yes to 41 or 42) Does (NAME) eat from his/her own separate bowl/cup? FREQUENCIES VARIABLES=q44aBowl /STATISTICS=STDDEV MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q44aBowl Kigeme N Valid 263 Missing 0 Mean ,88 Median 1,00 Std. Deviation ,323 Kaduha N Valid 266 Missing 0 Mean ,94 Additional and Replacement Documentation Protocal 257 Median 1,00 Std. Deviation ,245 q44aBowl HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 0 31 11,8 11,8 11,8 1 232 88,2 88,2 100,0 Total 263 100,0 100,0 Kaduha Valid 0 17 6,4 6,4 6,4 1 249 93,6 93,6 100,0 Total 266 100,0 100,0 Q45. Are you or someone in your family helping (NAME) eat? (ie. physically feeding them USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6 ). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q45 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q45 Kigeme N Valid 270 Missing 0 Kaduha N Valid 270 Missing 0 q45 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 11 4,1 4,1 4,1 Yes 259 95,9 95,9 100,0 Total 270 100,0 100,0 Kaduha Valid No 1 ,4 ,4 ,4 Yes 269 99,6 99,6 100,0 Total 270 100,0 100,0 Q46. IF NO: At what age did (NAME) start eating by himself/herself? [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav SORT CASES BY HospitalCatchment. SPLIT FILE LAYERED BY HospitalCatchment. USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6 and q41s = 1and q45 = 0). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 and q41s = 1and q45 = 0 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). Additional and Replacement Documentation Protocal 258 FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q46 /STATISTICS=STDDEV MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q46 Kigeme N Valid 5 Missing 0 Mean 12,40 Median 14,00 Std. Deviation 2,608 q46 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 8months 1 20,0 20,0 20,0 12 months 1 20,0 20,0 40,0 14 months 3 60,0 60,0 100,0 Total 5 100,0 100,0 Q46b. Do you encourage (NAME) to eat/feed (including when you breastfeed)? USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6 and q41s = 1). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 and q41s = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q46b_Encourage /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q46b_Encourage Kigeme N Valid 256 Missing 0 Kaduha N Valid 265 Missing 0 q46b_Encourage HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 10 3,9 3,9 3,9 Yes 246 96,1 96,1 100,0 Total 256 100,0 100,0 Kaduha Valid No 4 1,5 1,5 1,5 Yes 261 98,5 98,5 100,0 Additional and Replacement Documentation Protocal 259 Statistics q46b_Encourage Kigeme N Valid 256 Missing 0 Kaduha N Valid 265 Total 265 100,0 100,0 Q47. Has (NAME) ever received a vitamin A dose (like this/any of these)? USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6 ). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q47 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q47 Kigeme N Valid 270 Missing 0 Kaduha N Valid 270 Missing 0 q47 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 94 34,8 34,8 34,8 Yes 176 65,2 65,2 100,0 Total 270 100,0 100,0 Kaduha Valid No 80 29,6 29,6 29,6 Yes 190 70,4 70,4 100,0 Total 270 100,0 100,0 Q48. If Yes, did (NAME) receive a vitamin A dose within the last 6 months? USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6 and q47 = 1). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 and q47 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q48 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q48 Kigeme N Valid 176 Missing 0 Additional and Replacement Documentation Protocal 260 Kaduha N Valid 190 Missing 0 q48 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 15 8,5 8,5 8,5 Yes 161 91,5 91,5 100,0 Total 176 100,0 100,0 Kaduha Valid No 12 6,3 6,3 6,3 Yes 178 93,7 93,7 100,0 Total 190 100,0 100,0 Q49. Has (NAME) taken any drug for intestinal worms in the past 6 months? USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6 ). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q49 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q49 Kigeme N Valid 270 Missing 0 Kaduha N Valid 270 Missing 0 q49 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 190 70,4 70,4 70,4 Yes 80 29,6 29,6 100,0 Total 270 100,0 100,0 Kaduha Valid No 180 66,7 66,7 66,7 Yes 88 32,6 32,6 99,3 Don't know 2 ,7 ,7 100,0 Total 270 100,0 100,0 Q49a. Has (NAME) ever received any MNP packets, like these? USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6 ). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q49a Additional and Replacement Documentation Protocal 261 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Q49a Kigeme N Valid 270 Missing 0 Kaduha N Valid 270 Missing 0 Q49a HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 77 28,5 28,5 28,5 Yes 193 71,5 71,5 100,0 Total 270 100,0 100,0 Kaduha Valid No 43 15,9 15,9 15,9 Yes 227 84,1 84,1 100,0 Total 270 100,0 100,0 Q49b. If yes, did (NAME) receive it in the last 3 months? USE ALL. COMPUTE filter_$=( CalcAgeChild >= 5 and Q49a = 1). VARIABLE LABEL filter_$ ' CalcAgeChild >= 5 and Q49a = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q49b /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Q49b Kigeme N Valid 193 Missing 0 Kaduha N Valid 227 Missing 0 Q49b HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 10 5,2 5,2 5,2 Yes 183 94,8 94,8 100,0 Total 193 100,0 100,0 Kaduha Valid No 11 4,8 4,8 4,8 Yes 216 95,2 95,2 100,0 Total 227 100,0 100,0 Additional and Replacement Documentation Protocal 262 Q50. Sometimes children get sick and need to receive care or treatment for illnesses. What are the signs of illness that would indicate your child needs treatment? GET FILE='C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav'. DATASET NAME DataSet0 WINDOW=FRONT. FILTER OFF. USE ALL. EXECUTE. SORT CASES BY HospitalCatchment. SPLIT FILE LAYERED BY HospitalCatchment. FREQUENCIES VARIABLES=Q50A Q50B Q50C Q50D Q50E Q50F Q50G Q50H Q50I Q50J Q50K /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q50A Q50B Q50C Q50D Q50E Q50F Q50G Q50H Q50I Q50J Q50K Kigeme N Valid 360 360 360 360 360 360 360 360 360 360 360 Missing 0 0 0 0 0 0 0 0 0 0 0 Kaduha N Valid 360 360 360 360 360 360 360 360 360 360 360 Missing 0 0 0 0 0 0 0 0 0 0 0 Frequency Table Q50A Don’t Know/ HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 359 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 360 100,0 100,0 Kaduha Valid No 360 100,0 100,0 100,0 Q50B Looks Unwell Or Not Playing Normally HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 294 81,7 81,7 81,7 Yes 66 18,3 18,3 100,0 Total 360 100,0 100,0 Kaduha Valid No 254 70,6 70,6 70,6 Yes 106 29,4 29,4 100,0 Total 360 100,0 100,0 Q50C Not Eating Or Drinking/ HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 189 52,5 52,5 52,5 Yes 171 47,5 47,5 100,0 Total 360 100,0 100,0 Kaduha Valid No 149 41,4 41,4 41,4 Yes 211 58,6 58,6 100,0 Total 360 100,0 100,0 Q50D Lethargic Or Difficult To Wake Additional and Replacement Documentation Protocal 263 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 259 71,9 71,9 71,9 Yes 101 28,1 28,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 217 60,3 60,3 60,3 Yes 143 39,7 39,7 100,0 Total 360 100,0 100,0 Q50E High Fever HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 44 12,2 12,2 12,2 Yes 316 87,8 87,8 100,0 Total 360 100,0 100,0 Kaduha Valid No 38 10,6 10,6 10,6 Yes 322 89,4 89,4 100,0 Total 360 100,0 100,0 Q50F Fast Or Difficult Breathing HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 298 82,8 82,8 82,8 Yes 62 17,2 17,2 100,0 Total 360 100,0 100,0 Kaduha Valid No 277 76,9 76,9 76,9 Yes 83 23,1 23,1 100,0 Total 360 100,0 100,0 Q50G Vomits Everything HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 241 66,9 66,9 66,9 Yes 119 33,1 33,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 205 56,9 56,9 56,9 Yes 155 43,1 43,1 100,0 Total 360 100,0 100,0 Q50H Convulsions HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 349 96,9 96,9 96,9 Yes 11 3,1 3,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 331 91,9 91,9 91,9 Yes 29 8,1 8,1 100,0 Total 360 100,0 100,0 Q50I Gets worse despite home care Additional and Replacement Documentation Protocal 264 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 328 91,1 91,1 91,1 Yes 32 8,9 8,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 287 79,7 79,7 79,7 Yes 73 20,3 20,3 100,0 Total 360 100,0 100,0 Q50J Looks dehydrated (dry mouth or no tear HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 338 93,9 93,9 93,9 Yes 22 6,1 6,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 338 93,9 93,9 93,9 Yes 22 6,1 6,1 100,0 Total 360 100,0 100,0 Q50K Other HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 218 60,6 60,6 60,6 Yes 142 39,4 39,4 100,0 Total 360 100,0 100,0 Kaduha Valid No 250 69,4 69,4 69,4 Yes 110 30,6 30,6 100,0 Total 360 100,0 100,0 Q51. Has (Name) been ill with fever at any time in the last 2 weeks? FREQUENCIES VARIABLES=q51 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q51 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q51 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 256 71,1 71,1 71,1 Yes 104 28,9 28,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 272 75,6 75,6 75,6 Yes 88 24,4 24,4 100,0 Additional and Replacement Documentation Protocal 265 Statistics q51 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Total 360 100,0 100,0 USE ALL. COMPUTE filter_$=(q51 = 1). VARIABLE LABEL filter_$ 'q51 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q52 Q52. Did you seek advice or treatment for (NAME’S) fever? [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q52 Kigeme N Valid 104 Missing 0 Kaduha N Valid 88 Missing 0 q52 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 35 33,7 33,7 33,7 Yes 69 66,3 66,3 100,0 Total 104 100,0 100,0 Kaduha Valid No 24 27,3 27,3 27,3 Yes 64 72,7 72,7 100,0 Total 88 100,0 100,0 Q53. Where did you first go for advice or treatment for fever? USE ALL. COMPUTE filter_$=(q51 = 1and q52 = 1). VARIABLE LABEL filter_$ 'q51 = 1and q52 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q53 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q53 Kigeme N Valid 69 Missing 0 Additional and Replacement Documentation Protocal 266 Kaduha N Valid 64 Missing 0 q53 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Hospital 1 1,4 1,4 1,4 Health center 26 37,7 37,7 39,1 Health Post 3 4,3 4,3 43,5 Comunity Health worker 35 50,7 50,7 94,2 Traditional Practitioner 1 1,4 1,4 95,7 Pharmacy 1 1,4 1,4 97,1 Friend/Relative 2 2,9 2,9 100,0 Total 69 100,0 100,0 Kaduha Valid Health center 22 34,4 34,4 34,4 Comunity Health worker 35 54,7 54,7 89,1 Traditional Practitioner 1 1,6 1,6 90,6 Pharmacy 3 4,7 4,7 95,3 Friend/Relative 3 4,7 4,7 100,0 Total 64 100,0 100,0 Q54. How long after you noticed (NAME’S) fever did you seek treatment? FREQUENCIES VARIABLES=q54 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q54 Kigeme N Valid 69 Missing 0 Kaduha N Valid 64 Missing 0 q54 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Same day 29 42,0 42,0 42,0 Next day 27 39,1 39,1 81,2 Two days 11 15,9 15,9 97,1 Three or more days 2 2,9 2,9 100,0 Total 69 100,0 100,0 Kaduha Valid Same day 22 34,4 34,4 34,4 Next day 23 35,9 35,9 70,3 Two days 16 25,0 25,0 95,3 Three or more days 3 4,7 4,7 100,0 Total 64 100,0 100,0 Q55. At any time during the illness, did (Name) take any drugs for the fever? FREQUENCIES VARIABLES=q55 /ORDER=ANALYSIS. Additional and Replacement Documentation Protocal 267 Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q55 Kigeme N Valid 69 Missing 0 Kaduha N Valid 64 Missing 0 q55 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 10 14,5 14,5 14,5 Yes 59 85,5 85,5 100,0 Total 69 100,0 100,0 Kaduha Valid No 6 9,4 9,4 9,4 Yes 58 90,6 90,6 100,0 Total 64 100,0 100,0 Q56. Which medicines were given to (NAME) for his/her fever? USE ALL. COMPUTE filter_$=(q51 = 1and q52 = 1 and q55 = 1). VARIABLE LABEL filter_$ 'q51 = 1and q52 = 1 and q55 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q56a /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q56a Kigeme N Valid 59 Missing 0 Kaduha N Valid 58 Missing 0 q56a Coartem HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 49 83,1 83,1 83,1 Yes 10 16,9 16,9 100,0 Total 59 100,0 100,0 Kaduha Valid No 35 60,3 60,3 60,3 Yes 23 39,7 39,7 100,0 Total 58 100,0 100,0 USE ALL. COMPUTE filter_$=(q51 = 1and q52 = 1 and q55 = 1 and q56a = 1). Additional and Replacement Documentation Protocal 268 VARIABLE LABEL filter_$ 'q51 = 1and q52 = 1 and q55 = 1 and q56a = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q56aT /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q56aT Kigeme N Valid 10 Missing 0 Kaduha N Valid 23 Missing 0 q56a Coartem/ Times HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Same day 7 70,0 70,0 70,0 Next day 2 20,0 20,0 90,0 Two days 1 10,0 10,0 100,0 Total 10 100,0 100,0 Kaduha Valid Same day 10 43,5 43,5 43,5 Next day 7 30,4 30,4 73,9 Two days 6 26,1 26,1 100,0 Total 23 100,0 100,0 USE ALL. COMPUTE filter_$=(q51 = 1and q52 = 1 and q55 = 1). VARIABLE LABEL filter_$ 'q51 = 1and q52 = 1 and q55 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q56b /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q56b Kigeme N Valid 59 Missing 0 Kaduha N Valid 58 Missing 0 q56b Quinine HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 59 100,0 100,0 100,0 Kaduha Valid No 55 94,8 94,8 94,8 Additional and Replacement Documentation Protocal 269 Yes 3 5,2 5,2 100,0 Total 58 100,0 100,0 USE ALL. COMPUTE filter_$=(q51 = 1and q52 = 1 and q55 = 1and q56b = 1). VARIABLE LABEL filter_$ 'q51 = 1and q52 = 1 and q55 = 1and q56b = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q56bT /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q56bT Kaduha N Valid 3 Missing 0 q56b Quinine /Times HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kaduha Valid Same day 1 33,3 33,3 33,3 Next day 1 33,3 33,3 66,7 Two days 1 33,3 33,3 100,0 Total 3 100,0 100,0 USE ALL. COMPUTE filter_$=(q51 = 1and q52 = 1 and q55 = 1). VARIABLE LABEL filter_$ 'q51 = 1and q52 = 1 and q55 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q56c /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q56c Kigeme N Valid 59 Missing 0 Kaduha N Valid 58 Missing 0 q56c Paracetamol HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 36 61,0 61,0 61,0 Yes 23 39,0 39,0 100,0 Total 59 100,0 100,0 Kaduha Valid No 44 75,9 75,9 75,9 Yes 14 24,1 24,1 100,0 Additional and Replacement Documentation Protocal 270 Statistics q56c Kigeme N Valid 59 Missing 0 Kaduha N Valid 58 Total 58 100,0 100,0 USE ALL. COMPUTE filter_$=(q51 = 1and q52 = 1 and q55 = 1and q56c = 1). VARIABLE LABEL filter_$ 'q51 = 1and q52 = 1 and q55 = 1and q56c = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q54cT /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q54cT Kigeme N Valid 23 Missing 0 Kaduha N Valid 14 Missing 0 q56c Paracetamol/Times HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Same day 14 60,9 60,9 60,9 Next day 4 17,4 17,4 78,3 Two days 5 21,7 21,7 100,0 Total 23 100,0 100,0 Kaduha Valid Same day 7 50,0 50,0 50,0 Next day 7 50,0 50,0 100,0 Total 14 100,0 100,0 USE ALL. COMPUTE filter_$=(q51 = 1and q52 = 1 and q55 = 1). VARIABLE LABEL filter_$ 'q51 = 1and q52 = 1 and q55 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q56d /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q56d Kigeme N Valid 59 Missing 0 Additional and Replacement Documentation Protocal 271 Kaduha N Valid 58 Missing 0 q56d Unknown Drug HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 53 89,8 89,8 89,8 Yes 6 10,2 10,2 100,0 Total 59 100,0 100,0 Kaduha Valid No 44 75,9 75,9 75,9 Yes 14 24,1 24,1 100,0 Total 58 100,0 100,0 USE ALL. COMPUTE filter_$=(q51 = 1and q52 = 1 and q55 = 1and q56d = 1). VARIABLE LABEL filter_$ 'q51 = 1and q52 = 1 and q55 = 1and q56d = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q56dT /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q56dT Kigeme N Valid 6 Missing 0 Kaduha N Valid 14 Missing 0 q56d Unknown Drug /Times HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Same day 6 100,0 100,0 100,0 Kaduha Valid Same day 6 42,9 42,9 42,9 Next day 3 21,4 21,4 64,3 Two days 3 21,4 21,4 85,7 Three or more days 2 14,3 14,3 100,0 Total 14 100,0 100,0 USE ALL. COMPUTE filter_$=(q51 = 1and q52 = 1 and q55 = 1). VARIABLE LABEL filter_$ 'q51 = 1and q52 = 1 and q55 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q56e /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Additional and Replacement Documentation Protocal 272 q56e Kigeme N Valid 59 Missing 0 Kaduha N Valid 58 Missing 0 q56e Other HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 30 50,8 50,8 50,8 Yes 29 49,2 49,2 100,0 Total 59 100,0 100,0 Kaduha Valid No 39 67,2 67,2 67,2 Yes 19 32,8 32,8 100,0 Total 58 100,0 100,0 USE ALL. COMPUTE filter_$=(q51 = 1and q52 = 1 and q55 = 1and q56e = 1). VARIABLE LABEL filter_$ 'q51 = 1and q52 = 1 and q55 = 1and q56e = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q56eT /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q56eT Kigeme N Valid 29 Missing 0 Kaduha N Valid 19 Missing 0 q56e Other/Times HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Same day 15 51,7 51,7 51,7 Next day 10 34,5 34,5 86,2 Two days 2 6,9 6,9 93,1 Three or more days 2 6,9 6,9 100,0 Total 29 100,0 100,0 Kaduha Valid Same day 13 68,4 68,4 68,4 Next day 2 10,5 10,5 78,9 Two days 3 15,8 15,8 94,7 Three or more days 1 5,3 5,3 100,0 Total 19 100,0 100,0 Q57. Does your household have any mosquito nets that can be used while sleeping? [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Additional and Replacement Documentation Protocal 273 q57 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q57 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 81 22,5 22,5 22,5 Yes 279 77,5 77,5 100,0 Total 360 100,0 100,0 Kaduha Valid No 85 23,6 23,6 23,6 Yes 275 76,4 76,4 100,0 Total 360 100,0 100,0 Q58. Who slept under a bed net last night? [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q58A Q58B Q58C Q58D Kigeme N Valid 279 279 279 279 Missing 0 0 0 0 Kaduha N Valid 275 275 275 275 Missing 0 0 0 0 Frequency Table Q58A No One HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 277 99,3 99,3 99,3 Yes 2 ,7 ,7 100,0 Total 279 100,0 100,0 Kaduha Valid No 267 97,1 97,1 97,1 Yes 8 2,9 2,9 100,0 Total 275 100,0 100,0 Q58B Child(Name) HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 96 34,4 34,4 34,4 Yes 183 65,6 65,6 100,0 Total 279 100,0 100,0 Kaduha Valid No 94 34,2 34,2 34,2 Yes 181 65,8 65,8 100,0 Total 275 100,0 100,0 Q58C Mother HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Additional and Replacement Documentation Protocal 274 Kigeme Valid No 14 5,0 5,0 5,0 Yes 265 95,0 95,0 100,0 Total 279 100,0 100,0 Kaduha Valid No 12 4,4 4,4 4,4 Yes 263 95,6 95,6 100,0 Total 275 100,0 100,0 Q58D Other HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 142 50,9 50,9 50,9 Yes 137 49,1 49,1 100,0 Total 279 100,0 100,0 Kaduha Valid No 144 52,4 52,4 52,4 Yes 131 47,6 47,6 100,0 Total 275 100,0 100,0 Q59. Which brand of bed net did (Name) sleep under last night? [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Q59 Kigeme N Valid 183 Missing 0 Kaduha N Valid 181 Missing 0 Q59 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Long Lasting Nets 177 96,7 96,7 96,7 Pretreated Nets 6 3,3 3,3 100,0 Total 183 100,0 100,0 Kaduha Valid Long Lasting Nets 181 100,0 100,0 100,0 USE ALL. COMPUTE filter_$=(q57 = 1and Q58B = 1). VARIABLE LABEL filter_$ 'q57 = 1and Q58B = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=59a 59b Q59C /ORDER=ANALYSIS. FREQUENCIES VARIABLES=Q59a Q59b Q59C /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q59a Q59b Q59C Kigeme N Valid 183 6 0 Additional and Replacement Documentation Protocal 275 Missing 0 177 183 Kaduha N Valid 181 0 0 Missing 0 181 181 Frequency Table Q59a Permanet HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 6 3,3 3,3 3,3 1;Permanet 173 94,5 94,5 97,8 2;Olyset 2 1,1 1,1 98,9 3;Netprotect 2 1,1 1,1 100,0 Total 183 100,0 100,0 Kaduha Valid 1;Permanet 175 96,7 96,7 96,7 2;Olyset 1 ,6 ,6 97,2 3;Netprotect 5 2,8 2,8 100,0 Total 181 100,0 100,0 Q59b Olyset HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No tag 1 ,5 16,7 16,7 Don't know 5 2,7 83,3 100,0 Total 6 3,3 100,0 Missing System 177 96,7 Total 183 100,0 Kaduha Missing System 181 100,0 Q59C Netprotect HospitalCatchment Frequency Percent Kigeme Missing System 183 100,0 Kaduha Missing System 181 100,0 Q60. Was the bed net that (Name) slept under last night ever soaked or dipped in a liquid treated to repel mosquitoes or bugs? USE ALL. COMPUTE filter_$=(q57 = 1and Q58B = 1and Q59b = 4 or Q59b = 88). VARIABLE LABEL filter_$ 'q57 = 1and Q58B = 1and Q59b = 4 or Q59b = 88 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q60 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q60 Kigeme N Valid 6 Missing 0 Additional and Replacement Documentation Protocal 276 q60 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 2 33,3 33,3 33,3 Don't know 4 66,7 66,7 100,0 Total 6 100,0 100,0 Q61. How long ago was the net last soaked or dipped in a liquid treated to repel mosquitoes or bugs? USE ALL. COMPUTE filter_$=(q60 = 1). VARIABLE LABEL filter_$ 'q60 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q61 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q61 Kigeme N Valid 2 Missing 0 q61. How long ago was the net last soaked or dipped in a liquid treated to repel mosquitoes or bugs? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 1 50,0 50,0 50,0 No 1 50,0 50,0 100,0 Total 2 100,0 100,0 q62. Has (Name) had an illness with a cough that comes from the chest at any time in the last two weeks? GET FILE='C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav'. DATASET NAME DataSet0 WINDOW=FRONT. SORT CASES BY HospitalCatchment. SPLIT FILE LAYERED BY HospitalCatchment. FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q62 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q62 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 Additional and Replacement Documentation Protocal 277 q62. Has (Name) had an illness with a cough that comes from the chest at any time in the last two weeks? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 208 57,8 57,8 57,8 Yes 152 42,2 42,2 100,0 Total 360 100,0 100,0 Kaduha Valid No 246 68,3 68,3 68,3 Yes 114 31,7 31,7 100,0 Total 360 100,0 100,0 q63. When (Name) had an illness with a cough, did s/he have trouble breathing or breath faster than usual with short, fast breath? USE ALL. COMPUTE filter_$=(q62 = 1). VARIABLE LABEL filter_$ 'q62 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q63 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q63 Kigeme N Valid 152 Missing 0 Kaduha N Valid 114 Missing 0 q63. When (Name) had an illness with a cough, did s/he have trouble breathing or breath faster than usual with short, fast breath? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 39 25,7 25,7 25,7 Yes 113 74,3 74,3 100,0 Total 152 100,0 100,0 Kaduha Valid No 46 40,4 40,4 40,4 Yes 68 59,6 59,6 100,0 Total 114 100,0 100,0 q64. Did you seek advice or treatment for the cough/fast breathing? USE ALL. COMPUTE filter_$=(q63 = 1). VARIABLE LABEL filter_$ 'q63 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q64 /ORDER=ANALYSIS. Additional and Replacement Documentation Protocal 278 Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q64 Kigeme N Valid 113 Missing 0 Kaduha N Valid 68 Missing 0 q64. Did you seek advice or treatment for the cough/fast breathing? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 31 27,4 27,4 27,4 Yes 82 72,6 72,6 100,0 Total 113 100,0 100,0 Kaduha Valid No 17 25,0 25,0 25,0 Yes 51 75,0 75,0 100,0 Total 68 100,0 100,0 Q65. Who gave you advice or treatment? Anyone else? USE ALL. COMPUTE filter_$=( q64 = 1). VARIABLE LABEL filter_$ ' q64 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q65A Q65B Q65C Q65D /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q65A Q65B Q65C Q65D Kigeme N Valid 82 82 82 82 Missing 0 0 0 0 Kaduha N Valid 52 52 52 52 Missing 0 0 0 0 Frequency Table Q65A. Doctor HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 81 98,8 98,8 98,8 Yes 1 1,2 1,2 100,0 Total 82 100,0 100,0 Kaduha Valid No 52 100,0 100,0 100,0 Q65B. Nurse HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Additional and Replacement Documentation Protocal 279 Kigeme Valid No 37 45,1 45,1 45,1 Yes 45 54,9 54,9 100,0 Total 82 100,0 100,0 Kaduha Valid No 34 65,4 65,4 65,4 Yes 18 34,6 34,6 100,0 Total 52 100,0 100,0 Q65C. Community Health Worker HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 48 58,5 58,5 58,5 Yes 34 41,5 41,5 100,0 Total 82 100,0 100,0 Kaduha Valid No 25 48,1 48,1 48,1 Yes 27 51,9 51,9 100,0 Total 52 100,0 100,0 USE ALL. COMPUTE filter_$=(q66 = 1and CalcAgeChild >6). VARIABLE LABEL filter_$ 'q66 = 1and CalcAgeChild >6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q69 /ORDER=ANALYSIS. Q65D. Other HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 75 91,5 91,5 91,5 Yes 7 8,5 8,5 100,0 Total 82 100,0 100,0 Kaduha Valid No 42 80,8 80,8 80,8 Yes 10 19,2 19,2 100,0 Total 52 100,0 100,0 q66. Has (NAME) had diarrhea in the last 2 weeks? FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q66 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q66 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Additional and Replacement Documentation Protocal 280 Statistics q66 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q66. Has (NAME) had diarrhea in the last 2 weeks? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 288 80,0 80,0 80,0 Yes 72 20,0 20,0 100,0 Total 360 100,0 100,0 Kaduha Valid No 320 88,9 88,9 88,9 Yes 40 11,1 11,1 100,0 Total 360 100,0 100,0 Q67. What was given to treat the diarrhea? USE ALL. COMPUTE filter_$=(q66 = 1). VARIABLE LABEL filter_$ 'q66 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q67A Q67B Q67C Q67D Q67E Q67F Q67G Q67H Q67X /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q67A Q67B Q67C Q67D Q67E Q67F Q67G Q67H Q67X Kigeme N Valid 72 72 72 72 72 72 72 72 72 Missing 0 0 0 0 0 0 0 0 0 Kaduha N Valid 40 40 40 40 40 40 40 40 40 Missing 0 0 0 0 0 0 0 0 0 Frequency Table Q67A. NOTHING HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 60 83,3 83,3 83,3 Yes 12 16,7 16,7 100,0 Total 72 100,0 100,0 Kaduha Valid No 28 70,0 70,0 70,0 Yes 12 30,0 30,0 100,0 Total 40 100,0 100,0 Q67B. FLUID FROM ORS PACKET Additional and Replacement Documentation Protocal 281 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 53 73,6 73,6 73,6 Yes 19 26,4 26,4 100,0 Total 72 100,0 100,0 Kaduha Valid No 27 67,5 67,5 67,5 Yes 13 32,5 32,5 100,0 Total 40 100,0 100,0 Q67C. Home-made fluid HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 64 88,9 88,9 88,9 Yes 8 11,1 11,1 100,0 Total 72 100,0 100,0 Kaduha Valid No 37 92,5 92,5 92,5 Yes 3 7,5 7,5 100,0 Total 40 100,0 100,0 Q67D. Pill or syrup, zinc HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 57 79,2 79,2 79,2 Yes 15 20,8 20,8 100,0 Total 72 100,0 100,0 Kaduha Valid No 34 85,0 85,0 85,0 Yes 6 15,0 15,0 100,0 Total 40 100,0 100,0 Q67E. Pill or syrup, no zinc HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 66 91,7 91,7 91,7 Yes 6 8,3 8,3 100,0 Total 72 100,0 100,0 Kaduha Valid No 39 97,5 97,5 97,5 Yes 1 2,5 2,5 100,0 Total 40 100,0 100,0 Q67F. Injection HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 72 100,0 100,0 100,0 Kaduha Valid No 38 95,0 95,0 95,0 Yes 2 5,0 5,0 100,0 Total 40 100,0 100,0 Q67G. ( IV) Intravenous Additional and Replacement Documentation Protocal 282 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 71 98,6 98,6 98,6 Yes 1 1,4 1,4 100,0 Total 72 100,0 100,0 Kaduha Valid No 40 100,0 100,0 100,0 Q67H. Home remedies HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 63 87,5 87,5 87,5 Yes 9 12,5 12,5 100,0 Total 72 100,0 100,0 Kaduha Valid No 37 92,5 92,5 92,5 Yes 3 7,5 7,5 100,0 Total 40 100,0 100,0 Q67X. Other HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 57 79,2 79,2 79,2 Yes 15 20,8 20,8 100,0 Total 72 100,0 100,0 Kaduha Valid No 30 75,0 75,0 75,0 Yes 10 25,0 25,0 100,0 Total 40 100,0 100,0 q68. When (name of child) was sick, was s/he offered more breastmilk than usual, about the same amount, or less than usual? FREQUENCIES VARIABLES=q68 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q68 Kigeme N Valid 72 Missing 0 Kaduha N Valid 40 Missing 0 q68. When (name of child) was sick, was s/he offered more breastmilk than usual, about the same amount, or less than usual? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Less than usual 18 25,0 25,0 25,0 Same amount 13 18,1 18,1 43,1 More than usual 41 56,9 56,9 100,0 Total 72 100,0 100,0 Additional and Replacement Documentation Protocal 283 Kaduha Valid Less than usual 8 20,0 20,0 20,0 Same amount 7 17,5 17,5 37,5 More than usual 25 62,5 62,5 100,0 Total 40 100,0 100,0 q69.When (NAME) had diarrhea, was he/she offered less than usual to drink, about the same amount, or more than usual to drink? [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q69 Kigeme N Valid 63 Missing 0 Kaduha N Valid 35 Missing 0 q69.When (NAME) had diarrhea, was he/she offered less than usual to drink, about the same amount, or more than usual to drink? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Less than usual 27 42,9 42,9 42,9 Same amount 9 14,3 14,3 57,1 More than usual 27 42,9 42,9 100,0 Total 63 100,0 100,0 Kaduha Valid Less than usual 18 51,4 51,4 51,4 Same amount 4 11,4 11,4 62,9 More than usual 13 37,1 37,1 100,0 Total 35 100,0 100,0 q70. When (name of child) was sick, was s/he offered more than usual to eat, about the same amount, or less than usual to eat? FREQUENCIES VARIABLES=q70 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q70 Kigeme N Valid 63 Missing 0 Kaduha N Valid 35 Missing 0 q70. When (name of child) was sick, was s/he offered more than usual to eat, about the same amount, or less than usual to eat? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Less than usual 42 66,7 66,7 66,7 Same amount 10 15,9 15,9 82,5 More than usual 11 17,5 17,5 100,0 Total 63 100,0 100,0 Additional and Replacement Documentation Protocal 284 Kaduha Valid Less than usual 18 51,4 51,4 51,4 Same amount 7 20,0 20,0 71,4 More than usual 10 28,6 28,6 100,0 Total 35 100,0 100,0 Q71. Was s/he given any of the following to drink at any time s/he started having diarrhea? FREQUENCIES VARIABLES=Q71A Q71B Q71C /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q71A Q71B Q71C Kigeme N Valid 63 63 63 Missing 0 0 0 Kaduha N Valid 35 35 35 Missing 0 0 0 Frequency Table Q71A. A fluid made from a special packet called (local name for ORS packet) HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 45 71,4 71,4 71,4 Yes 18 28,6 28,6 100,0 Total 63 100,0 100,0 Kaduha Valid No 22 62,9 62,9 62,9 Yes 13 37,1 37,1 100,0 Total 35 100,0 100,0 Q71B. Cereal based ORT (rice water, maize water) HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 35 55,6 55,6 55,6 Yes 28 44,4 44,4 100,0 Total 63 100,0 100,0 Kaduha Valid No 25 71,4 71,4 71,4 Yes 10 28,6 28,6 100,0 Total 35 100,0 100,0 Q71C. Other home available fluids HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 41 65,1 65,1 65,1 Yes 22 34,9 34,9 100,0 Total 63 100,0 100,0 Kaduha Valid No 26 74,3 74,3 74,3 Yes 9 25,7 25,7 100,0 Total 35 100,0 100,0 Q72. Did you seek advice or treatment from someone outside of the home for (NAME’S) diarrhea? Additional and Replacement Documentation Protocal 285 USE ALL. COMPUTE filter_$=(q66 = 1). VARIABLE LABEL filter_$ 'q66 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q72 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q72 Kigeme N Valid 72 Missing 0 Kaduha N Valid 40 Missing 0 q72. Did you seek advice or treatment from someone outside of the home for (NAME’S) diarrhea? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 28 38,9 38,9 38,9 Yes 44 61,1 61,1 100,0 Total 72 100,0 100,0 Kaduha Valid No 16 40,0 40,0 40,0 Yes 24 60,0 60,0 100,0 Total 40 100,0 100,0 q73. Where did you first go for advice or treatment? USE ALL. COMPUTE filter_$=(q66 = 1and q72 = 1). VARIABLE LABEL filter_$ 'q66 = 1and q72 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q73 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q73 Kigeme N Valid 44 Missing 0 Kaduha N Valid 24 Missing 0 q73. Where did you first go for advice or treatment? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Additional and Replacement Documentation Protocal 286 Kigeme Valid Health center 9 20,5 20,5 20,5 Health post 1 2,3 2,3 22,7 Community Health Worker 23 52,3 52,3 75,0 Friend/Relative 8 18,2 18,2 93,2 Other 3 6,8 6,8 100,0 Total 44 100,0 100,0 Kaduha Valid Health center 4 16,7 16,7 16,7 Community Health Worker 16 66,7 66,7 83,3 Friend/Relative 2 8,3 8,3 91,7 Other 2 8,3 8,3 100,0 Total 24 100,0 100,0 Q74. Who decided that you should go there for (NAME’S) diarrhea? FREQUENCIES VARIABLES=Q74A Q74B Q74C Q74D Q74E Q74X /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q74A Q74B Q74C Q74D Q74E Q74X Kigeme N Valid 44 44 44 44 44 44 Missing 0 0 0 0 0 0 Kaduha N Valid 24 24 24 24 24 24 Missing 0 0 0 0 0 0 Frequency Table Q74A. RESPONDENT HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 15 34,1 34,1 34,1 Yes 29 65,9 65,9 100,0 Total 44 100,0 100,0 Kaduha Valid No 7 29,2 29,2 29,2 Yes 17 70,8 70,8 100,0 Total 24 100,0 100,0 Q74B.HUSBAND/PARTNER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 21 47,7 47,7 47,7 Yes 23 52,3 52,3 100,0 Total 44 100,0 100,0 Kaduha Valid No 18 75,0 75,0 75,0 Yes 6 25,0 25,0 100,0 Total 24 100,0 100,0 Q74C. RESPONDENT’S MOTHER Additional and Replacement Documentation Protocal 287 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 38 86,4 86,4 86,4 Yes 6 13,6 13,6 100,0 Total 44 100,0 100,0 Kaduha Valid No 19 79,2 79,2 79,2 Yes 5 20,8 20,8 100,0 Total 24 100,0 100,0 Q74D. MOTHER-IN-LAW HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 44 100,0 100,0 100,0 Kaduha Valid No 24 100,0 100,0 100,0 Q74E. FRIENDS/NEIGHBORS HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 43 97,7 97,7 97,7 Yes 1 2,3 2,3 100,0 Total 44 100,0 100,0 Kaduha Valid No 24 100,0 100,0 100,0 Q74X. OTHER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 44 100,0 100,0 100,0 Kaduha Valid No 24 100,0 100,0 100,0 q75. Since (NAME) has been recovering from diarrhea, did you give him/her less than usual to eat, about the same to eat, or more than usual to eat? USE ALL. COMPUTE filter_$=(q66 = 1and CalcAgeChild >= 6). VARIABLE LABEL filter_$ 'q66 = 1and CalcAgeChild >= 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q75 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q75 Kigeme N Valid 66 Missing 0 Kaduha N Valid 37 Missing 0 Additional and Replacement Documentation Protocal 288 q75. Since (NAME) has been recovering from diarrhea, did you give him/her less than usual to eat, about the same to eat, or more than usual to eat? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Less 14 21,2 21,2 21,2 Same 25 37,9 37,9 59,1 More 24 36,4 36,4 95,5 Still has diarrhea 3 4,5 4,5 100,0 Total 66 100,0 100,0 Kaduha Valid Less 8 21,6 21,6 21,6 Same 10 27,0 27,0 48,6 More 16 43,2 43,2 91,9 Still has diarrhea 3 8,1 8,1 100,0 Total 37 100,0 100,0 SORT CASES BY HospitalCatchment. SPLIT FILE LAYERED BY HospitalCatchment. FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q76 /ORDER=ANALYSIS. FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q76 /ORDER=ANALYSIS. Q76. Do you treat your water in any way to make it safer for drinking [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q76 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q76. Do you treat your water in any way to make it safer for drinking? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 113 31,4 31,4 31,4 Yes 247 68,6 68,6 100,0 Total 360 100,0 100,0 Kaduha Valid No 73 20,3 20,3 20,3 Yes 287 79,7 79,7 100,0 Total 360 100,0 100,0 Q77. IF YES: What do you usually do to the water to make it safer to drink? Additional and Replacement Documentation Protocal 289 USE ALL. COMPUTE filter_$=(q76 = 1). VARIABLE LABEL filter_$ 'q76 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q77A Q77B Q77C Q77D Q77E Q77F Q77H /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q77A Q77B Q77C Q77D Q77E Q77F Q77H Kigeme N Valid 247 247 247 247 247 247 247 Missing 0 0 0 0 0 0 0 Kaduha N Valid 287 287 287 287 287 287 287 Missing 0 0 0 0 0 0 0 Frequency Table Q77A.Let It Stand And Settle HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 235 95,1 95,1 95,1 Yes 12 4,9 4,9 100,0 Total 247 100,0 100,0 Kaduha Valid No 284 99,0 99,0 99,0 Yes 3 1,0 1,0 100,0 Total 287 100,0 100,0 Q77B.Strain It Through Cloth HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 247 100,0 100,0 100,0 Kaduha Valid No 287 100,0 100,0 100,0 Q77C.Boil HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 46 18,6 18,6 18,6 Yes 201 81,4 81,4 100,0 Total 247 100,0 100,0 Kaduha Valid No 65 22,6 22,6 22,6 Yes 222 77,4 77,4 100,0 Total 287 100,0 100,0 Q77D.Add Bleach/Chlorine HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 180 72,9 72,9 72,9 Yes 67 27,1 27,1 100,0 Additional and Replacement Documentation Protocal 290 Total 247 100,0 100,0 Kaduha Valid No 180 62,7 62,7 62,7 Yes 107 37,3 37,3 100,0 Total 287 100,0 100,0 Q77E.Water Filter (Ceramic, Sand, Composite) HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 242 98,0 98,0 98,0 Yes 5 2,0 2,0 100,0 Total 247 100,0 100,0 Kaduha Valid No 287 100,0 100,0 100,0 Q77F.Solar Disinfection/ HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 247 100,0 100,0 100,0 Kaduha Valid No 287 100,0 100,0 100,0 Q77H.Other/ HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 247 100,0 100,0 100,0 Kaduha Valid No 287 100,0 100,0 100,0 Q78. When do you wash your hands? FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=Q78A Q78B Q78C Q78D Q78E Q78F /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q78A Q78B Q78C Q78D Q78E Q78F Kigeme N Valid 360 360 360 360 360 360 Missing 0 0 0 0 0 0 Kaduha N Valid 360 360 360 360 360 360 Missing 0 0 0 0 0 0 Frequency Table Q78A.Never HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 360 100,0 100,0 100,0 Kaduha Valid No 360 100,0 100,0 100,0 Q78B.Before Food Preparation HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 100 27,8 27,8 27,8 Additional and Replacement Documentation Protocal 291 Yes 260 72,2 72,2 100,0 Total 360 100,0 100,0 Kaduha Valid No 26 7,2 7,2 7,2 Yes 334 92,8 92,8 100,0 Total 360 100,0 100,0 Q78C.Before Feeding Child HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 284 78,9 78,9 78,9 Yes 76 21,1 21,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 338 93,9 93,9 93,9 Yes 22 6,1 6,1 100,0 Total 360 100,0 100,0 Q78D.After Defecation/Visiting The Toilet HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 346 96,1 96,1 96,1 Yes 14 3,9 3,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 353 98,1 98,1 98,1 Yes 7 1,9 1,9 100,0 Total 360 100,0 100,0 Q78E.After attending to a child who has defecated/soiled HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 358 99,4 99,4 99,4 Yes 2 ,6 ,6 100,0 Total 360 100,0 100,0 Kaduha Valid No 355 98,6 98,6 98,6 Yes 5 1,4 1,4 100,0 Total 360 100,0 100,0 Q78F.Other HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 288 80,0 80,0 80,0 Yes 72 20,0 20,0 100,0 Total 360 100,0 100,0 Kaduha Valid No 310 86,1 86,1 86,1 Yes 50 13,9 13,9 100,0 Total 360 100,0 100,0 Q79.Can you show me where you usually wash your hands and what you use to wash hands? Additional and Replacement Documentation Protocal 292 [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav FREQUENCIES VARIABLES=q79 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q79 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q79.Can you show me where you usually wash your hands and what you use to wash hands? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Inside/Near Toilet Facility 52 14,4 14,4 14,4 Inside/Near Kitchen/Cooking Place 31 8,6 8,6 23,1 Elsewhere in Yard 211 58,6 58,6 81,7 Outside Yard 14 3,9 3,9 85,6 No Specific Place 52 14,4 14,4 100,0 Total 360 100,0 100,0 Kaduha Valid Inside/Near Toilet Facility 39 10,8 10,8 10,8 Inside/Near Kitchen/Cooking Place 33 9,2 9,2 20,0 Elsewhere in Yard 252 70,0 70,0 90,0 Outside Yard 12 3,3 3,3 93,3 No Specific Place 24 6,7 6,7 100,0 Total 360 100,0 100,0 Q80a.OBSERVATION ONLY: Is there soap or detergent or locally used cleansing agent FREQUENCIES VARIABLES=q80 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q80a Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q80a.OBSERVATION ONLY: Is there soap or detergent or locally used cleansing agent HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Soap 316 87,8 87,8 87,8 Mud/Sand 8 2,2 2,2 90,0 None 36 10,0 10,0 100,0 Additional and Replacement Documentation Protocal 293 Total 360 100,0 100,0 Kaduha Valid Soap 326 90,6 90,6 90,6 Ash 1 ,3 ,3 90,8 Mud/Sand 9 2,5 2,5 93,3 None 24 6,7 6,7 100,0 Total 360 100,0 100,0 Q80b. OBSERVATION ONLY: Specify what kind of hand washing facility is used, if any FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=Q80bA Q80bB Q80bC Q80bD Q80bE Q80bF Q80bG /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q80bA Q80bB Q80bC Q80bD Q80bE Q80bF Q80bG Kigeme N Valid 360 360 360 360 360 360 360 Missing 0 0 0 0 0 0 0 Kaduha N Valid 360 360 360 360 360 360 360 Missing 0 0 0 0 0 0 0 Frequency Table Q80bA.Tippy tap HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 301 83,6 83,6 83,6 Yes 59 16,4 16,4 100,0 Total 360 100,0 100,0 Kaduha Valid No 305 84,7 84,7 84,7 Yes 55 15,3 15,3 100,0 Total 360 100,0 100,0 Q80bB.Basin HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 50 13,9 13,9 13,9 Yes 310 86,1 86,1 100,0 Total 360 100,0 100,0 Kaduha Valid No 46 12,8 12,8 12,8 Yes 314 87,2 87,2 100,0 Total 360 100,0 100,0 Q80bC.Jerry can HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 310 86,1 86,1 86,1 Additional and Replacement Documentation Protocal 294 Yes 50 13,9 13,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 317 88,1 88,1 88,1 Yes 43 11,9 11,9 100,0 Total 360 100,0 100,0 Q80bD.Pan / pot HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 354 98,3 98,3 98,3 Yes 6 1,7 1,7 100,0 Total 360 100,0 100,0 Kaduha Valid No 356 98,9 98,9 98,9 Yes 4 1,1 1,1 100,0 Total 360 100,0 100,0 Q80bE.Sink HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 360 100,0 100,0 100,0 Kaduha Valid No 360 100,0 100,0 100,0 Q80bF.None HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 355 98,6 98,6 98,6 Yes 5 1,4 1,4 100,0 Total 360 100,0 100,0 Kaduha Valid No 358 99,4 99,4 99,4 Yes 2 ,6 ,6 100,0 Total 360 100,0 100,0 Q80bG.Other HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 335 93,1 93,1 93,1 Yes 25 6,9 6,9 100,0 Total 360 100,0 100,0 Kaduha Valid No 344 95,6 95,6 95,6 Yes 16 4,4 4,4 100,0 Total 360 100,0 100,0 Q80C.(If pan, pot, bowl, or basin) What else, if anything, are you using this receptacle for other than hand washing? Additional and Replacement Documentation Protocal 295 USE ALL. COMPUTE filter_$=(Q80bB = 1 or Q80bD = 1). VARIABLE LABEL filter_$ 'Q80bB = 1 or Q80bD = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q80cA /ORDER=ANALYSIS. [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KP C 04242015.sav FREQUENCIES VARIABLES=q80cA q80cB q80cC q80cD /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment q80cA q80cB q80cC q80cD Kigeme N Valid 311 311 311 311 Missing 0 0 0 0 Kaduha N Valid 317 317 317 317 Missing 0 0 0 0 Frequency Table q80cA.Nothing else HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 280 90,0 90,0 90,0 Yes 31 10,0 10,0 100,0 Total 311 100,0 100,0 Kaduha Valid No 244 77,0 77,0 77,0 Yes 73 23,0 23,0 100,0 Total 317 100,0 100,0 q80cB.Food preparation HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 286 92,0 92,0 92,0 Yes 25 8,0 8,0 100,0 Total 311 100,0 100,0 Kaduha Valid No 305 96,2 96,2 96,2 Yes 12 3,8 3,8 100,0 Total 317 100,0 100,0 q80cC.Laundry HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 40 12,9 12,9 12,9 Yes 271 87,1 87,1 100,0 Total 311 100,0 100,0 Additional and Replacement Documentation Protocal 296 Kaduha Valid No 85 26,8 26,8 26,8 Yes 232 73,2 73,2 100,0 Total 317 100,0 100,0 q80cD.Other HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 273 87,8 87,8 87,8 Yes 38 12,2 12,2 100,0 Total 311 100,0 100,0 Kaduha Valid No 288 90,9 90,9 90,9 Yes 29 9,1 9,1 100,0 Total 317 100,0 100,0 Q81.What kind of toilet facility do you have? Can I see it? FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q81 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q81 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q81 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No toilet facility 29 8,1 8,1 8,1 Open latrine 210 58,3 58,3 66,4 Closed latrine 120 33,3 33,3 99,7 Flush toilet 1 ,3 ,3 100,0 Total 360 100,0 100,0 Kaduha Valid No toilet facility 33 9,2 9,2 9,2 Open latrine 208 57,8 57,8 66,9 Closed latrine 119 33,1 33,1 100,0 Total 360 100,0 100,0 Q82.The last time (NAME) passed stools, where were the feces disposed of? FREQUENCIES VARIABLES=q82 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Additional and Replacement Documentation Protocal 297 q82 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Disposed into a latrine or toilet facility 322 89,4 89,4 89,4 Disposed into a garbage /trash bin 18 5,0 5,0 94,4 Dug and buried - near the house or in the yard 5 1,4 1,4 95,8 Dug and buried -far from the house or yard 8 2,2 2,2 98,1 Did not bury -near the house or yard 1 ,3 ,3 98,3 Did not bury -far from the house or yard 2 ,6 ,6 98,9 Other 4 1,1 1,1 100,0 Total 360 100,0 100,0 Kaduha Valid Disposed into a latrine or toilet facility 304 84,4 84,4 84,4 Disposed into a garbage /trash bin 9 2,5 2,5 86,9 Dug and buried - near the house or in the yard 10 2,8 2,8 89,7 Dug and buried -far from the house or yard 15 4,2 4,2 93,9 Did not bury -near the house or yard 1 ,3 ,3 94,2 Did not bury -far from the house or yard 4 1,1 1,1 95,3 Other 17 4,7 4,7 100,0 Total 360 100,0 100,0 Q83.Did you receive a card or child health booklet where (name of child’s) vaccinations and Vitamin A doses can be written down? If so, can I see the card? [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q83 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q83 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Additional and Replacement Documentation Protocal 298 Kigeme Valid Yes,interviewer sees the card 346 96,1 96,1 96,1 Yes,but card is missing or lost 11 3,1 3,1 99,2 No,never had a card 3 ,8 ,8 100,0 Total 360 100,0 100,0 Kaduha Valid Yes,interviewer sees the card 328 91,1 91,1 91,1 Yes,but card is missing or lost 28 7,8 7,8 98,9 No,never had a card 4 1,1 1,1 100,0 Total 360 100,0 100,0 Q84.Copy the following vaccination dates from the card or booklet. If vaccines are not recorded in the child booklet, fill in 99/99/9999 / USE ALL. COMPUTE filter_$=(q83 = 1). VARIABLE LABEL filter_$ 'q83 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q84bcg /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84BCG Kigeme N Valid 346 Missing 0 Kaduha N Valid 328 Missing 0 q84BCG HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 346 100,0 100,0 100,0 Kaduha Valid Yes 328 100,0 100,0 100,0 FREQUENCIES VARIABLES=q84po0 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84 Polio O Kigeme N Valid 346 Missing 0 Kaduha N Valid 328 Missing 0 q84Polio O HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 4 1,2 1,2 1,2 Additional and Replacement Documentation Protocal 299 Yes 342 98,8 98,8 100,0 Total 346 100,0 100,0 Kaduha Valid No 5 1,5 1,5 1,5 Yes 323 98,5 98,5 100,0 Total 328 100,0 100,0 FREQUENCIES VARIABLES=q84po1 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84Polio 1 Kigeme N Valid 346 Missing 0 Kaduha N Valid 328 Missing 0 q84 Polio 1 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 26 7,5 7,5 7,5 Yes 320 92,5 92,5 100,0 Total 346 100,0 100,0 Kaduha Valid No 22 6,7 6,7 6,7 Yes 306 93,3 93,3 100,0 Total 328 100,0 100,0 FREQUENCIES VARIABLES=q84po2 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84 Polio2 Kigeme N Valid 346 Missing 0 Kaduha N Valid 328 Missing 0 q84 Polio2 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 47 13,6 13,6 13,6 Yes 299 86,4 86,4 100,0 Total 346 100,0 100,0 Kaduha Valid No 37 11,3 11,3 11,3 Yes 291 88,7 88,7 100,0 Total 328 100,0 100,0 FREQUENCIES VARIABLES=q84po3 Additional and Replacement Documentation Protocal 300 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84 Polio3 Kigeme N Valid 346 Missing 0 Kaduha N Valid 328 Missing 0 q84 Polio3 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 67 19,4 19,4 19,4 Yes 279 80,6 80,6 100,0 Total 346 100,0 100,0 Kaduha Valid No 50 15,2 15,2 15,2 Yes 278 84,8 84,8 100,0 Total 328 100,0 100,0 FREQUENCIES VARIABLES=q84_PENTA1 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84_PENTA1 Kigeme N Valid 346 Missing 0 Kaduha N Valid 328 Missing 0 q84_PENTA1 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 27 7,8 7,8 7,8 Yes 319 92,2 92,2 100,0 Total 346 100,0 100,0 Kaduha Valid No 25 7,6 7,6 7,6 Yes 303 92,4 92,4 100,0 Total 328 100,0 100,0 FREQUENCIES VARIABLES=q84_PENTA2 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84_PENTA2 Kigeme N Valid 346 Missing 0 Additional and Replacement Documentation Protocal 301 Kaduha N Valid 328 Missing 0 q84_PENTA2 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 47 13,6 13,6 13,6 Yes 299 86,4 86,4 100,0 Total 346 100,0 100,0 Kaduha Valid No 37 11,3 11,3 11,3 Yes 291 88,7 88,7 100,0 Total 328 100,0 100,0 FREQUENCIES VARIABLES=q84_PENTA3 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84_PENTA3 Kigeme N Valid 346 Missing 0 Kaduha N Valid 328 Missing 0 q84_PENTA3 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 67 19,4 19,4 19,4 Yes 279 80,6 80,6 100,0 Total 346 100,0 100,0 Kaduha Valid No 50 15,2 15,2 15,2 Yes 278 84,8 84,8 100,0 Total 328 100,0 100,0 FREQUENCIES VARIABLES=q84PPneumo1 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84Pneumo1 Kigeme N Valid 346 Missing 0 Kaduha N Valid 328 Missing 0 q84Pneumo1 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 27 7,8 7,8 7,8 Additional and Replacement Documentation Protocal 302 Yes 319 92,2 92,2 100,0 Total 346 100,0 100,0 Kaduha Valid No 26 7,9 7,9 7,9 Yes 302 92,1 92,1 100,0 Total 328 100,0 100,0 FREQUENCIES VARIABLES=q84Pin2 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84Pneumo2 Kigeme N Valid 346 Missing 0 Kaduha N Valid 328 Missing 0 q84Pneumo2 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 47 13,6 13,6 13,6 Yes 299 86,4 86,4 100,0 Total 346 100,0 100,0 Kaduha Valid No 37 11,3 11,3 11,3 Yes 291 88,7 88,7 100,0 Total 328 100,0 100,0 FREQUENCIES VARIABLES=q84Pin3 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84Pneumo3 Kigeme N Valid 346 Missing 0 Kaduha N Valid 328 Missing 0 q84Pneumo3 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 69 19,9 19,9 19,9 Yes 277 80,1 80,1 100,0 Total 346 100,0 100,0 Kaduha Valid No 51 15,5 15,5 15,5 Yes 277 84,5 84,5 100,0 Total 328 100,0 100,0 FREQUENCIES VARIABLES=Q84Rota1 Additional and Replacement Documentation Protocal 303 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics Q84Rota1 Kigeme N Valid 346 Missing 0 Kaduha N Valid 328 Missing 0 Q84Rota1 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 29 8,4 8,4 8,4 Yes 317 91,6 91,6 100,0 Total 346 100,0 100,0 Kaduha Valid No 33 10,1 10,1 10,1 Yes 295 89,9 89,9 100,0 Total 328 100,0 100,0 FREQUENCIES VARIABLES=Q84Rota2 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics Q84Rota2 Kigeme N Valid 346 Missing 0 Kaduha N Valid 328 Missing 0 Q84Rota2 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 50 14,5 14,5 14,5 Yes 296 85,5 85,5 100,0 Total 346 100,0 100,0 Kaduha Valid No 48 14,6 14,6 14,6 Yes 280 85,4 85,4 100,0 Total 328 100,0 100,0 FREQUENCIES VARIABLES=Q84Rota3 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics Q84Rota3 Kigeme N Valid 346 Missing 0 Additional and Replacement Documentation Protocal 304 Kaduha N Valid 328 Missing 0 Q84Rota3 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 70 20,2 20,2 20,2 Yes 276 79,8 79,8 100,0 Total 346 100,0 100,0 Kaduha Valid No 62 18,9 18,9 18,9 Yes 266 81,1 81,1 100,0 Total 328 100,0 100,0 USE ALL. COMPUTE filter_$=(q83 = 1and CalcAgeChild >= 12). VARIABLE LABEL filter_$ 'q83 = 1and CalcAgeChild >= 12 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q84mea1_Rub /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84measles1_Rub Kigeme N Valid 141 Missing 0 Kaduha N Valid 142 Missing 0 q84measles1_Rub HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 11 7,8 7,8 7,8 Yes 130 92,2 92,2 100,0 Total 141 100,0 100,0 Kaduha Valid No 8 5,6 5,6 5,6 Yes 134 94,4 94,4 100,0 Total 142 100,0 100,0 Frequencies USE ALL. COMPUTE filter_$=(q83 = 1and CalcAgeChild >= 15). VARIABLE LABEL filter_$ 'q83 = 1and CalcAgeChild >= 15 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). Additional and Replacement Documentation Protocal 305 FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q84mea2 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84measles2 Kigeme N Valid 103 Missing 0 Kaduha N Valid 94 Missing 0 q84measles2 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 20 19,4 19,4 19,4 Yes 83 80,6 80,6 100,0 Total 103 100,0 100,0 Kaduha Valid No 37 39,4 39,4 39,4 Yes 57 60,6 60,6 100,0 Total 94 100,0 100,0 USE ALL. COMPUTE filter_$=(q83 = 1and CalcAgeChild >= 6). VARIABLE LABEL filter_$ 'q83 = 1and CalcAgeChild >= 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q84vita1 /ORDER=ANALYSIS. Frequencies Additional and Replacement Documentation Protocal 306 [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84vita recent dose1 Kigeme N Valid 257 Missing 0 Kaduha N Valid 247 Missing 0 q84vita recent dose HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 158 61,5 61,5 61,5 Yes 99 38,5 38,5 100,0 Total 257 100,0 100,0 Kaduha Valid No 145 58,7 58,7 58,7 Yes 102 41,3 41,3 100,0 Total 247 100,0 100,0 FREQUENCIES VARIABLES=q84vitap /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\KPC_VACCINATION.sav Statistics q84vita previous dose Kigeme N Valid 257 Missing 0 Kaduha N Valid 247 Missing 0 q84vita previous dose HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 238 92,6 92,6 92,6 Yes 19 7,4 7,4 100,0 Total 257 100,0 100,0 Kaduha Valid No 227 91,9 91,9 91,9 Yes 20 8,1 8,1 100,0 Total 247 100,0 100,0 Q85.Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations given during immunization campaigns? FILTER OFF. USE ALL. Additional and Replacement Documentation Protocal 307 EXECUTE. FREQUENCIES VARIABLES=q85 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav FREQUENCIES VARIABLES=q85 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q85 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q85 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 351 97,5 97,5 97,5 Yes 9 2,5 2,5 100,0 Total 360 100,0 100,0 Kaduha Valid No 341 94,7 94,7 94,7 Yes 14 3,9 3,9 98,6 Don't know 5 1,4 1,4 100,0 Total 360 100,0 100,0 Q86.Please tell me if (NAME) received BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar? USE ALL. COMPUTE filter_$=(q85 = 1). VARIABLE LABEL filter_$ 'q85 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q86 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q86 Kigeme N Valid 9 Missing 0 Kaduha N Valid 14 Missing 0 q86. BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar? Additional and Replacement Documentation Protocal 308 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 1 11,1 11,1 11,1 Yes 6 66,7 66,7 77,8 Don't know 2 22,2 22,2 100,0 Total 9 100,0 100,0 Kaduha Valid No 5 35,7 35,7 35,7 Yes 9 64,3 64,3 100,0 Total 14 100,0 100,0 Q87. Please tell me if (NAME) received Polio vaccine, that is, drops like these, in the mouth? USE ALL. COMPUTE filter_$=(q85 = 1). VARIABLE LABEL filter_$ 'q85 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q87 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q87 Kigeme N Valid 9 Missing 0 Kaduha N Valid 14 Missing 0 q87 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 1 11,1 11,1 11,1 Yes 6 66,7 66,7 77,8 Don't Know 2 22,2 22,2 100,0 Total 9 100,0 100,0 Kaduha Valid No 5 35,7 35,7 35,7 Yes 9 64,3 64,3 100,0 Total 14 100,0 100,0 Q88. When was the first polio vaccine received? [In the first two weeks after birth or later? USE ALL. COMPUTE filter_$=(q87 = 1). VARIABLE LABEL filter_$ 'q87 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q88 /ORDER=ANALYSIS. Additional and Replacement Documentation Protocal 309 Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q88 Kigeme N Valid 6 Missing 0 Kaduha N Valid 9 Missing 0 q88 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid First Two Weeks After Birth 6 100,0 100,0 100,0 Kaduha Valid First Two Weeks After Birth 6 66,7 66,7 66,7 Later 3 33,3 33,3 100,0 Total 9 100,0 100,0 Q89.How many times was the polio vaccine received? USE ALL. COMPUTE filter_$=(q87 = 1). VARIABLE LABEL filter_$ 'q87 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q89 /STATISTICS=STDDEV MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q89 Kigeme N Valid 6 Missing 0 Mean 2,67 Median 1,00 Std. Deviation 2,875 Kaduha N Valid 9 Missing 0 Mean 2,67 Median 3,00 Std. Deviation 1,225 q89 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid yes 4 66,7 66,7 66,7 4 times 1 16,7 16,7 83,3 88 Don’t Know 1 16,7 16,7 100,0 Additional and Replacement Documentation Protocal 310 Total 6 100,0 100,0 Kaduha Valid yes 2 22,2 22,2 22,2 2 times 2 22,2 22,2 44,4 3 times 2 22,2 22,2 66,7 4 times 3 33,3 33,3 100,0 Total 9 100,0 100,0 Q90. Has (NAME) received DTP vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops? USE ALL. COMPUTE filter_$=(q87 = 1). VARIABLE LABEL filter_$ 'q87 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q90 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q90 Kigeme N Valid 6 Missing 0 Kaduha N Valid 9 Missing 0 q90 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 6 100,0 100,0 100,0 Kaduha Valid Yes 9 100,0 100,0 100,0 Q91.How many times? USE ALL. COMPUTE filter_$=(q87 = 1). VARIABLE LABEL filter_$ 'q87 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q91 /STATISTICS=STDDEV MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav FREQUENCIES VARIABLES=q91 /STATISTICS=STDDEV MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Additional and Replacement Documentation Protocal 311 q91 Kigeme N Valid 6 Missing 0 Mean 2,67 Median 3,00 Std. Deviation ,816 Kaduha N Valid 9 Missing 0 Mean 3,00 Median 3,00 Std. Deviation 2,062 q91 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 1 16,7 16,7 16,7 3 times 5 83,3 83,3 100,0 Total 6 100,0 100,0 Kaduha Valid Yes 2 22,2 22,2 22,2 2 times 1 11,1 11,1 33,3 3 times 5 55,6 55,6 88,9 88 Don’t know 1 11,1 11,1 100,0 Total 9 100,0 100,0 Q92a.Did (name of child) ever receive an injection in the arm to prevent Measles? Frequencies USE ALL. COMPUTE filter_$=(CalcAgeChild >= 12 and q85 = 1). VARIABLE LABEL filter_$ 'CalcAgeChild >= 12 and q85 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q92a /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q92a Kigeme N Valid 5 Missing 0 Kaduha N Valid 9 Missing 0 q92a HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 5 100,0 100,0 100,0 Additional and Replacement Documentation Protocal 312 Kaduha Valid No 2 22,2 22,2 22,2 Yes 7 77,8 77,8 100,0 Total 9 100,0 100,0 Q92b.Did (name of child) ever receive a dose of vitamin A? USE ALL. COMPUTE filter_$=(CalcAgeChild >=6 and q85 = 1). VARIABLE LABEL filter_$ 'CalcAgeChild >=6 and q85 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q92b /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q92b Kigeme N Valid 9 Missing 0 Kaduha N Valid 13 Missing 0 q92b HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 1 11,1 11,1 11,1 Yes 8 88,9 88,9 100,0 Total 9 100,0 100,0 Kaduha Valid No 1 7,7 7,7 7,7 Yes 12 92,3 92,3 100,0 Total 13 100,0 100,0 Q93. May I weigh (name of child)? Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q93 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q93 Child weight HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 360 100,0 100,0 100,0 Kaduha Valid Yes 360 100,0 100,0 100,0 Q93. Child Weight Additional and Replacement Documentation Protocal 313 Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q93weightavg Kigeme N Valid 360 Missing 0 Mean 7,889 Median 8,000 Std. Deviation 2,1093 Kaduha N Valid 360 Missing 0 Mean 8,131 Median 8,400 Std. Deviation 2,1814 q93weightavg HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 3 1 ,3 ,3 ,3 3.1 1 ,3 ,3 ,6 3.4 1 ,3 ,3 ,8 3.5 4 1,1 1,1 1,9 3.6 2 ,6 ,6 2,5 3.8 1 ,3 ,3 2,8 3.9 4 1,1 1,1 3,9 4 2 ,6 ,6 4,4 4.1 1 ,3 ,3 4,7 4.2 2 ,6 ,6 5,3 4.3 3 ,8 ,8 6,1 4.4 5 1,4 1,4 7,5 4.5 2 ,6 ,6 8,1 4.6 1 ,3 ,3 8,3 4.7 4 1,1 1,1 9,4 4.9 2 ,6 ,6 10,0 5 1 ,3 ,3 10,3 5.1 4 1,1 1,1 11,4 5.3 3 ,8 ,8 12,2 5.4 6 1,7 1,7 13,9 5.5 6 1,7 1,7 15,6 5.6 5 1,4 1,4 16,9 5.7 2 ,6 ,6 17,5 5.8 4 1,1 1,1 18,6 5.9 2 ,6 ,6 19,2 Additional and Replacement Documentation Protocal 314 6 5 1,4 1,4 20,6 6.1 6 1,7 1,7 22,2 6.2 5 1,4 1,4 23,6 6.3 3 ,8 ,8 24,4 6.4 3 ,8 ,8 25,3 6.5 5 1,4 1,4 26,7 6.6 5 1,4 1,4 28,1 6.7 2 ,6 ,6 28,6 6.8 6 1,7 1,7 30,3 6.9 6 1,7 1,7 31,9 7 3 ,8 ,8 32,8 7.1 6 1,7 1,7 34,4 7.2 7 1,9 1,9 36,4 7.3 6 1,7 1,7 38,1 7.4 9 2,5 2,5 40,6 7.5 8 2,2 2,2 42,8 7.6 7 1,9 1,9 44,7 7.7 2 ,6 ,6 45,3 7.8 10 2,8 2,8 48,1 7.9 4 1,1 1,1 49,2 8 6 1,7 1,7 50,8 8.1 6 1,7 1,7 52,5 8.2 9 2,5 2,5 55,0 8.3 13 3,6 3,6 58,6 8.4 6 1,7 1,7 60,3 8.5 7 1,9 1,9 62,2 8.6 2 ,6 ,6 62,8 8.7 6 1,7 1,7 64,4 8.8 6 1,7 1,7 66,1 8.9 3 ,8 ,8 66,9 9 5 1,4 1,4 68,3 9.1 10 2,8 2,8 71,1 9.2 9 2,5 2,5 73,6 9.3 5 1,4 1,4 75,0 9.4 7 1,9 1,9 76,9 9.5 6 1,7 1,7 78,6 9.6 3 ,8 ,8 79,4 9.7 4 1,1 1,1 80,6 9.8 3 ,8 ,8 81,4 9.9 2 ,6 ,6 81,9 10 4 1,1 1,1 83,1 Additional and Replacement Documentation Protocal 315 10.1 2 ,6 ,6 83,6 10.2 6 1,7 1,7 85,3 10.3 2 ,6 ,6 85,8 10.4 4 1,1 1,1 86,9 10.5 6 1,7 1,7 88,6 10.6 1 ,3 ,3 88,9 10.7 2 ,6 ,6 89,4 10.8 4 1,1 1,1 90,6 10.9 5 1,4 1,4 91,9 11 7 1,9 1,9 93,9 11.1 2 ,6 ,6 94,4 11.2 3 ,8 ,8 95,3 11.4 3 ,8 ,8 96,1 11.5 3 ,8 ,8 96,9 11.6 1 ,3 ,3 97,2 11.7 1 ,3 ,3 97,5 11.8 2 ,6 ,6 98,1 11.9 3 ,8 ,8 98,9 12 1 ,3 ,3 99,2 12.3 1 ,3 ,3 99,4 12.6 1 ,3 ,3 99,7 12.7 1 ,3 ,3 100,0 Total 360 100,0 100,0 Kaduha Valid 2.6 1 ,3 ,3 ,3 3 1 ,3 ,3 ,6 3.2 3 ,8 ,8 1,4 3.4 2 ,6 ,6 1,9 3.5 3 ,8 ,8 2,8 3.7 2 ,6 ,6 3,3 3.8 1 ,3 ,3 3,6 3.9 1 ,3 ,3 3,9 4 2 ,6 ,6 4,4 4.1 2 ,6 ,6 5,0 4.2 1 ,3 ,3 5,3 4.3 3 ,8 ,8 6,1 4.4 3 ,8 ,8 6,9 4.5 4 1,1 1,1 8,1 4.6 1 ,3 ,3 8,3 4.7 1 ,3 ,3 8,6 4.8 3 ,8 ,8 9,4 4.9 1 ,3 ,3 9,7 5 4 1,1 1,1 10,8 Additional and Replacement Documentation Protocal 316 5.1 1 ,3 ,3 11,1 5.2 5 1,4 1,4 12,5 5.3 2 ,6 ,6 13,1 5.4 3 ,8 ,8 13,9 5.6 1 ,3 ,3 14,2 5.7 1 ,3 ,3 14,4 5.8 7 1,9 1,9 16,4 5.9 4 1,1 1,1 17,5 6 3 ,8 ,8 18,3 6.1 4 1,1 1,1 19,4 6.2 1 ,3 ,3 19,7 6.3 1 ,3 ,3 20,0 6.4 5 1,4 1,4 21,4 6.5 5 1,4 1,4 22,8 6.7 2 ,6 ,6 23,3 6.8 4 1,1 1,1 24,4 6.9 6 1,7 1,7 26,1 7 6 1,7 1,7 27,8 7.1 5 1,4 1,4 29,2 7.2 7 1,9 1,9 31,1 7.3 4 1,1 1,1 32,2 7.4 5 1,4 1,4 33,6 7.5 10 2,8 2,8 36,4 7.6 3 ,8 ,8 37,2 7.7 4 1,1 1,1 38,3 7.8 3 ,8 ,8 39,2 7.9 6 1,7 1,7 40,8 8 9 2,5 2,5 43,3 8.1 12 3,3 3,3 46,7 8.2 5 1,4 1,4 48,1 8.3 4 1,1 1,1 49,2 8.4 13 3,6 3,6 52,8 8.5 12 3,3 3,3 56,1 8.6 4 1,1 1,1 57,2 8.7 6 1,7 1,7 58,9 8.8 7 1,9 1,9 60,8 8.9 7 1,9 1,9 62,8 9 9 2,5 2,5 65,3 9.1 7 1,9 1,9 67,2 9.2 10 2,8 2,8 70,0 9.3 6 1,7 1,7 71,7 9.4 9 2,5 2,5 74,2 9.5 9 2,5 2,5 76,7 9.6 2 ,6 ,6 77,2 Additional and Replacement Documentation Protocal 317 9.7 3 ,8 ,8 78,1 9.8 10 2,8 2,8 80,8 9.9 3 ,8 ,8 81,7 10 7 1,9 1,9 83,6 10.1 2 ,6 ,6 84,2 10.2 5 1,4 1,4 85,6 10.3 3 ,8 ,8 86,4 10.4 5 1,4 1,4 87,8 10.5 4 1,1 1,1 88,9 10.7 3 ,8 ,8 89,7 10.8 3 ,8 ,8 90,6 10.9 2 ,6 ,6 91,1 11 5 1,4 1,4 92,5 11.1 2 ,6 ,6 93,1 11.2 2 ,6 ,6 93,6 11.3 1 ,3 ,3 93,9 11.4 2 ,6 ,6 94,4 11.5 3 ,8 ,8 95,3 11.7 1 ,3 ,3 95,6 11.8 2 ,6 ,6 96,1 12 4 1,1 1,1 97,2 12.1 1 ,3 ,3 97,5 12.4 1 ,3 ,3 97,8 12.5 1 ,3 ,3 98,1 12.6 1 ,3 ,3 98,3 13 1 ,3 ,3 98,6 13.2 2 ,6 ,6 99,2 13.5 1 ,3 ,3 99,4 14 1 ,3 ,3 99,7 14.1 1 ,3 ,3 100,0 Total 360 100,0 100,0 Q94.May I use MUAC Tape with (name of child)? USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q94 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q94 Kigeme N Valid 270 Additional and Replacement Documentation Protocal 318 Missing 0 Kaduha N Valid 270 Missing 0 q94 Child MUAC HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 270 100,0 100,0 100,0 Kaduha Valid Yes 270 100,0 100,0 100,0 q94. Child MUAC FREQUENCIES VARIABLES=q94muacavg /STATISTICS=STDDEV MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q94muacavg Kigeme N Valid 270 Missing 0 Mean 14,091 Median 14,000 Std. Deviation 1,1210 Kaduha N Valid 270 Missing 0 Mean 14,346 Median 14,100 Std. Deviation 1,1020 q94 Child MUAC HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 11.0 1 ,4 ,4 ,4 11.4 1 ,4 ,4 ,7 11.5 1 ,4 ,4 1,1 11.8 2 ,7 ,7 1,9 12.0 5 1,9 1,9 3,7 12.1 1 ,4 ,4 4,1 12.2 1 ,4 ,4 4,4 12.3 1 ,4 ,4 4,8 12.4 1 ,4 ,4 5,2 12.5 4 1,5 1,5 6,7 12.6 4 1,5 1,5 8,1 12.7 3 1,1 1,1 9,3 12.8 3 1,1 1,1 10,4 12.9 3 1,1 1,1 11,5 Additional and Replacement Documentation Protocal 319 13.0 22 8,1 8,1 19,6 13.1 11 4,1 4,1 23,7 13.2 4 1,5 1,5 25,2 13.3 4 1,5 1,5 26,7 13.4 1 ,4 ,4 27,0 13.5 18 6,7 6,7 33,7 13.6 9 3,3 3,3 37,0 13.7 3 1,1 1,1 38,1 13.8 2 ,7 ,7 38,9 13.9 3 1,1 1,1 40,0 14.0 40 14,8 14,8 54,8 14.1 11 4,1 4,1 58,9 14.2 3 1,1 1,1 60,0 14.3 6 2,2 2,2 62,2 14.4 5 1,9 1,9 64,1 14.5 20 7,4 7,4 71,5 14.6 3 1,1 1,1 72,6 14.7 2 ,7 ,7 73,3 14.9 5 1,9 1,9 75,2 15.0 17 6,3 6,3 81,5 15.1 7 2,6 2,6 84,1 15.2 4 1,5 1,5 85,6 15.3 2 ,7 ,7 86,3 15.4 4 1,5 1,5 87,8 15.5 6 2,2 2,2 90,0 15.6 2 ,7 ,7 90,7 15.7 2 ,7 ,7 91,5 15.8 2 ,7 ,7 92,2 15.9 1 ,4 ,4 92,6 16.0 7 2,6 2,6 95,2 16.1 3 1,1 1,1 96,3 16.2 2 ,7 ,7 97,0 16.3 1 ,4 ,4 97,4 16.5 2 ,7 ,7 98,1 16.7 1 ,4 ,4 98,5 16.9 1 ,4 ,4 98,9 17.0 2 ,7 ,7 99,6 17.5 1 ,4 ,4 100,0 Total 270 100,0 100,0 Kaduha Valid 11.5 1 ,4 ,4 ,4 12.0 3 1,1 1,1 1,5 Additional and Replacement Documentation Protocal 320 12.1 1 ,4 ,4 1,9 12.4 1 ,4 ,4 2,2 12.5 1 ,4 ,4 2,6 12.6 1 ,4 ,4 3,0 12.7 1 ,4 ,4 3,3 12.8 2 ,7 ,7 4,1 12.9 6 2,2 2,2 6,3 13.0 19 7,0 7,0 13,3 13.1 7 2,6 2,6 15,9 13.2 8 3,0 3,0 18,9 13.3 4 1,5 1,5 20,4 13.4 1 ,4 ,4 20,7 13.5 23 8,5 8,5 29,3 13.6 5 1,9 1,9 31,1 13.7 2 ,7 ,7 31,9 13.8 2 ,7 ,7 32,6 13.9 1 ,4 ,4 33,0 14.0 42 15,6 15,6 48,5 14.1 6 2,2 2,2 50,7 14.2 5 1,9 1,9 52,6 14.3 2 ,7 ,7 53,3 14.4 3 1,1 1,1 54,4 14.5 21 7,8 7,8 62,2 14.6 2 ,7 ,7 63,0 14.7 2 ,7 ,7 63,7 14.8 1 ,4 ,4 64,1 14.9 2 ,7 ,7 64,8 1.05 29 10,7 10,7 75,6 15.1 7 2,6 2,6 78,1 15.2 7 2,6 2,6 80,7 15.3 4 1,5 1,5 82,2 15.4 1 ,4 ,4 82,6 15.5 10 3,7 3,7 86,3 15.6 2 ,7 ,7 87,0 15.9 1 ,4 ,4 87,4 16.0 18 6,7 6,7 94,1 16.1 3 1,1 1,1 95,2 16.3 1 ,4 ,4 95,6 16.4 1 ,4 ,4 95,9 16.5 6 2,2 2,2 98,1 17.0 4 1,5 1,5 99,6 17.5 1 ,4 ,4 100,0 Total 270 100,0 100,0 Q95. May I measure length for (name of child)? Additional and Replacement Documentation Protocal 321 FREQUENCIES VARIABLES=q95 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q95 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q95 Child Length HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 360 100,0 100,0 100,0 Kaduha Valid Yes 360 100,0 100,0 100,0 q95. Child Length FREQUENCIES VARIABLES=q95lengthavg /ORDER=ANALYSIS. Frequencies Statistics q95lengthavg Kigeme N Valid 360 Missing 0 Mean 68,412 Median 69,000 Std. Deviation 8,6880 Kaduha N Valid 360 Missing 0 Mean 68,861 Median 69,500 Std. Deviation 8,5419 q95 child length( cm) HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 47.0 1 ,3 ,3 ,3 48.4 1 ,3 ,3 ,6 49.0 2 ,6 ,6 1,1 50.0 4 1,1 1,1 2,2 50.1 2 ,6 ,6 2,8 51.0 4 1,1 1,1 3,9 51.2 1 ,3 ,3 4,2 52.0 3 ,8 ,8 5,0 Additional and Replacement Documentation Protocal 322 52.5 1 ,3 ,3 5,3 53.0 1 ,3 ,3 5,6 53.2 1 ,3 ,3 5,8 53.5 2 ,6 ,6 6,4 53.9 1 ,3 ,3 6,7 54.0 3 ,8 ,8 7,5 54.1 1 ,3 ,3 7,8 54.3 1 ,3 ,3 8,1 54.8 1 ,3 ,3 8,3 55.0 2 ,6 ,6 8,9 55.3 1 ,3 ,3 9,2 55.4 1 ,3 ,3 9,4 56.0 5 1,4 1,4 10,8 56.1 2 ,6 ,6 11,4 56.3 2 ,6 ,6 11,9 57.0 2 ,6 ,6 12,5 57.1 2 ,6 ,6 13,1 57.2 1 ,3 ,3 13,3 57.4 2 ,6 ,6 13,9 57.6 1 ,3 ,3 14,2 58.0 2 ,6 ,6 14,7 58.1 1 ,3 ,3 15,0 58.4 1 ,3 ,3 15,3 58.5 1 ,3 ,3 15,6 58.8 1 ,3 ,3 15,8 59.0 4 1,1 1,1 16,9 59.2 2 ,6 ,6 17,5 59.5 3 ,8 ,8 18,3 60.0 7 1,9 1,9 20,3 60.1 1 ,3 ,3 20,6 60.2 1 ,3 ,3 20,8 60.5 3 ,8 ,8 21,7 60.6 1 ,3 ,3 21,9 61.0 3 ,8 ,8 22,8 61.3 1 ,3 ,3 23,1 61.6 1 ,3 ,3 23,3 61.7 1 ,3 ,3 23,6 61.8 1 ,3 ,3 23,9 62.0 3 ,8 ,8 24,7 62.1 1 ,3 ,3 25,0 63.o 3 ,8 ,8 25,8 Additional and Replacement Documentation Protocal 323 63.1 1 ,3 ,3 26,1 63.3 1 ,3 ,3 26,4 63.4 2 ,6 ,6 26,9 63.5 1 ,3 ,3 27,2 63.9 1 ,3 ,3 27,5 64.0 7 1,9 1,9 29,4 64.1 2 ,6 ,6 30,0 64.2 1 ,3 ,3 30,3 64.4 2 ,6 ,6 30,8 64.5 2 ,6 ,6 31,4 64.6 2 ,6 ,6 31,9 65.0 1 ,3 ,3 32,2 65.1 7 1,9 1,9 34,2 65.2 1 ,3 ,3 34,4 65.3 1 ,3 ,3 34,7 65.5 2 ,6 ,6 35,3 65.6 1 ,3 ,3 35,6 66.0 7 1,9 1,9 37,5 66.1 1 ,3 ,3 37,8 66.2 1 ,3 ,3 38,1 66.4 1 ,3 ,3 38,3 66.5 2 ,6 ,6 38,9 66.6 2 ,6 ,6 39,4 67.0 9 2,5 2,5 41,9 67.3 2 ,6 ,6 42,5 67.5 1 ,3 ,3 42,8 67.6 2 ,6 ,6 43,3 67.8 1 ,3 ,3 43,6 68.0 9 2,5 2,5 46,1 68.1 3 ,8 ,8 46,9 68.2 1 ,3 ,3 47,2 68.3 1 ,3 ,3 47,5 68.4 2 ,6 ,6 48,1 68.6 1 ,3 ,3 48,3 68.7 2 ,6 ,6 48,9 68.8 1 ,3 ,3 49,2 68.9 1 ,3 ,3 49,4 69.0 5 1,4 1,4 50,8 69.1 1 ,3 ,3 51,1 69.2 1 ,3 ,3 51,4 69.5 1 ,3 ,3 51,7 Additional and Replacement Documentation Protocal 324 69.9 1 ,3 ,3 51,9 70.0 7 1,9 1,9 53,9 70.1 2 ,6 ,6 54,4 70.5 1 ,3 ,3 54,7 70.6 2 ,6 ,6 55,3 71.0 6 1,7 1,7 56,9 71.1 5 1,4 1,4 58,3 71.2 1 ,3 ,3 58,6 71.3 3 ,8 ,8 59,4 71.4 1 ,3 ,3 59,7 71.9 1 ,3 ,3 60,0 72.0 4 1,1 1,1 61,1 72.2 2 ,6 ,6 61,7 72.4 1 ,3 ,3 61,9 72.5 2 ,6 ,6 62,5 72.7 1 ,3 ,3 62,8 73.0 8 2,2 2,2 65,0 73.1 4 1,1 1,1 66,1 73.3 2 ,6 ,6 66,7 73.5 1 ,3 ,3 66,9 73.6 1 ,3 ,3 67,2 74.0 11 3,1 3,1 70,3 74.1 1 ,3 ,3 70,6 74.2 2 ,6 ,6 71,1 74.4 2 ,6 ,6 71,7 74.5 3 ,8 ,8 72,5 74.8 1 ,3 ,3 72,8 74.9 1 ,3 ,3 73,1 75.0 10 2,8 2,8 75,8 75.1 4 1,1 1,1 76,9 75.3 1 ,3 ,3 77,2 75.5 2 ,6 ,6 77,8 75.6 1 ,3 ,3 78,1 76.0 6 1,7 1,7 79,7 76.1 1 ,3 ,3 80,0 76.2 1 ,3 ,3 80,3 76.3 2 ,6 ,6 80,8 76.6 1 ,3 ,3 81,1 76.9 1 ,3 ,3 81,4 77.0 6 1,7 1,7 83,1 77.1 2 ,6 ,6 83,6 Additional and Replacement Documentation Protocal 325 77.2 1 ,3 ,3 83,9 77.3 1 ,3 ,3 84,2 77.4 1 ,3 ,3 84,4 77.8 2 ,6 ,6 85,0 78.0 5 1,4 1,4 86,4 78.1 1 ,3 ,3 86,7 78.2 2 ,6 ,6 87,2 78.4 2 ,6 ,6 87,8 78.5 1 ,3 ,3 88,1 79.0 6 1,7 1,7 89,7 79.1 1 ,3 ,3 90,0 79.2 1 ,3 ,3 90,3 79.3 1 ,3 ,3 90,6 79.5 1 ,3 ,3 90,8 79.6 1 ,3 ,3 91,1 79.8 1 ,3 ,3 91,4 80.0 4 1,1 1,1 92,5 80.1 1 ,3 ,3 92,8 80.2 1 ,3 ,3 93,1 80.5 2 ,6 ,6 93,6 80.7 1 ,3 ,3 93,9 80.8 1 ,3 ,3 94,2 81.0 8 2,2 2,2 96,4 81.1 1 ,3 ,3 96,7 82.0 2 ,6 ,6 97,2 82.1 2 ,6 ,6 97,8 83.0 1 ,3 ,3 98,1 83.1 1 ,3 ,3 98,3 83.4 1 ,3 ,3 98,6 83.5 1 ,3 ,3 98,9 84.1 1 ,3 ,3 99,2 85.0 1 ,3 ,3 99,4 85.1 1 ,3 ,3 99,7 86.3 1 ,3 ,3 100,0 Total 360 100,0 100,0 Kaduha Valid 45.5 1 ,3 ,3 ,3 48.0 1 ,3 ,3 ,6 49.5 1 ,3 ,3 ,8 50.0 5 1,4 1,4 2,2 51.0 1 ,3 ,3 2,5 51.1 1 ,3 ,3 2,8 Additional and Replacement Documentation Protocal 326 51.4 1 ,3 ,3 3,1 52.0 2 ,6 ,6 3,6 52.1 1 ,3 ,3 3,9 53.0 2 ,6 ,6 4,4 53.2 2 ,6 ,6 5,0 54.0 4 1,1 1,1 6,1 54.3 1 ,3 ,3 6,4 54.9 1 ,3 ,3 6,7 55.0 5 1,4 1,4 8,1 55.1 1 ,3 ,3 8,3 55.5 2 ,6 ,6 8,9 55.7 1 ,3 ,3 9,2 55.8 1 ,3 ,3 9,4 56.0 6 1,7 1,7 11,1 56.4 1 ,3 ,3 11,4 56.9 1 ,3 ,3 11,7 57.0 1 ,3 ,3 11,9 57.2 1 ,3 ,3 12,2 57.3 2 ,6 ,6 12,8 57.4 1 ,3 ,3 13,1 58.0 1 ,3 ,3 13,3 58.1 2 ,6 ,6 13,9 58.7 2 ,6 ,6 14,4 59.0 4 1,1 1,1 15,6 59.1 1 ,3 ,3 15,8 59.5 3 ,8 ,8 16,7 60.0 4 1,1 1,1 17,8 60.2 1 ,3 ,3 18,1 60.5 2 ,6 ,6 18,6 60.7 1 ,3 ,3 18,9 61.0 4 1,1 1,1 20,0 61.1 1 ,3 ,3 20,3 61.2 1 ,3 ,3 20,6 61.8 1 ,3 ,3 20,8 62.0 5 1,4 1,4 22,2 62.9 1 ,3 ,3 22,5 63.0 5 1,4 1,4 23,9 63.1 2 ,6 ,6 24,4 63.5 2 ,6 ,6 25,0 63.7 1 ,3 ,3 25,3 64.0 5 1,4 1,4 26,7 64.1 3 ,8 ,8 27,5 64.5 1 ,3 ,3 27,8 64.9 1 ,3 ,3 28,1 Additional and Replacement Documentation Protocal 327 65.0 8 2,2 2,2 30,3 65.2 3 ,8 ,8 31,1 65.3 1 ,3 ,3 31,4 65.4 1 ,3 ,3 31,7 65.6 1 ,3 ,3 31,9 66.0 7 1,9 1,9 33,9 66.1 1 ,3 ,3 34,2 66.4 1 ,3 ,3 34,4 66.5 2 ,6 ,6 35,0 66.7 1 ,3 ,3 35,3 66.8 1 ,3 ,3 35,6 66.9 1 ,3 ,3 35,8 67.0 6 1,7 1,7 37,5 67.1 2 ,6 ,6 38,1 67.4 1 ,3 ,3 38,3 67.6 1 ,3 ,3 38,6 68.0 10 2,8 2,8 41,4 68.1 1 ,3 ,3 41,7 68.3 3 ,8 ,8 42,5 68.5 2 ,6 ,6 43,1 68.8 1 ,3 ,3 43,3 68.9 1 ,3 ,3 43,6 69.0 15 4,2 4,2 47,8 69.1 2 ,6 ,6 48,3 69.2 3 ,8 ,8 49,2 69.3 1 ,3 ,3 49,4 69.4 1 ,3 ,3 49,7 69.5 2 ,6 ,6 50,3 69.7 1 ,3 ,3 50,6 70.0 17 4,7 4,7 55,3 70.1 3 ,8 ,8 56,1 70.2 1 ,3 ,3 56,4 70.3 1 ,3 ,3 56,7 71.0 9 2,5 2,5 59,2 71.1 1 ,3 ,3 59,4 71.2 1 ,3 ,3 59,7 71.3 1 ,3 ,3 60,0 71.4 1 ,3 ,3 60,3 71.5 2 ,6 ,6 60,8 71.7 1 ,3 ,3 61,1 71.9 1 ,3 ,3 61,4 72.0 10 2,8 2,8 64,2 72.1 1 ,3 ,3 64,4 72.3 1 ,3 ,3 64,7 Additional and Replacement Documentation Protocal 328 72.4 2 ,6 ,6 65,3 72.7 1 ,3 ,3 65,6 73.0 7 1,9 1,9 67,5 73.1 2 ,6 ,6 68,1 73.2 2 ,6 ,6 68,6 73.3 2 ,6 ,6 69,2 73.5 1 ,3 ,3 69,4 73.7 1 ,3 ,3 69,7 74.0 8 2,2 2,2 71,9 74.1 2 ,6 ,6 72,5 74.2 1 ,3 ,3 72,8 74.4 1 ,3 ,3 73,1 74.5 3 ,8 ,8 73,9 74.8 1 ,3 ,3 74,2 75.0 10 2,8 2,8 76,9 75.1 1 ,3 ,3 77,2 75.4 1 ,3 ,3 77,5 75.8 1 ,3 ,3 77,8 75.9 1 ,3 ,3 78,1 76.0 3 ,8 ,8 78,9 76.1 4 1,1 1,1 80,0 76.2 2 ,6 ,6 80,6 76.4 1 ,3 ,3 80,8 76.5 4 1,1 1,1 81,9 76.8 1 ,3 ,3 82,2 77.0 5 1,4 1,4 83,6 77.1 1 ,3 ,3 83,9 77.5 2 ,6 ,6 84,4 77.9 1 ,3 ,3 84,7 78.0 6 1,7 1,7 86,4 78.3 1 ,3 ,3 86,7 78.5 3 ,8 ,8 87,5 78.8 1 ,3 ,3 87,8 79.0 2 ,6 ,6 88,3 79.1 1 ,3 ,3 88,6 79.4 1 ,3 ,3 88,9 79.6 1 ,3 ,3 89,2 80.0 9 2,5 2,5 91,7 80.1 1 ,3 ,3 91,9 80.3 1 ,3 ,3 92,2 80.8 1 ,3 ,3 92,5 81.0 5 1,4 1,4 93,9 81.1 1 ,3 ,3 94,2 81.5 2 ,6 ,6 94,7 Additional and Replacement Documentation Protocal 329 82.0 3 ,8 ,8 95,6 82.2 1 ,3 ,3 95,8 82.3 1 ,3 ,3 96,1 83.0 3 ,8 ,8 96,9 83.1 1 ,3 ,3 97,2 84.0 2 ,6 ,6 97,8 84.4 1 ,3 ,3 98,1 85.0 2 ,6 ,6 98,6 85.1 1 ,3 ,3 98,9 85.5 1 ,3 ,3 99,2 86.0 1 ,3 ,3 99,4 87.5 1 ,3 ,3 99,7 88.1 1 ,3 ,3 100,0 Total 360 100,0 100,0 Q95a. Check if (name of child) has oedema in both feet Statistics q95a Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q95a HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 358 99,4 99,4 99,4 Yes 2 ,6 ,6 100,0 Total 360 100,0 100,0 Kaduha Valid No 359 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 360 100,0 100,0 Q96.May I use MUAC Tape with you? USE ALL. COMPUTE filter_$=(BiologicalMother = 1). VARIABLE LABEL filter_$ 'BiologicalMother = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q96 /ORDER=ANALYSIS. Statistics q96 Kigeme N Valid 360 Missing 0 Kaduha N Valid 357 Additional and Replacement Documentation Protocal 330 Statistics q96 Kigeme N Valid 360 Missing 0 Kaduha N Valid 357 Missing 0 q96 Maternal MUAC HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 360 100,0 100,0 100,0 Kaduha Valid Yes 357 100,0 100,0 100,0 Q96. Maternal MUAC Frequencies [DataSet1] C:\Users\World Relief RWANDA\Desktop\KPC RAW DATA\WRR YEAR4 KPC 04242015.sav Statistics q96muacavg Kigeme N Valid 360 Missing 0 Mean 25,904 Median 26,000 Std. Deviation 2,4124 Kaduha N Valid 357 Missing 0 Mean 25,568 Median 25,500 Std. Deviation 2,3410 q96 Maternal MUAC (cm) HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 19.1 1 ,3 ,3 ,3 21.0 1 ,3 ,3 ,6 21.5 3 ,8 ,8 1,4 21.7 1 ,3 ,3 1,7 21.8 1 ,3 ,3 1,9 22.0 6 1,7 1,7 3,6 22.1 1 ,3 ,3 3,9 22.2 2 ,6 ,6 4,4 22.3 1 ,3 ,3 4,7 22.4 3 ,8 ,8 5,6 22.5 2 ,6 ,6 6,1 22.6 6 1,7 1,7 7,8 22.8 1 ,3 ,3 8,1 22.9 2 ,6 ,6 8,6 Additional and Replacement Documentation Protocal 331 23.0 7 1,9 1,9 10,6 23.1 5 1,4 1,4 11,9 23.2 5 1,4 1,4 13,3 23.5 13 3,6 3,6 16,9 23.6 2 ,6 ,6 17,5 23.7 3 ,8 ,8 18,3 23.8 1 ,3 ,3 18,6 23.9 2 ,6 ,6 19,2 24.0 19 5,3 5,3 24,4 24.1 7 1,9 1,9 26,4 24.2 3 ,8 ,8 27,2 24.3 2 ,6 ,6 27,8 24.4 5 1,4 1,4 29,2 24.5 11 3,1 3,1 32,2 24.6 7 1,9 1,9 34,2 24.8 1 ,3 ,3 34,4 25.0 17 4,7 4,7 39,2 25.1 5 1,4 1,4 40,6 25.2 1 ,3 ,3 40,8 25.3 2 ,6 ,6 41,4 25.4 2 ,6 ,6 41,9 25.5 18 5,0 5,0 46,9 25.6 5 1,4 1,4 48,3 25.9 2 ,6 ,6 48,9 26.0 27 7,5 7,5 56,4 26.1 4 1,1 1,1 57,5 26.2 5 1,4 1,4 58,9 26.3 3 ,8 ,8 59,7 26.4 5 1,4 1,4 61,1 26.5 15 4,2 4,2 65,3 26.6 2 ,6 ,6 65,8 26.7 2 ,6 ,6 66,4 26.8 2 ,6 ,6 66,9 26.9 3 ,8 ,8 67,8 27.0 18 5,0 5,0 72,8 27.1 7 1,9 1,9 74,7 27.2 1 ,3 ,3 75,0 27.4 2 ,6 ,6 75,6 27.5 12 3,3 3,3 78,9 27.6 4 1,1 1,1 80,0 27.7 1 ,3 ,3 80,3 Additional and Replacement Documentation Protocal 332 27.8 2 ,6 ,6 80,8 28.0 11 3,1 3,1 83,9 28.1 7 1,9 1,9 85,8 28.2 2 ,6 ,6 86,4 28.3 2 ,6 ,6 86,9 28.5 10 2,8 2,8 89,7 28.6 3 ,8 ,8 90,6 29.0 5 1,4 1,4 91,9 29.1 4 1,1 1,1 93,1 29.5 4 1,1 1,1 94,2 30.0 4 1,1 1,1 95,3 30.1 1 ,3 ,3 95,6 30.2 2 ,6 ,6 96,1 31.0 2 ,6 ,6 96,7 31.2 1 ,3 ,3 96,9 31.4 1 ,3 ,3 97,2 31.6 1 ,3 ,3 97,5 32.0 3 ,8 ,8 98,3 32.1 1 ,3 ,3 98,6 32.6 1 ,3 ,3 98,9 33.1 1 ,3 ,3 99,2 35.0 2 ,6 ,6 99,7 35.4 1 ,3 ,3 100,0 Total 360 100,0 100,0 Kaduha Valid 19.9 1 ,3 ,3 ,3 20.0 2 ,6 ,6 ,8 20.5 2 ,6 ,6 1,4 21.0 1 ,3 ,3 1,7 21.3 1 ,3 ,3 2,0 21.4 1 ,3 ,3 2,2 21.5 2 ,6 ,6 2,8 21.6 1 ,3 ,3 3,1 21.7 1 ,3 ,3 3,4 22.0 7 2,0 2,0 5,3 22.1 2 ,6 ,6 5,9 22.3 1 ,3 ,3 6,2 22.4 3 ,8 ,8 7,0 22.5 3 ,8 ,8 7,8 22.6 2 ,6 ,6 8,4 23.0 20 5,6 5,6 14,0 23.1 3 ,8 ,8 14,8 23.2 2 ,6 ,6 15,4 Additional and Replacement Documentation Protocal 333 23.3 2 ,6 ,6 16,0 23.4 2 ,6 ,6 16,5 23.5 11 3,1 3,1 19,6 23.6 1 ,3 ,3 19,9 23.7 3 ,8 ,8 20,7 23.8 1 ,3 ,3 21,0 24.0 26 7,3 7,3 28,3 24.1 2 ,6 ,6 28,9 24.2 1 ,3 ,3 29,1 24.3 2 ,6 ,6 29,7 24.4 3 ,8 ,8 30,5 24.5 22 6,2 6,2 36,7 24.6 2 ,6 ,6 37,3 24.7 1 ,3 ,3 37,5 24.8 2 ,6 ,6 38,1 24.9 2 ,6 ,6 38,7 25.0 27 7,6 7,6 46,2 25.1 2 ,6 ,6 46,8 25.2 4 1,1 1,1 47,9 25.3 6 1,7 1,7 49,6 25.4 1 ,3 ,3 49,9 25.5 16 4,5 4,5 54,3 25.6 2 ,6 ,6 54,9 25.7 4 1,1 1,1 56,0 25.8 1 ,3 ,3 56,3 25.9 3 ,8 ,8 57,1 26.0 31 8,7 8,7 65,8 26.1 3 ,8 ,8 66,7 26.2 2 ,6 ,6 67,2 26.3 4 1,1 1,1 68,3 26.4 2 ,6 ,6 68,9 26.5 9 2,5 2,5 71,4 26.6 1 ,3 ,3 71,7 26.7 3 ,8 ,8 72,5 26.8 3 ,8 ,8 73,4 26.9 2 ,6 ,6 73,9 27.0 14 3,9 3,9 77,9 27.1 6 1,7 1,7 79,6 27.2 2 ,6 ,6 80,1 27.3 1 ,3 ,3 80,4 27.4 1 ,3 ,3 80,7 27.5 8 2,2 2,2 82,9 27.6 1 ,3 ,3 83,2 28.0 10 2,8 2,8 86,0 Additional and Replacement Documentation Protocal 334 28.1 2 ,6 ,6 86,6 28.2 2 ,6 ,6 87,1 28.3 1 ,3 ,3 87,4 28.5 4 1,1 1,1 88,5 28.6 2 ,6 ,6 89,1 28.7 1 ,3 ,3 89,4 28.8 1 ,3 ,3 89,6 28.9 2 ,6 ,6 90,2 29.0 12 3,4 3,4 93,6 29.1 2 ,6 ,6 94,1 29.3 1 ,3 ,3 94,4 29.4 1 ,3 ,3 94,7 29.5 4 1,1 1,1 95,8 29.8 3 ,8 ,8 96,6 30.0 4 1,1 1,1 97,8 30.6 1 ,3 ,3 98,0 30.8 1 ,3 ,3 98,3 31.0 2 ,6 ,6 98,9 31.3 1 ,3 ,3 99,2 33.7 1 ,3 ,3 99,4 34.0 1 ,3 ,3 99,7 37.5 1 ,3 ,3 100,0 Total 357 100,0 100,0 Total 357 100,0 100,0 Q97.In the past 6 months, have you participated in a week-long training on child feeding and food preparation? USE ALL. COMPUTE filter_$=(HospitalCatchment = 2). VARIABLE LABEL filter_$ 'HospitalCatchment = 2 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q97 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q97 Kaduha N Valid 360 Missing 0 q97 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kaduha Valid No 41 11,4 11,4 11,4 Additional and Replacement Documentation Protocal 335 Yes 319 88,6 88,6 100,0 Total 360 100,0 100,0 98.IF YES: How many times? USE ALL. COMPUTE filter_$=(HospitalCatchment = 2 and q97 = 1). VARIABLE LABEL filter_$ 'HospitalCatchment = 2 and q97 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q98 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q98 Kaduha N Valid 319 Missing 0 q98 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kaduha Valid Once 12 3,8 3,8 3,8 Twice 57 17,9 17,9 21,6 Tree or more 250 78,4 78,4 100,0 Total 319 100,0 100,0 Additional and Replacement Documentation Protocal 336 Q99. When was the most recent time you participated in such a week-long training?Statistics q99. When was the most recent time you participated in such a week-long training? Kaduha N Valid 319 Missing 0 q99. When was the most recent time you participated in such a week-long training? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kaduha Valid March 2015 314 98,4 98,4 98,4 December 2014 2 ,6 ,6 99,1 March 2014 3 ,9 ,9 100,0 Total 319 100,0 100,0 Q100. The most recent time, how many of the days did you participate? FREQUENCIES VARIABLES=Q100 /ORDER=ANALYSIS. Statistics Q100. The most recent time, how many of the days did you participate? Kaduha N Valid 319 Missing 0 Q100. The most recent time, how many of the days did you participate? HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kaduha Valid Once 15 4,7 4,7 4,7 Twice 21 6,6 6,6 11,3 3 times 42 13,2 13,2 24,5 4 times 75 23,5 23,5 48,0 5 times 166 52,0 52,0 100,0 Total 319 100,0 100,0 101.Did you receive a visit related to health in the past month? FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q101 /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics q101 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 q101 Additional and Replacement Documentation Protocal 337 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 200 55,6 55,6 55,6 Yes 159 44,2 44,2 99,7 Don't know 1 ,3 ,3 100,0 Total 360 100,0 100,0 Kaduha Valid No 134 37,2 37,2 37,2 Yes 226 62,8 62,8 100,0 Total 360 100,0 100,0 Q101a. If yes, who visited you? USE ALL. COMPUTE filter_$=(q101 = 1). VARIABLE LABEL filter_$ 'q101 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q101A Q101B Q101C Q101D Q101E /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q101A Q101B Q101C Q101D Q101E Kigeme N Valid 159 159 159 159 159 Missing 0 0 0 0 0 Kaduha N Valid 226 226 226 226 226 Missing 0 0 0 0 0 Frequency Table Q101A. Care group member HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 19 11,9 11,9 11,9 Yes 140 88,1 88,1 100,0 Total 159 100,0 100,0 Kaduha Valid No 6 2,7 2,7 2,7 Yes 220 97,3 97,3 100,0 Total 226 100,0 100,0 Q101B. Health facilities staff HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 141 88,7 88,7 88,7 Yes 18 11,3 11,3 100,0 Total 159 100,0 100,0 Kaduha Valid No 218 96,5 96,5 96,5 Additional and Replacement Documentation Protocal 338 Yes 8 3,5 3,5 100,0 Total 226 100,0 100,0 Q101C. Local government staff HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 145 91,2 91,2 91,2 Yes 14 8,8 8,8 100,0 Total 159 100,0 100,0 Kaduha Valid No 199 88,1 88,1 88,1 Yes 27 11,9 11,9 100,0 Total 226 100,0 100,0 Q101D. Others?/ HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 148 93,1 93,1 93,1 Yes 11 6,9 6,9 100,0 Total 159 100,0 100,0 Kaduha Valid No 223 98,7 98,7 98,7 Yes 3 1,3 1,3 100,0 Total 226 100,0 100,0 Q102. If yes, can you tell me what the purpose of the visit was? USE ALL. COMPUTE filter_$=(q101 = 1). VARIABLE LABEL filter_$ 'q101 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q102A Q102B Q102C Q102D Q102E Q102F Q102G /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q102A Q102B Q102C Q102D Q102E Q102F Q102G Kigeme N Valid 159 159 159 159 159 159 159 Missing 0 0 0 0 0 0 0 Kaduha N Valid 226 226 226 226 226 226 226 Missing 0 0 0 0 0 0 0 Frequency Table Q102A. FOLLOW UP ON SICK CHILD HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 121 76,1 76,1 76,1 Yes 38 23,9 23,9 100,0 Total 159 100,0 100,0 Additional and Replacement Documentation Protocal 339 Kaduha Valid No 194 85,8 85,8 85,8 Yes 32 14,2 14,2 100,0 Total 226 100,0 100,0 Q102B. PROVIDE HEALTH EDUCATION ON MALARIA PREVENTION HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 111 69,8 69,8 69,8 Yes 48 30,2 30,2 100,0 Total 159 100,0 100,0 Kaduha Valid No 164 72,6 72,6 72,6 Yes 62 27,4 27,4 100,0 Total 226 100,0 100,0 Q102C. PROVIDE HEALTH EDUCATION ON DIARRHEA PREVENTION HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 111 69,8 69,8 69,8 Yes 48 30,2 30,2 100,0 Total 159 100,0 100,0 Kaduha Valid No 167 73,9 73,9 73,9 Yes 59 26,1 26,1 100,0 Total 226 100,0 100,0 Q102D. PROVIDE HEALTH EDUCATION ON PNEUMONIA HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 127 79,9 79,9 79,9 Yes 32 20,1 20,1 100,0 Total 159 100,0 100,0 Kaduha Valid No 185 81,9 81,9 81,9 Yes 41 18,1 18,1 100,0 Total 226 100,0 100,0 Q102E. PROVIDE HEALTH EDUCATION ON NUTRITION HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 65 40,9 40,9 40,9 Yes 94 59,1 59,1 100,0 Total 159 100,0 100,0 Kaduha Valid No 71 31,4 31,4 31,4 Yes 155 68,6 68,6 100,0 Total 226 100,0 100,0 Q102F. PROVIDE HEALTH EDUCATION ON IMMUNIZATION HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 127 79,9 79,9 79,9 Additional and Replacement Documentation Protocal 340 Yes 32 20,1 20,1 100,0 Total 159 100,0 100,0 Kaduha Valid No 180 79,6 79,6 79,6 Yes 46 20,4 20,4 100,0 Total 226 100,0 100,0 Q102G. OTHER HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 103 64,8 64,8 64,8 Yes 56 35,2 35,2 100,0 Total 159 100,0 100,0 Kaduha Valid No 174 77,0 77,0 77,0 Yes 52 23,0 23,0 100,0 Total 226 100,0 100,0 Q103.Did you receive any health information from a CHW in the last month? If yes, where did you receive that health information? USE ALL. COMPUTE filter_$=(Q103A = 1). VARIABLE LABEL filter_$ 'Q103A = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q103A Q103B Q103C Q103D Q103E Q103F Q103G Q103H Q103I /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q103A Q103B Q103C Q103D Q103E Q103F Q103G Q103H Q103I Kigeme N Valid 129 129 129 129 129 129 129 129 129 Missing 0 0 0 0 0 0 0 0 0 Kaduha N Valid 127 127 127 127 127 127 127 127 127 Missing 0 0 0 0 0 0 0 0 0 Frequency Table Q103A. Home visit HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid yes 129 100,0 100,0 100,0 Kaduha Valid yes 127 100,0 100,0 100,0 Q103B. Community Meeting HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 98 76,0 76,0 76,0 yes 31 24,0 24,0 100,0 Additional and Replacement Documentation Protocal 341 Total 129 100,0 100,0 Kaduha Valid No 107 84,3 84,3 84,3 yes 20 15,7 15,7 100,0 Total 127 100,0 100,0 Q103C. Health Facility HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 115 89,1 89,1 89,1 yes 14 10,9 10,9 100,0 Total 129 100,0 100,0 Kaduha Valid No 118 92,9 92,9 92,9 yes 9 7,1 7,1 100,0 Total 127 100,0 100,0 Q103D. Growth Monitoring and Counseling HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 101 78,3 78,3 78,3 yes 28 21,7 21,7 100,0 Total 129 100,0 100,0 Kaduha Valid No 98 77,2 77,2 77,2 yes 29 22,8 22,8 100,0 Total 127 100,0 100,0 Q103E. Nutrition Week HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 120 93,0 93,0 93,0 yes 9 7,0 7,0 100,0 Total 129 100,0 100,0 Kaduha Valid No 65 51,2 51,2 51,2 yes 62 48,8 48,8 100,0 Total 127 100,0 100,0 Q103F. Other HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 127 98,4 98,4 98,4 yes 2 1,6 1,6 100,0 Total 129 100,0 100,0 Kaduha Valid No 126 99,2 99,2 99,2 yes 1 ,8 ,8 100,0 Total 127 100,0 100,0 Q103G. Did not receive any health information from a CHW last month. Additional and Replacement Documentation Protocal 342 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 128 99,2 99,2 99,2 yes 1 ,8 ,8 100,0 Total 129 100,0 100,0 Kaduha Valid No 125 98,4 98,4 98,4 yes 2 1,6 1,6 100,0 Total 127 100,0 100,0 Q104. Did you receive any health information from a church in the last month? If yes, what was the information? USE ALL. COMPUTE filter_$=(Q104A = 1). VARIABLE LABEL filter_$ 'Q104A = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q104A Q104B Q104C Q104D Q104E Q104F Q104G Q104H Q104I /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q104A Q104B Q104C Q104D Q104E Q104F Q104G Q104H Q104I Kigeme N Valid 13 13 13 13 13 13 13 13 13 Missing 0 0 0 0 0 0 0 0 0 Kaduha N Valid 15 15 15 15 15 15 15 15 15 Missing 0 0 0 0 0 0 0 0 0 Frequency Table Q104A. Ante-Natal Care or Post-Natal Care HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 13 100,0 100,0 100,0 Kaduha Valid Yes 15 100,0 100,0 100,0 Q104B. Pneumonia HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 10 76,9 76,9 76,9 Yes 3 23,1 23,1 100,0 Total 13 100,0 100,0 Kaduha Valid No 15 100,0 100,0 100,0 Q104C. Water treatment HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 11 84,6 84,6 84,6 Yes 2 15,4 15,4 100,0 Additional and Replacement Documentation Protocal 343 Total 13 100,0 100,0 Kaduha Valid No 8 53,3 53,3 53,3 Yes 7 46,7 46,7 100,0 Total 15 100,0 100,0 Q104D. Hand Washing HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 11 84,6 84,6 84,6 Yes 2 15,4 15,4 100,0 Total 13 100,0 100,0 Kaduha Valid No 14 93,3 93,3 93,3 Yes 1 6,7 6,7 100,0 Total 15 100,0 100,0 Q104E. Diarrhea HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 13 100,0 100,0 100,0 Kaduha Valid No 13 86,7 86,7 86,7 yes 2 13,3 13,3 100,0 Total 15 100,0 100,0 Q104F. Breastfeeding HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 11 84,6 84,6 84,6 yes 2 15,4 15,4 100,0 Total 13 100,0 100,0 Kaduha Valid No 15 100,0 100,0 100,0 Q104G. Nutrition HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 9 69,2 69,2 69,2 yes 4 30,8 30,8 100,0 Total 13 100,0 100,0 Kaduha Valid No 15 100,0 100,0 100,0 Q104H. Other HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 11 84,6 84,6 84,6 yes 2 15,4 15,4 100,0 Total 13 100,0 100,0 Kaduha Valid No 15 100,0 100,0 100,0 Additional and Replacement Documentation Protocal 344 Q104I. Did not receive any health information from a church in the last month HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 13 100,0 100,0 100,0 Kaduha Valid No 15 100,0 100,0 100,0 Q105.Do you own a kitchen garden? FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=Q105a /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Q105a Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 Q105a HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 159 44,2 44,2 44,2 Yes 201 55,8 55,8 100,0 Total 360 100,0 100,0 Kaduha Valid No 103 28,6 28,6 28,6 Yes 257 71,4 71,4 100,0 Total 360 100,0 100,0 105b.If “Yes”, do you sell the vegetables or eat the vegetables, or both? USE ALL. COMPUTE filter_$=(Q105a = 1). VARIABLE LABEL filter_$ 'Q105a = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=105b /ORDER=ANALYSIS. FREQUENCIES VARIABLES=Q105b /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Q105b Kigeme N Valid 201 Missing 0 Kaduha N Valid 257 Additional and Replacement Documentation Protocal 345 Statistics Q105b Kigeme N Valid 201 Missing 0 Kaduha N Valid 257 Missing 0 Q105b HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Eat 197 98,0 98,0 98,0 Sell and eat 4 2,0 2,0 100,0 Total 201 100,0 100,0 Kaduha Valid Eat 255 99,2 99,2 99,2 Sell and eat 2 ,8 ,8 100,0 Total 257 100,0 100,0 Q105c.If you sell some or all of the vegetables (if 105b: A or C), what do you spend the money on? Frequencies USE ALL. COMPUTE filter_$=(Q105b ~= A or Q105b ~= C).p{color:0;font-family:Monospaced;font-size:13pt;font-style:normal;font￾weight:normal;text-decoration:none} >Error # 4285 in column 30. Text: A >Incorrect variable name: either the name is more than 64 characters, or it is >not defined by a previous command. >This command not executed. VARIABLE LABEL filter_$ 'Q105b ~= A or Q105b ~= C (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q105cA Q105cB Q105cC /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics HospitalCatchment Q105cA Q105cB Q105cC Kigeme N Valid 4 4 4 Missing 197 197 197 Kaduha N Valid 2 2 2 Missing 255 255 255 Frequency Table Q105cA. Food HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 4 2,0 100,0 100,0 Missing System 197 98,0 Additional and Replacement Documentation Protocal 346 Total 201 100,0 Kaduha Valid Yes 2 ,8 100,0 100,0 Missing System 255 99,2 Total 257 100,0 Q105cB. Healthcare HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 4 2,0 100,0 100,0 Missing System 197 98,0 Total 201 100,0 Kaduha Valid No 1 ,4 50,0 50,0 Yes 1 ,4 50,0 100,0 Total 2 ,8 100,0 Missing System 255 99,2 Total 257 100,0 Q105cC. Other (specify) HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 4 2,0 100,0 100,0 Missing System 197 98,0 Total 201 100,0 Kaduha Valid No 1 ,4 50,0 50,0 Yes 1 ,4 50,0 100,0 Total 2 ,8 100,0 Missing System 255 99,2 Total 257 100,0 Q105 d. If you eat some or all of the vegetables (if 105b: B or C), who in the household eats the vegetables? USE ALL. COMPUTE filter_$=(Q105b ~= B or Q105b ~= C).p{color:0;font-family:Monospaced;font-size:13pt;font-style:normal;font￾weight:normal;text-decoration:none} >Error # 4285 in column 30. Text: B >Incorrect variable name: either the name is more than 64 characters, or it is >not defined by a previous command. >This command not executed. VARIABLE LABEL filter_$ 'Q105b ~= B or Q105b ~= C (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q105d /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Additional and Replacement Documentation Protocal 347 Q105d Kigeme N Valid 201 Missing 0 Kaduha N Valid 257 Missing 0 Q105d HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid A 1 ,5 ,5 ,5 B 6 3,0 3,0 3,5 C 194 96,5 96,5 100,0 Total 201 100,0 100,0 Kaduha Valid A 7 2,7 2,7 2,7 B 4 1,6 1,6 4,3 C 246 95,7 95,7 100,0 Total 257 100,0 100,0 Q106 .Do you raise small animals at home?/ FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=Q106a /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav FREQUENCIES VARIABLES=Q106a /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Q106 Kigeme N Valid 360 Missing 0 Kaduha N Valid 360 Missing 0 Q106 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 0 155 43,1 43,1 43,1 1 205 56,9 56,9 100,0 Total 360 100,0 100,0 Kaduha Valid 0 165 45,8 45,8 45,8 1 195 54,2 54,2 100,0 Total 360 100,0 100,0 Q106b.If “Yes”, do you sell the animals or eat the animals, or both?/ USE ALL. COMPUTE filter_$=(Q106a = 1). Additional and Replacement Documentation Protocal 348 VARIABLE LABEL filter_$ 'Q106a = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q106b /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Q106b Kigeme N Valid 205 Missing 0 Kaduha N Valid 195 Missing 0 Q106b HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Sell 119 58,0 58,0 58,0 Eat 40 19,5 19,5 77,6 Sell and Eat 46 22,4 22,4 100,0 Total 205 100,0 100,0 Kaduha Valid Sell 89 45,6 45,6 45,6 Eat 68 34,9 34,9 80,5 Sell and Eat 38 19,5 19,5 100,0 Total 195 100,0 100,0 Q106C.If you sell some or all of the animals (if 106b: A or C), what do you spend the money on? USE ALL. COMPUTE filter_$=(Q106b ~= A or Q106b ~= C).p{color:0;font-family:Monospaced;font-size:13pt;font-style:normal;font￾weight:normal;text-decoration:none} >Error # 4285 in column 28. Text: A >Incorrect variable name: either the name is more than 64 characters, or it is >not defined by a previous command. >This command not executed. VARIABLE LABEL filter_$ 'Q106b ~= A or Q106b ~= C (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q106cA /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Q106cA Kigeme N Valid 165 Missing 40 Kaduha N Valid 127 Missing 68 Q106cA HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Additional and Replacement Documentation Protocal 349 Kigeme Valid No 25 12,2 15,2 15,2 Yes 140 68,3 84,8 100,0 Total 165 80,5 100,0 Missing System 40 19,5 Total 205 100,0 Kaduha Valid No 15 7,7 11,8 11,8 Yes 112 57,4 88,2 100,0 Total 127 65,1 100,0 Missing System 68 34,9 Total 195 100,0 Q106d. If you eat some or all of the animals (if 106b: B or C), who in the household eats the animals?/ USE ALL. COMPUTE filter_$=(Q106b ~= B or Q106b ~= C).p{color:0;font-family:Monospaced;font-size:13pt;font-style:normal;font￾weight:normal;text-decoration:none} >Error # 4285 in column 28. Text: B >Incorrect variable name: either the name is more than 64 characters, or it is >not defined by a previous command. >This command not executed. VARIABLE LABEL filter_$ 'Q106b ~= B or Q106b ~= C (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Q106d /ORDER=ANALYSIS. Frequencies [DataSet1] C:\Users\wrr\Desktop\WRR YEAR4 KPC 04242015.sav Statistics Q106d Kigeme N Valid 205 Missing 0 Kaduha N Valid 195 Missing 0 Q106d HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 119 58,0 58,0 58,0 Children 22 10,7 10,7 68,8 Adults 3 1,5 1,5 70,2 Children & Adults 61 29,8 29,8 100,0 Total 205 100,0 100,0 Kaduha Valid 88 45,1 45,1 45,1 Children 14 7,2 7,2 52,3 Adults 1 ,5 ,5 52,8 Children & Adults 92 47,2 47,2 100,0 Total 195 100,0 100,0 Rwanda ICSP Final Evaluation Report September 2015 Page 350 of 997 ANNEX V. COMMUNITY HEALTH WORKER TRAINING MATRIX Project Area (Name of District Or Community) Type of CHW Official Government CHW or Grantee￾Developed Cadre Paid or Volunteer Number Trained Over Life of Project Focus of Training Male Female Nyamagabe District Child Health “Binome” Community health worker Government Paid 536 536 Maternal, Infant and Young Child Feeding practices (trained in MOH Community Based Nutrition Protocol standard curriculum Counseling and CB data collection/analysis Nutrition Weeks facilitation (as part of Village Nutrition Committee (VNC)) Nyamagabe District Maternal health workers (Agente San Maternelle￾ASM) Government Paid 0 536 Maternal and Newborn Care (MOH standard curriculum for ASM CHWs) Nutrition Weeks facilitation (as part of VNC) Nyamagabe District Village Nutrition Committee members (5 members including 3 CHWs) Government Volunteer 1,072 (includi ng Binome ) 1,608 (including Binome and ASM) Nutrition Weeks facilitation Nyamagabe District Integrated Care Group members (local leaders, non￾VNC members) Grantee￾Developed Cadre Volunteer 2144 536 Maternal and child nutrition, maternal and newborn care, hygiene and control of diarrheal disease, pneumonia control (cascade training from Binome CHWs who led Integrated Care Groups) Rwanda ICSP Final Evaluation Report September 2015 Page 351 of 997 ANNEX VI. EVALUATION SCOPE OF WORK Terms of Reference for Final Evaluator External Consultant for the Tangiraneza “Start Well” Innovation Child Survival Project in Nyamagabe District, Rwanda May 14, 2015 I. Introduction World Relief will hire an independent consultant to conduct a final performance evaluation for the Tangiraneza “Start Well” Innovation Child Survival Project funded by USAID’s Child Survival and Health Grants Program (CSHGP) [Cooperative Agreement #AID-OAA-A-11- 00056, October 2011-September 2015, Grant: $1,750,000, Match: $583,333] in Nyamagabe District, Rwanda. Contact: Rachel Hower, rhower@wr.org; Debbie Dortzbach, ddortzbach@wr.org; Allison Flynn, aflynn@wr.org. USAID’s CSHGP supports community￾oriented projects implemented by U.S. private voluntary organizations (PVOs) and nongovernmental organizations (NGOs) and their local partners. The purpose of this program is to contribute to sustained improvements in child survival and health outcomes by supporting the innovations of PVOs/NGOs and their in-country partners in reaching vulnerable populations. This document describes the final evaluator’s SOW for the Tangiraneza Project final evaluation. The overall goal of the Tangiraneza “Start Well” Innovation Child Survival Project (ICSP) is to reduce morbidity, mortality, and underlying undernutrition of children under five and pregnant women in the Nyamagabe District, Southern Province, Rwanda. The project’s objective is to improve capacity of Ministry of Health (MOH) staff and Community Health Workers (CHWs) to implement high impact maternal, newborn and child health interventions at the community level. Its strategy is to support MOH implementation of community health interventions related to nutrition (40% level of effort), maternal newborn care (35%), diarrhea (15%) and pneumonia (10%). Intermediate Results include: 1. Improved geographic access to and demand for high-quality maternal, newborn and child health (MNCH) services 2. Improved coordination and impact of community health activities 3. Develop Nutrition Weeks Innovation and conduct Operations Research to test effectiveness II. Background The overall goal of the Tangiraneza “Start Well” Innovation Child Survival Project (ICSP) is to reduce morbidity, mortality, and underlying undernutrition of children under five and pregnant women in the Nyamagabe district, Southern Province, Rwanda. Nyamagabe district is divided into 17 sectors, 92 cells and 536 villages. Ninety-five percent of families rely on subsistence agriculture. The project’s objective is to improve capacity of MOH staff and CHWs to Additional and Replacement Documentation Protocal 352 implement high impact maternal, newborn and child health interventions at the community level. ICSP’s strategy is to support MOH implementation of community health interventions related to nutrition (40% level of effort), maternal and newborn care (35%), diarrhea (15%) and pneumonia (10%). The project has partnered closely with the MOH from the planning and formative research stages through implementation/capacity building and monitoring. ICSP staff meet monthly with CHWs and quarterly with health center staff, CHW cell coordinators, village nutrition committees and religious leaders. In addition, the project meets regularly with higher level coordination groups (e.g., the National Food and Nutrition Technical Working Group and the Community Health Technical Working Group). Most project activities are implemented through Modified Care Groups (described below), whose members are all officially recognized by the MOH or other government agency for a specific role in the community. As noted, project activities are implemented primarily through Modified Care Groups (MCGs), which were established by the project in the entire Nyamagabe District, both Kaduha and Kigeme hospital zones. MCGs are comprised of three CHWs, the head of the village, one religious leader, one village leader in charge of social affairs, one women’s leader, one village leader in charge of information, one village leader in charge of community development and one representative of a hygiene club. MCGs meet with ICSP staff monthly to learn/review health lessons/key messages and to discuss challenges. MCGs implement a package of high impact interventions across both Kaduha and Kigeme hospital zones, including the standard Rwanda MOH Community Based Nutrition Program (CBNP). MCG members reinforce key behavior change communication (BCC) messages through home visits and community meetings, promoting healthy behaviors such as care seeking, utilization of MOH services like Growth Monitoring and Promotion (GMP) sessions and kitchen gardens. In addition, with the University of British Columbia (UBC) and the MOH as research partners (Dr. Judy Mclean from UBC and Dr. Fidele Ngabo from MOH as Principal Investigators), the project is conducting Operations Research by implementing an innovative intervention called “Nutrition Weeks” in Kaduha only, with the Kigeme hospital zone as a comparison area. Nutrition Weeks use a supportive group education technique heavily based on aspects of the Positive Deviance/Hearth Nutrition program, but targets all children in the first 1,000 days of life, rather than just malnourished children. Nutrition Week cycles are conducted by the Village Nutrition Committees, made up of five members: three CHWs, the head of the village and village leader in charge of social affairs. Over time, the project tapered off food support to Nutrition Week sessions, so that by the end of FY2014 all contributions came from the community and none came from the project. Often, the Nutrition Week ingredients come from beneficiaries’ kitchen gardens or are purchased with money from sales of small animals or garden produce raised in associations that have been formed in the project area. While not an official project activity, project staff has provided technical assistance to many groups of community members wanting to form associations for food production and/or income generation. Rwanda ICSP Final Evaluation Report September 2015 Page 353 of 997 III. Project Population BENEFICIARIES Kaduha Zone Kigeme Zone TOTAL: Nyamagabe District Total Population Source: Nyamagabe District Statistics 2011 161,743 168,767 330,510 Total Neonates .08 x 0-11m population 324 338 Children 0-59m** .125 x population 20,218 21,096 41,314 0-11m 4,044 4,219 8,263 12-23m 4,044 4,219 8,263 24-35m 4,044 4,219 8,263 36-47m 4,044 4,219 8,263 48-59m 4,044 4,219 8,263 WRA 15-49* .613 x .55 x population 54,531 56,900 111,431 Expected Pregnancies*** 3,381 3,528 6,909 Community Health Workers, disaggregated by sex (includes Maternal and Child Health CHWs) M F 536 1072 Health Facilities (Hospital to Sub Health Post) Hospitals Health Centers 2 16 Modified Care Groups 536 Village Nutrition Committees 536 Associations for MCGs 536 Associations for NW participants 47 Associations for vulnerable families with malnourished children 13 Association for Pastors 3 *2007 Census reported that 55% of Nyamagabe District population was female and 61.3% ages 15-49; these proporti2ons were applied to the population figures from Nyamagabe District Statistics 2011. **2007 Census reported that 12.5% of Nyamagabe District population was under five years of age; no data were provided on the relative breakdown of children under five—for simplicity it was assumed above to be equally divided amongst each 12-month sub-age category. ***Nyamagabe is in the South Province, where 6.2% of women aged 15-49 were currently pregnant at the time of the 2010 DHS Rwanda ICSP Final Evaluation Report September 2015 Page 354 of 997 IV. Partners The project has partnered closely with the Rwanda MOH from the planning and formative research stages through implementation/capacity building and monitoring. Dr. Fidele Ngabo of the MOH is one of the Principal Investigators of the project’s Operations Research. The project also partners with Dr. Judy Mclean of the University of British Columbia, another Principal Investigator for the project’s Operations Research. V. Key Activities Project Goal: To reduce morbidity, mortality and underlying nutrition of children under five and pregnant women in Nyamagabe District of Rwanda. Strategic Objective: Improve capacity of MOH staff and CHWs to implement high impact maternal, newborn and child health interventions at the community level. IR 1. Improved geographic access to and demand for high-quality MNCH services IR 2. Improved coordination and impact of community health activities IR 3. Develop Nutrition Weeks Innovation and conduct OR to test effectiveness Activities: Activities: Activities: 5) Build capacity of Community Health Supervisor and Hygienists from all 16 Health Centers as TOT trainers who will train Care Groups in all CSP interventions. 6) Train Cell-Coordinators and Cell Social Affairs in-charges to supervise modified Care Groups comprised of CHWs, village and religious leaders. (3-10 modified CGs per cell) 7) Train leaders of modified Care Groups to train their peers in BCC for all interventions: Nutrition, MNC, Diarrhea and Pneumonia (see table of activities below for details). The Social Affairs in￾charge at the cell level will train CHWs for Nutrition Weeks, and support the CHW Coordinator in BCC/ community mobilization. 8) Train Kaduha area CBN Village Committees with the ‘Nutrition Week’ innovation. 9) Train 536 maternal health CHWs (ASM) in MNC package. 4) CHWs, religious leaders and community representatives meet monthly in modified CG to: • Make action plans based on data reported by CHWs ; • Cross-train in BCC for key family practices based on barrier analysis and BCC strategy; • Coordinate regular home visits • Improve referral to appropriate CHW and/or health facility. 5) Build capacity of Sector and Cell level In-Charge of Social Affairs to support BCC. 6) Mobilize churches to assist vulnerable households with kitchen gardens & tippy taps. 4) Conduct Operations Research comparing standard CBNP activities vs. CBNP plus ‘Nutrition Weeks’ intervention. Evaluate impact with regard to cost and feasibility for scale-up. 5) Participate in National Food and Nutrition Technical Working Group; solicit input and share findings. 6) Improve CHWs records and reporting system for nutrition. Rwanda ICSP Final Evaluation Report September 2015 Page 355 of 997 VI. Purpose of the Final Evaluation The purpose of USAID’s CSHGP is to contribute to advancing the health system strengthening goals of Ministries of Health toward achieving sustained improvements in child survival and health outcomes, particularly among vulnerable populations, by supporting the innovative, integrated community-oriented programming of PVOs/NGOs and their in-country partners. CSHGP cooperative agreements offer unique opportunities to demonstrate the links between specific delivery strategies and measured outcomes. The final evaluation is intended as a performance evaluation but should be broadly accessible to various audiences including Ministries of Health (MOHs), and findings will contribute evidence relevant to global initiatives such as the Global Health Initiative and Feed the Future.1 It is important that the final evaluator consider the audiences listed below, when conducting the evaluation and writing the report. The final evaluation provides an opportunity for all project stakeholders to take stock of accomplishments to date and to listen to the beneficiaries at all levels, including mothers and caregivers, other community members and opinion leaders, health workers, health system administrators, local partners, other organizations, and donors. The evaluation report will be used by the following audiences as a source of evidence to help inform decisions about future program designs and policies: In-country partners at national, regional, and local levels (e.g., MOH and other relevant ministries, district health team, local organizations, communities in project areas). USAID (CSHGP, Global Health Bureau, USAID Missions), and other CSHGP grantees. The international global health community. The report will be posted for public use at http://www.mchipngo.net and the USAID Development Experience Clearinghouse at https://dec.usaid.gov. VII. Methodology The evaluation methodology consists of a mixed-methods approach using both quantitative and qualitative data. The approach comprises both a desk review of secondary data sources and the collection of qualitative data to complement existing data. The written design of the evaluation must be further defined and specified by the final evaluator (e.g., number of key informant interviews, focus groups discussions, observations, and locations) and must be shared with project stakeholders and implementing partners for comment before the evaluation commences. World Relief will facilitate this sharing and feedback. 1 For more information on these two initiatives, visit http://www.usaid.gov and http://www.feedthefuture.gov. Rwanda ICSP Final Evaluation Report September 2015 Page 356 of 997 Secondary Data: The final evaluator will review project reports (e.g., Detailed Implementation Plan (DIP); annual reports; knowledge, practice, and coverage baseline and monitoring surveys; and final survey and any monitoring reports) to assess the quality of quantitative and qualitative data and make assessments of project results in relation to the project design and targets set. The final evaluator should also review key U.S. Government/USAID strategic documents at the global and national levels relevant to the content of project. All relevant policy and strategy documents at the national level (e.g., MOH policies and strategies) are also crucial and should be used and referenced. Qualitative Data: In-depth qualitative interviews or focus group discussions may be conducted with stakeholders, including project staff, MOH, local NGOs and community-based organizations, district health teams, community- and facility-based health workers, community members, community leaders, and mothers (exit interviews). If possible, the assessment will also include observations of activities supported by the project. This will involve site visits to one or more implementation areas. It is recommended that the final evaluator randomly select communities to visit from a list provided by World Relief. However, purposive sampling may be warranted in addition to explore certain areas in more depth to investigate particular results (e.g., high or low performance or unexpected results). Limitations: The evaluation report must include a discussion of the methodological limitations of the evaluation. Additional guidance on reporting format is provided in the CSHGP Guidelines for Final Evaluations, specifically in the “Final Evaluation Report Template” included therein. VIII. Evaluation Questions The final evaluator and the evaluation team will use existing data collected or compiled during the life of the project, as well as additional data collected during the evaluation to answer the following questions: 1. To what extent did the project accomplish and/or contribute to the results (goals/objectives) stated in the DIP? • What is the quality of evidence for project results? • How were results achieved? If the project improved coverage of high-impact interventions simultaneously, what types of integration enabled this? Specifically, refer to project strategies and approaches and construct a logic model describing inputs, process/activities, Rwanda ICSP Final Evaluation Report September 2015 Page 357 of 997 outputs, and outcomes. Describe the extent to which the project was implemented as planned, any changes to the planned implementation, and why those changes were made. What were the key strategies and factors, including management issues, that contributed to what worked or did not work? • What were the contextual factors (such as socioeconomic factors, gender, demographic factors, environmental characteristics, baseline health conditions, health services characteristics,2 and so forth) that affected implementation and outcomes? • What capacities were built, and how? • Were gender considerations adequately incorporated into the project, either at the design phase or midway through the project? If so, how? Are there any specific gender-related outcomes? Are there any unintended consequences (positive and negative) related to gender? Which elements of the project have been or are likely to be sustained or expanded (e.g., through institutionalization or policies)? • Analyze the elements of scaling-up and types of scaling-up that have occurred or could likely occur (dissemination and advocacy, organizational process, costs and/resource mobilization, monitoring and evaluation using the ExpandNet resource for reference).3 • Analyze the costs and resources associated with implementation relevant for replication or expansion, as well as estimated cost per beneficiary (using Marginal Budgeting for Bottlenecks, Lives Saved Tool, Cost Benefit Analysis: A Primer for Community Health Workers, 4 or other tools). These questions above are required for framing the evaluation but should be tailored to the specific project context and address the needs of in-country government and USAID stakeholders by World Relief and/or USAID when the evaluation methodology is shared for comment. Additional Questions: 1. How effective are Modified Care Groups in helping achieve changes in maternal and child health outcomes in their communities? Should MCGs be replicated? What modifications would increase their effectiveness? a. Are the members of the MCGs doing what is expected of them, including home visits? (Even the different local leaders?) If not, is a different profile of member 2 See Table 1 in the document here: http://heapol.oxfordjournals.org/content/20/suppl_1/i18.long 3 http://expandnet.net/PDFs/ExpandNet-WHO%20Nine%20Step%20Guide%20published.pdf 4 https://apps.publichealth.arizona.edu/CHWToolkit/PDFs/Framewor/costbene.pdf Rwanda ICSP Final Evaluation Report September 2015 Page 358 of 997 needed, or possibly differentiation made between different types of members and their expected duties? (Perhaps some are included because of their influence in other realms and others are included because they will actually be the boots on the ground? Are all households reached?) The MOH is looking for ways that heavily burdened CHWs can leverage the energy of others in the community (not just anyone, but “existing structures” – which the MCGs do). Learning from this has the potential to influence the work that MCSP is currently planning in Rwanda as well. 2. Did Nutrition Weeks add value to the MOH Community Based Nutrition Protocol, and if so, what were the key elements that made them work? a. Were there significant improvements in nutrition outcomes among the households exposed to MCGs alone compared to the households exposed to MCGs and NWs? If so, what are they? b. Did Nutrition Weeks improve functioning of the CBNP? If so, how? Considering all Ministry priorities, is there a cost benefit to NWs? c. Which parts of the NW curriculum are most effective? Are there certain parts that have greater impact than others? d. Is nutrition information reinforced differently by MCGs in Kaduha compared to Kigeme (since Kaduha has the NW experience)? If so, how? IX. Final Evaluator Characteristics and Expected Timeline The consultant will serve as the evaluation team leader and is welcome to propose additional evaluation team members to round out the evaluation team’s skill set in order to ensure adequate representation of evaluation, technical, geographic, cultural and language skills. Team members, their affiliations, and disclosure of conflicts of interest must be listed in an annex to the evaluation report. The consultant will coordinate closely with the World Relief team regarding tool finalization, evaluation methodology, timeline, and draft report finalization. The Lead Evaluator is a former WR employee (from 10 years ago). A statement of disclosure of conflict of interests will be included in the final version of this SOW. Requirements: The consultant must be approved by USAID CSHGP and should meet the following minimum requirements: • Proven expertise and leadership in Rwanda ICSP Final Evaluation Report September 2015 Page 359 of 997 o integrated community-oriented reproductive, maternal, newborn, and child health projects o conduct of evaluations (baseline, endline) using mixed methods • Experience using applied research methods in an international program context. This includes quantitative and qualitative research and program design, hypothesis testing, large-scale data collection and analysis (including statistical analysis) and scientific report writing. Familiarity with public health system in Rwanda • Demonstrated ability to communicate with and lead a team of stakeholders, staff, and national experts in participatory evaluation • Familiarity with USAID programming • Skill or familiarity with cost analysis methods for program assessments • Excellent analytical and writing skills (English) • Signed statement explaining any conflict of interest5 Key Tasks of the Evaluation Team Leader: • Review project documents and resources to understand the project (see Annex 1) • Refine the evaluation objectives and key questions based on the CSHGP guidelines in coordination with World Relief team and its partners • Develop the field evaluation schedule and assessment tools • Train enumerators and team members on objective and process of the evaluation including evaluation tools • Lead the team to complete the collection, analysis, and synthesis of supplemental information regarding the program performance • Interpret both quantitative and qualitative results and draw conclusions, lessons learned, and recommendations regarding project outcome • Lead an in-country debriefing meeting with key stakeholders, including MCSP Rwanda staff, with a PowerPoint slideshow deliverable, no longer than 20 slides (with USAID/Washington, DC, participation remotely, as able) 5 CSHGP grantees are required to hire an external evaluator for the final evaluation. That fiduciary relationship creates a conflict of interest that is minimized by the CSHGP requirement of submission of a draft evaluation report directly to the CSHGP. Rwanda ICSP Final Evaluation Report September 2015 Page 360 of 997 • Prepare draft report in line with the CSHGP guidelines and submit to World Relief for review and feedback. • Respond to grantee feedback in the Statement of Differences, if applicable, and make any final revisions prior to grantee submission of the final report which is due to USAID CSHGP GH/HIDN/NUT office on or before 90 days after the end of the project. Timeline: The Final Evaluation will take place between May 15 and August 30, 2015, with approximately 10 working days in the field. The following timeline will be amended when exact travel dates are determined, and is subject to change depending on feedback from the Lead Evaluator. The evaluator agreed to this assignment when the first draft of the final evaluation report was due 30 days before the end of the grant (approximately August 30th). This due date has since been changed to 30 days after field work is completed (approximately June 30th). World Relief asks that flexibility be given to the evaluator regarding the due date, although she has been made aware of the modified requirement. Date Activity May 18, 2015 FE team briefing May 19, 2015 Pre-FE preparation such as review of evaluation instruments May 20 – May 21, 2015 Project site-visits; FE team may be divided up into two sub-teams. May 22 – May 23, 2015 Each sub-team analyses the data from their designated sites. May 24,2015 Prepare for debriefing, Program leadership discussions May 25, 2015 Dissemination of findings and recommendations from all FE sites in Nyamagabe May 26, 2015 In-country debriefing and presentation May 27, 2015 Reflection of results, recommendations and future propositions with WR June 30, 2015 First draft of FE report submitted to WR August 15, 2015 Input and response to Lead Evaluator’s draft report by World Relief. December 31, 2015 Report submission by World Relief Rwanda ICSP Final Evaluation Report September 2015 Page 361 of 997 X. Final Evaluation Report The FE report should follow the outline in USAID CSHGP’s Guidelines for Final Evaluations. A draft and final report, written by the final evaluator, must be submitted to World Relief. World Relief is responsible for submission of the final draft to the CSHGP and other required parties as indicated in the guidelines. XI. Budget The FE budget is not yet finalized, but the expected expenses are as follows: Evaluator Level of effort: 18 - 21 days (3-4 travel days, 10 field days, 5-7 writing days) Budget: $14,514 - $16,933 Additional Covered Expenses (international and local travel, lodging, meals): Budget: $2500 XII. Deliverables At the conclusion of the consultancy period, the consultant is expected to complete the following deliverables: Lead an in-country debriefing meeting with key stakeholders, including MCSP Rwanda staff, (and remote participation by USAID/Washington, DC) with a PowerPoint presentation no longer than 20 slides for distribution Prepare a draft report in line with the CSHGP guidelines and submit to World Relief for review and feedback Prepare the final report in time for formal submission by the grantee. The final report with all annexes is due at the USAID CSHGP GH/HIDN/NUT office on or before 90 days after the end of the project. Rwanda ICSP Final Evaluation Report September 2015 Page 362 of 997 Annex 1. Preliminary List of Documents for Evaluator Review 1. Project Proposal 2. 3rd Annual Report (FY2014) 3. USAID reporting template and Final Evaluation Guidelines 4. Theory of Change slides 5. DIP with baseline KPC 6. Midterm KPC report 7. Map of project area 8. Final KPC results and report 9. Preliminary final qualitative data and report 10. Operations Research Report and findings Rwanda ICSP Final Evaluation Report September 2015 Page 363 of 997 ANNEX VII. EVALUATION METHODS AND LIMITATIONS Mixed methods evaluation designs have become increasingly popular in both clinical and management research as the quantitative outcome data can be complemented by qualitative research contributions that provide a more in-depth understanding of contextual and other factors that led to the success or failures of the interventions and offer valuable insights for understanding program performance and value of the interventions provided by strategic stakeholders. Hence, in compliance with the USAID evaluation policy, the project team designed a mixed methods evaluation which systematically integrated the standard Knowledge Practice Coverage (KPC) survey and formative research. Quantitative Data Collection The endline KPC survey was conducted using the KPC 2000+ modules which integrated the 2008 Rapid Catch indicators. The KPC evaluation was performed by the WR project staff and health center staff and results shared prior to the evaluator’s visit. Together with the Principal Investigators, the project designed a quasi-experimental operations research study to test the effectiveness of the NW strategy using standard statistical measures for determining sample size with adequate power, based on the selected outcome measures: proportion of infants and young children 6-23m receiving minimum acceptable diet based on WHO standards (i.e., Minimum Acceptable Diet), number of food groups consumed for a 24h period (i.e., Minimum Dietary Diversity), minimum meal frequency, timely introduction of complementary food, and proportion of children 6-23m actively fed by caregivers. The evaluation instruments were jointly designed with the stakeholders, translated and field tested prior to the evaluation. IRB approvals were obtained annually from the Rwanda National Ethics Committee to ensure compliance to all ethical considerations for human subjects research. The KPC survey used a sample of 360 in each area at baseline and final to ensure an adequate sample of children 0-5 months needed for certain indicators. The survey used 30-cluster sampling to provide a sample that is expected to have the precision available from a random sample half as large. Even with cluster sampling the principles of randomness continue to be applicable. However, every individual in the community may not have the chance of being selected if sampling proceeds in a randomly determined direction from a central starting point and includes the next cluster of households. It is likely that residents at the periphery of the community, who may belong to the poorest wealth quintile, may not be selected if this method is employed. Inherent bias due to the purposive selection and subjective responses from formative research, non-random selection of participants are known, though formative findings from stakeholder perspectives on program effectiveness and value make valuable contributions to compliment and triangulate information obtained from quantitative findings. A brief summary of evaluation methods and sample for each stakeholder is provided in Table 5. Table 1. Sample Frame for KPC and Final Formative Evaluation KPC Evaluation – Caretakers of Children Under 2y Sample Size Baseline and Final Evaluation 720 (2 30X12 Cluster surveys) Year2, and 3 600 (2 30X10 Cluster Surveys) Rwanda ICSP Final Evaluation Report September 2015 Page 364 of 997 Final Qualitative Evaluation Stakeholders Kigeme Kaduha Total Participants NW participants - Mothers (FGD) - 3 30 NW participants - Fathers (FGD) - 3 29 NW non-participants – Fathers (FGD) - 3 30 Fathers (FGD) 2 3 48 Mothers (FGD) 2 3 49 ICG (FGD) 2 3 47 (25F, 22M) Village Nutrition Committee (FGD) - 3 13 (7F, 6M) Sector and Cell leaders (FGD) 2 3 42 (13F, 29M) Religious leaders (FGD) 2 3 48 (7F, 41M) Head of Health Center (KII) 2 3 5 (2F, 3M) Health Center Staff (FGD) 2 3 29 (17F, 12M) Hospital Teams (Director, nutritionist, CHS) (FGD) 1 1 5 (1F, 4M) DHMT/Vice Mayor, District Health officer 2 (1M, 1F) Sample Size Calculations n = D [(Zα + Zβ) 2 * (P1 (1 - P1) + P2 (1 - P2)) / (P2 - P1)2 ] Where, D= 2; Zα =1.645; Zβ = 0.84; α= 0.05; β= 0.80 Table 2. Sample Size Calculations based on Primary Outcome Indicator (M.A.D.) Proportion of infants and young children of ages 6m-23m fed according to a minimum of appropriate feeding practices* in sample 1 p1 Proportion of infants and young children of ages 6m-23m fed according to a minimum of appropriate feeding practices in sample 2 p2 ∆ n1 = n2 N 0.37** 0.47 0.10 596 1191 0.37 0.52 0.15 265 530 0.37 0.57 0.20 148 295 0.37 0.67 0.30 62 125 0.37 0.77 0.40 32 63 0.37 0.87 0.50 17 34 *At the time of sample size calculation, ‘minimum appropriate feeding practices’ was the closest indicator to minimum acceptable diet available. The final 2010 DHS report with calculation of MAD was not available until later. ** Source: Addendum to the 2005 Rwanda DHS (IYCF). http://www.measuredhs.com/pubs/pdf/FR183/Rwanda_IYCF_KM-2005.pdf From the above calculation, in order to detect a 15% or greater difference in the proportion of infants and young children of ages 6m-23m fed according to the minimum acceptable diet between baseline and end of study in the intervention area and in the comparison area, with α =0.05 and 80% power, we would need a total of 530 infants and young children of ages 6m-23m, with a minimum of 265 in each arm. In Rwanda ICSP Final Evaluation Report September 2015 Page 365 of 997 order to have a consistent number of children 6-23m in each of 30 clusters, 265 was rounded up to 270 per arm yielding 9 children 6-23m per cluster. In order to measure indicators like exclusive breastfeeding, limited to infants 0-5 months, a minimum sample of 75 infants was recommended by MCHIP at baseline. However, that number was increased to 90 in order to be evenly divisible by 30, so as to have the same number in each cluster. Another benefit to increasing the sample of 0-5 months to 90 was that with 270 6-23 month-olds, the sample for each age group would be proportional to the approximate composition of children under two years (assuming no infant mortality, for simplicity). As such, when calculating indicators based on children 0-23 months, neither sub-age group is inherently over-represented. In summary, the sample in each hospital zone totaled 360 mothers; 90 with children 0-5 months and 270 with children 6-23 months. The two 30x12 cluster samples combined totaled 720 interviews with mothers of children under two years of age. Qualitative Mixed Methods Data Collection Focus Group Discussion (FGD) and Key Informant Interview (KII) guides were designed based on project interventions and type of stakeholder with engagement by the WR staff and the final evaluator and were submitted to the Rwanda National Ethics Committee (IRB) for review and approval [Annex IX]. The final evaluation team for the formative assessments was comprised of project stakeholders, including representatives from the MOH district team, Kaduha and Kigeme hospitals, a representative from the pastor’s committee, USAID Maternal and Child Survival Project, Concern Worldwide, University of Rwanda, Anglican Church in Rwanda (EAR), African Christian Church Community (CESA) and Catholic Relief Services (CRS) aside from the WR team. A thirty-six member team participated in the final evaluation and teams were assigned to perform assessments in both the hospital zones. The field evaluation schedule is illustrated in Annex XVII A. The evaluator conducted a three day training on principles and methods of qualitative assessments, field survey and quality control procedures. The measurement instruments focused on multi-stakeholder perspectives and value of the project interventions, potential and challenges to scale up and sustainability, other health care environment factors, and lessons learned for continuing project interventions. Site visits were conducted by the evaluation teams to the hospitals, health facilities and communities to perform FGD and KII, with Care Groups, leaders, village nutrition committees, participants and non participants of interventions. There were no major impediments to the field implementation schedules and all selected sites were visited. It is also important to note that the Rwandan government had decided to conduct the national nutrition survey during this period and other key stakeholders who had indicated interest in participating in the evaluation were engaged in the planning and execution of the survey. As the final evaluation was planned in advance, the team solicited the support and permission from the Ministry of Health to conduct the ICSP final evaluation and ensured that there would be no disruption to ongoing national evaluation. Rwanda ICSP Final Evaluation Report September 2015 Page 366 of 997 Analysis Means or percentages with confidence intervals were generated for the descriptive analysis and linear probability model and p-values were calculated for select nutrition indicators. Since clustering was not accounted for, and sample size estimates were not generated for all 40 indicators, p-values were not generated for all indicators, but 95% confidence intervals were provided and design effect of two was used for sampling. The KPC report (Annex V) provides detailed information about the sampling strategy and selection of households and participants, indicating full compliance to standard procedures. There were no major issues with data quality in the collection, analysis and reporting for data, as WR has extensive experience in conducting these surveys since 2000. All the data used in this report was generated from primary data collection in this project. Although anecdotal information was obtained from the district mayor’s office, hospitals and health centers on service utilization, referral etc, the survey teams refrained from disrupting the activities of the ongoing nutrition surveys, and did not examine district or health records. Additional supportive supervision and mentoring measures were instituted to facilitate the activities in communities and cells that experienced greater challenges due to remote locations or inability to acquire ingredients for the cooking demonstrations etc. Income generating schemes through kitchen gardens, rearing small animals etc, were innovated to support community solidarity, ownership and long term sustainability and address some of the community specific bottlenecks in project implementation. Rwanda ICSP Final Evaluation Report September 2015 Page 367 of 997 ANNEX VIII DATA COLLECTION INSTRUMENTS Qualitative Tools FGD Guide with Mothers in Kigeme/ Ibibazo bibazwa ababyeyi muri zone ya Kigeme a. Did you participate in the Growth Monitoring and Promotion (GMP) sessions held in your village? / Mwaba mwaritabiriye gahunda yo gupima no gukurikirana imikurire y’umwana ibera mu mudugudu? b. What did you learn about Nutrition from the GMP sessions?/Ni iki mwize ku mirire muri gahunda yo gupima no gukurikirana imikurire y’abana ? c. What did you like about the GMP sessions? Benefits?/Ni iki cyabashimishije muri gahunda yo gupima no gukurikirana imikurire y’abana ? Ni iki mwahungukiye ? d. What did you not like about the GMP sessions?/ Ni iki kitabashimishije muri gahunda yo gupima no gukurikirana imikurire y’abana ? e. What other nutrition activities have taken place in your village? Ni ibihe bikorwa bindi birebana n’imirire byabereye mu mudugudu wanyu? f. What did you change in your family based on training received in GMP or other nutrition activities?/ Ni iki mwahinduye mu miryango yanyu mushingiye ku nyigisho mwahawe muri gahunda yo gupima no gukurikirana imikurire y’abana ? g. What are the challenges you are facing to implement new nutrition teachings in your family? Probe to know if any barriers related to food availability, affordability and acceptance. Ni izihe mbogamizi muhura nazo mugushyira mubikorwa ibyo mwigishijwe muri gahunda yo gupima no gukurikirana imikurire y’abana? Komeza ubabaze kugira ngo umenye niba hari imbogamizi bahura nazo (zirebana n’ ibiribwa bitaboneka, badashobora kugura cyangwa batemerewe kurya) . h. How did you respond to the challenges? /Ibyo bibazo mwabikemuye mute? i. Who in your family support you in the application of the new behavior? How? Ni bande bo mu muryango wanyu babafasha gushyira mu bikorwa inyigisho nshya ? Babafasha bate? j. What else could be done to improve nutrition in your village? Ni ibihe bikorwa bindi byakorwa kugira ngo biteze imbere imirire mu mudugudu wanyu? k. Is there anything you would like to tell me about how to improve GMP sessions or other nutrition activities? We are very interested in your opinions to change to make it better./ Ese hari ikintu mwumva mwatubwira cyateza imbere gahunda yo gupima no gukurikirana imirire y’abana ? Ibitekerezo byanyu ni ingenzi mu gutuma habaho impinduka. FGD Guide with Fathers in Kigeme/ IBIBAZO BIGENEWE ITSINDA RY’ABAGABO BITABIRIYE GAHUNDA YO GUPIMA NO GUKURIKIRANA IMIKURIRE Y’ABANA MU MUDUGUDU Rwanda ICSP Final Evaluation Report September 2015 Page 368 of 997 a. Did you participate in the GMP sessions or any other nutrition activities held in your village? Which activities? / Mwaba mwaritabiriye gahunda yo gupima no gukurikirana imikurire y’abana mu mudugudu wanyu? b. What did you learn about Nutrition from the nutrition activities?/Ni iki mwize ku mirire mu gihe cya gahunda yo gupima no gukurikirana imikurire y’abana mu mudugudu? c. What did you like about the GMP sessions or other nutrition activities? Benefits?/ Ni iki cyabashimishije muri gahunda yo gupima no gukurikirana imikurire y’abana ? Ni iki mwahungukiye ? d. What did you not like about the GMP sessions/other nutrition activities?/ Ni iki kitabashimishije muri gahunda yo gupima no gukurikirana imikurire y’abana ? e. What did you change in your family based on training received in GMP sessions or other nutrition activities?/ Ni iki mwahinduye mu miryango yanyu mushingiye ku nyigisho mwahawe muri gahunda yo gupima no gukurikirana imikurire y’abana cyangwa ibindi bikorwa by’imirire? f. How men in this village are involved in child feeding? Probe to know more./Mu mudugudu wanyu, nigute abagabo bagira uruhare mu kugaburira abana? Komeza ubabaze kugirango umenye byinshi. g. What are the challenges you are facing to feed properly your children?/Ni izihe ngorane muhura nazo mu kugaburira abana banyu neza? h. What can be done to improve men participation in children’s nutrition?/ Ni iki cyakorwa kugira ngo abagabo barusheho kugira uruhare mu mirire y’abana ? i. What can be done to improve participation in GMP? / Ni iki cyakorwa kugira ngo abagabo barusheho kwitabira ibikorwa byo gupima no gukurikirana imikurire y’abana babo ? j. What can be done to improve nutrition in your community? Ni iki cyakorwa kugira ngo imirire irusheho gutera imbere mu midugudu yanyu? FGD Guide with Modified Care Groups in Kigeme/ Ibibazo bibazwa abagize amatsinda y’ubuzima (CG) avuguruye. a. What are your main responsibilities in Community health?/Ni izihe nshingano z’ingenzi mufite kubijyanye n’ubuzima bw’abaturage? b. How do you collaborate (Binome CHW & ASM & Religious & Local Leaders) to mobilize community for behavior change? Probe to get details and more examples on their collaboration. /Mukorana mute (n’abajyanama b’ubuzima n’abahagarariye amadini ndetse n’abayobozi b’inzego z’ibanze) kugirango mushishikarize abantu guhindura imyifatire? Komeza ubabaze kugira ngo baguhe ubusobanuro n’ingero zifatika zijyanye n’uko bakorana. c. How do you appreciate the CG member’s attendance? Probe to estimate the attendance?/ Mubona mute ubwitabire bw’abagize itsinda ? Komeza ubabaze kugirango umenye ikigereranyo cy’ubwitabire. d. What are the main barriers that prevent volunteers to attend CG trainings? What can be done to improve CG attendance? / Ni izihe mbogamizi zituma abagize amatsinda batitabira cyane? Hakorwa iki kugira ngo ubwitabire bwiyongere? e. To what extend people or families apply in their lives the health messages they received from CHWs? What is the most challenging health behavior? How do you face to that challenge? / Ni gute mubona imiryango ishyira mu Rwanda ICSP Final Evaluation Report September 2015 Page 369 of 997 bikorwa inyigisho z’ubuzima bigishijwe n’Umujyanama w’ubuzima? Ni uwuhe mwifato mubona uruhije guhindura kuruta iyindi? Mubyifatamo gute? f. In what ways has the CG training impacted you and your family’s health? Probe to learn more changes occurred? / Ni gute inyigisho muhabwa mu matsinda zagize impinduka kuri mwe no ku miryango yanyu? Komeza ubabaze kugirango bavuge n’izindi mpinduka zabaye. g. Based on the report provided by the CHWs, the # of households visited monthly is still low. What are the main challenge CG members are facing that prevent them to accomplish more home visits? Probe to learn more about how the CG members share the HHs, and if no many HHs per each./ Duhereye kuri raporo zitangwa n’abajyanama b’ubuzima, umubare w’ingo zisurwa mu kwezi uracyari hasi. Ni ibihe bibazo bibangamira abagize amatsinda bikababuza gusura ingo nyinshi ? Komeza ubabaze neza kugirango umenye uburyo abagize amatsinda bagabana ingo no kumenya niba badafite ingo nyinshi. Program Implementation Review Meeting Guide with Health Center and Hospital staff in Kigeme a. Have you observed any health changes in the community since last year? What? Probe to learn more. /Uhereye umwaka ushize kugeza ubu, haba hari ibyo mwabonye byahindutse mungo? Ni ibihe? Komeza ubabaze kugirango bakubwire ibyahindutse byose. b. Have you visited GMP sessions? How many visit this year? / Mwigeze musura aho gahunda yo gupima no gukurikirana imikurire y’abana mu mudugudu ibera? Mwahasuye incuro zingahe muri uyu mwaka? c. Since GMP sessions began in your community what changes have you notice? (Only for Kaduha participants)/ Kuva aho gahunda yo gupima no gukurikirana imikurire y’abana yatangira mu midugudu yanyu, Hari impinduka mumaze kubona? d. Have you visited CGs? How many visit in last three months?/ Mwaba mwarasuye amatsinda y’ubuzima (C.G) ? Mwayasuye inshuro zingahe mu mezi atatu ashize? e. What are the main barriers that prevent you to supervise CHWs effectively? What can be done in order to improve supervisions to CHWs?/ Ni izihe nzitizi zituma rimwe na rimwe mudasura uko bikwiye ibikorwa by’ abajyanama b’ubuzima? Ni iki cyakorwa murwego rwo kuzamura ikurikirana bikorwa ry’abajyanamab’ubuzima? f. What community health concerns do you believe need to be better addressed?/ Ni ibihe bibazo by’ubuzima bw’abaturage mubona bikwiye kwitabwaho by’umwihariko? g. What can be done to better involve communities in health promotion? Hakorwa iki kugira ngo abaturage barusheho kugira uruhare mu bukangurambaga bw’ubuzima mu mudugudu? h. What can be done to better train communities in Health promotion?/ Ni iki cyakorwa kugirango abantu bigishwe kurutaho ku bijyana n’ubuzima i. What can be done to sustain community health programs?/ Ni iki cyakorwa ngo ibikorwa by’ubuzima mu mudugudu birusheho kuramba? Rwanda ICSP Final Evaluation Report September 2015 Page 370 of 997 Guide for Program Implementation Review Meeting with Sector and Cell Leaders in Kigeme/ Ibibazo bizifashishwa mu nama n’abayobozi b’akagali n’umurenge a. Now, what are your responsibilities in community health?/ Ubu ni izihe nshingano mufite kubirebana n’ubuzima bw’abaturage? b. Since BCC and GMP sessions began in your sector, what changes have you observed? Probe to learn more. / Guhera aho ubukangurambaga na gahunda z’icyumweru cy’imirire zatangiriye mu murenge wanyu, ni izihe mpinduka mwabonye. Komeza ubabaze kugira ngo ubashe kumenya byinshi. c. Have you visited CGs ? GMP sessions? How many visits in last three months? / Mwigeze musura amatsinda y’ubuzima (CG)? Ibikorwa byo gupima no gukurikirana imikurire y’abana mu mudugudu? Mwasuye inshuro zingahe mu mezi atatu ashize? d. What are the main barriers that prevent you to supervise CG effectively? What can be done in order to improve supervisions to CHWs?/ Ni izihe nzitizi muhura nazo mu gusura amatsinda y’ubuzima (CG) cyangwa gusura ibikorwa byo gupima no gukurikirana imikurire y’abana uko bikwiye? Ni iki cyakorwa kugirango ibikorwa by’isura birusheho kugenda neza? e. What is an area of need for health promotion in your sector/cell?/ Ni iki mwifuza ko cyatezwa imbere byumwihariko kubirebana n’ubukangurambaga bw’ubuzima muri uyu murenge/akagali? f. What could be done differently to meet your sector need?/ Ni ibihe bikorwa bitandukanye byakorwa kugira ngo haboneke ibisubizo by’ibibazo umurenge wanyu ufite? g. What are if any barriers faced when addressing your sector about health promotion? / Ni izihe nzitizi mwahuye nazo mu guteza imbere ubuzima mu murenge wanyu? h. What can be done to sustain community health programs?/ Ni iki cyakorwa kugira ngo hashimangirwe gahunda y’ubuzima bw’abaturage mu buryo burambye? Guide for Program Implementation Review Meeting with Religious Leaders in Kigeme/Ibibazo bizifashishwa mu nama n’abahagarariye amatorero a. As the church leaders, how are you involved in health promotion activities? Nk’abantu bahagarariye amatorero/amadini, mwibona cyangwa mwisanga gute mu bikorwa byo guteza imbere ubuzima bw’abaturage? b. In your community health role, with who do you collaborate more? And How? Ku birebana n’inshingano zanyu mu by’ubuzima bw’abaturage, ni bande mukorana kenshi? Kandi mukorana mute? c. Since BCC and GMP began in your community r, what changes have you observed? Probe to learn more./ Kuva aho ubukangurambaga na gahunda yo gupima no gukurikirana imikurire y’abana Rwanda ICSP Final Evaluation Report September 2015 Page 371 of 997 zatangiriye mu midugudu, ni izihe mpinduka mwabonye? Komeza ubabaze kugira ngo urusheho kumenya byinshi. d. What are the main challenges you are facing to promote health? What did you do or can be done to respond to the challenges?/ Ni izihe ngorane zikomeye muhura nazo mu guteza imbere ubuzima? Ni iki mwakoze cyangwa mubona cyakorwa kugira ngo izo ngorane zikemuke? e. What can be done to sustain community health programs?/ Ni iki cyakorwa kugira ngo hashimangirwe gahunda y’ubuzima bw’abaturage mu buryo burambwe? Focus Group Discussion Guide with CHWs in Kigeme/ Ibibazo bigenewe abajyanama b’ubuzima muri zone ya Kigeme a. What did you like about the CBNP (GMP sessions, etc.)? Benefits? What did you not like about it? / Ni iki cyabashimishije ku bijyanye na Gahunda y’Imirire Ishingiye ku Mudugudu (gupima no gukurikirana imikurire y’abana, igikoni cy’umudugudu,…)? Ni iki kitabashimishije muri izo gahunda? b. What did you change in your family based on training received for CBNP/GMP? / Nyuma yo guhabwa amahugurwa kubijyanye na Gahunda y’Imirire Ishingiye ku Mudugudu /gahunda yo gupima no gukurikirana imikurire y’abana, ni iki mwahinduye mu muryango? c. What are the challenges you are facing to implement nutrition activities in your community? Probe to know all challenges. How do you respond to each challenge? / Ni izihe ngorane muhura nazo mu gushyira mu bikorwa inyigisho zirebana na Gahunda y’Imirire Ishingiye ku Mudugudu? Komeza ubababaze kugirango bavuge ingorane zose. Ni iki mukora kuri buri kibazo? d. What need of training you feel in order to improve your skills for leading nutrition activities?/ Ni ayahe mahugurwa mwumva mwahabwa mu rwego rwo kongera ubumenyi bwanyu mu kuyobora ibikorwa by’imirire? e. Who support you more during the implementation of CBNP/GMP? or from whom you ask advice for implementing them? How often does he/she visit you? / Ninde ubaha ubufasha cyane mu gushyira mu bikorwa Gahunda y’Imirire Ishingiye ku Mudugudu/ Gahunda yo gupima no gukurikirana imikurire y’umwana mu mudugudu? Cyangwa ninde musaba inama zibafasha gushyira mu bikorwa Gahunda y’Imirire Ishingiye ku Mudugudu/ Gahunda yo gupima no gukurikirana imikurire y’umwana mu mudugudu? Yabasuye kangahe muri gahunda iherutse? f. After GMP, have you visited the families that attended GMP or other nutrition activities? What are the behaviors taught they applied more and what behaviors they did not apply?/ Mwigeze musura ababyeyi bitabiriye gahunda yo gupima no gukurikirana imikurire y’abana mu ngo zabo? Ni ibiki mwasanze bashyira mu bikorwa cyane mu nyigisho bahawe? Ni ibiki mwasanze badashyira mu bikorwa g. What more could be done to improve nutrition in your village? Ni ikihe gikorwa kindi cyakorwa kugira ngo imirire irusheho gutera imbere mu mudugudu wanyu? h. Is there anything you would like to tell me about how to improve nutrition activities? We are very interested in your opinions to change to make it better./ Ni ikihe gitekerezo mwatanga mu rwego rwo kurushaho guteza imbere ibikorwa by’imirire? Twifuza cyane kumenya ibitekerezo byanyu byatuma gahunda yo gupima no gukurikirana imirire y’abana irushaho kugenda neza. Rwanda ICSP Final Evaluation Report September 2015 Page 372 of 997 Interview Guide with Mothers Participants in NW (had Exit interview)/ Ibibazo byo kongera kubaza ababyeyi bitabiriye icyumweru cy’imirire a. How many children do you have?/Ufite abana bangahe? b. What did you learn about Nutrition from the Nutrition Week?/Ni iki mwize ku mirire mugihe cy’icyumweru cyahariwe imirire? c. What did you like about the Nutrition Week? Benefits?/Ni iki cyabashimishije mugihe cy’icyumweru cy’imirire? Ni iki byabunguye? d. What did you not like about the Nutrition Week?/Ni iki kitabashimishije mu cyumweru cy’imirire? e. What did you change in your family based on training received in NW?/ Ni iki mwahinduye mu miryango yanyu mushingiye ku nyigisho mwahawe mugihe cy’icyumweru cy’mirire ? f. What are the challenges you are facing to implement NW teachings in your family? Probe to know if any barriers related to food availability, affordability and acceptance.Ni izihe ngorane muhura nazo mugushyira mubikorwa ibyo mwigishijwe mu cyumweru cy’imirire?Komeza ubabaze kugira ngo umenye niba hari ingorane bahura nazo (zirebana n’ ibiribwa bitaboneka, badashobora kugura cyangwa batemerewe kurya) . How did you respond to the challenges? / byo bibazo mwabicyemuye mute? g. Who in your family support you in the application of the new behavior? How? Ni bande bo mu muryango wanyu babafasha gushyira mubikorwa imyifatire mishya? babafasha bate? h. Is there anything you would like to tell me about how to improve the groups? We are very interested in your opinions to change to make it better./ Ese hari ikintu mwumva mwatubwira cyateza imbere imirimo y’amatsinda mu gihe cy’icyumweru cy’imirire? Ibitekerezo byanyu ni ingenzi mugutuma habaho impinduka. FGD Guide with Mothers Participants in NW (did not have prior exit interview)/ Ibibazo bibaza ababyeyi bitabiriye icyumweru cy’imirire ariko batabajijwe a. Did you participate in the NW held in your village? / Mwaba mwaritabiriye icyumweru cy’imirire mu mudugudu wanyu? b. What did you learn about Nutrition from the Nutrition Week?/Ni iki mwize ku mirire mugihe cy’icyumweru cyahariwe imirire? c. What did you like about the Nutrition Week? Benefits?/Ni iki cyabashimishije mugihe cy’icyumweru cy’imirire? Ni iki byabunguye? d. What did you not like about the Nutrition Week?/Ni iki kitabashimishije mu cyumweru cy’imirire? e. What did you change in your family based on training received in NW?/ Ni iki mwahinduye mu miryango yanyu mushingiye ku nyigisho mwahawe mugihe cy’icyumweru cy’mirire ? f. What are the challenges you are facing to implement NW teachings in your family? Probe to know if any barriers related to food availability, affordability and acceptance.Ni izihe ngorane muhura nazo mugushyira mubikorwa ibyo mwigishijwe mu cyumweru cy’imirire? Komeza Rwanda ICSP Final Evaluation Report September 2015 Page 373 of 997 ubabaze kugira ngo umenye niba hari ingorane bahura nazo (zirebana n’ ibiribwa bitaboneka, badashobora kugura cyangwa batemerewe kurya) . a. How did you respond to the challenges? /Ibyo bibazo mwabicyemuye mute? g. Who in your family support you in the application of the new behavior? How? a. Ni bande bo mu muryango wanyu babafasha gushyira mubikorwa imyifatire mishya? Babafasha bate? h. Is there anything you would like to tell me about how to improve the groups? We are very interested in your opinions to change to make it better./ Ese hari ikintu mwumva mwatubwira cyateza imbere imirimo y’amatsinda mu gihe cy’icyumweru cy’imirire? Ibitekerezo byanyu ni ingenzi mugutuma habaho impinduka. FGD Guide with Father participants in NW/ ITSINDA RY’ABAGABO BITABIRIYE ICYUMWERU CYIMIRIRE CYO MUMUDUGUDU a. Did you participate in the NW held in your village? / Mwaba mwaritabiriye icyumweru cy’imirire mu mudugudu wanyu? b. What did you learn about Nutrition from the Nutrition Week?/Ni iki mwize ku mirire mugihe cy’icyumweru cyahariwe imirire? c. What did you like about the Nutrition Week? Benefits?/Ni iki cyabashimishije mugihe cy’icyumweru cy’imirire? Ni iki byabunguye? d. What did you not like about the Nutrition Week?/Ni iki kitabashimishije mu cyumweru cy’imirire? e. What did you change in your family based on training received in NW?/ Ni iki mwahinduye mu miryango yanyu mushingiye ku nyigisho mwahawe mugihe cy’icyumweru cy’mirire ? f. How men in this village are involved in child feeding? Probe to know more./Mu mudugudu wanyu, nigute abagabo bagira uruhare mu kugaburira abana? Komeza ubabaze kugirango umenye byinshi. g. What are the challenges you are facing to feed properly your children?/Ni izihe ngorane muhura nazo mu kugaburira abana banyu neza? h. What can be done to improve men participation to NW sessions in the community?/ Ni iki cyakorwa kugirango abagabo barusheho kwitabira icyumweru cy’imirire mu mudugudu wanyu? i. What can be done to improve NW participation and to implement successfully NW sessions in the community? / Ni iki cyakorwa kugirango icyumweru cy’imirire kirusheho kwitabirwa no gushyirwa mu bikorwa neza mu mudugudu? FGD Guide with Father non-participants in NW a. Did you hear about the NW held in your village? What did you learn about Nutrition Week? /Mwigeze mwumva bavuga iby’ icyumweru cy’imirire cyabereye mu mudugudu wanyu? Mwabyumviseho iki? Rwanda ICSP Final Evaluation Report September 2015 Page 374 of 997 b. Did you participate to NW sessions? What are the challenges that prevent you to attend the NW?/ Mwaba mwaritabiriye icyumweru cy’imirire cyo mumudugu? Ni iki cyatumye mutitabira icyumweru cy’imrire? c. How men in this village are involved in child feeding? Probe to know more.Mu mudugudu wanyu, abagabo bagira uruhe ruhare mu kugaburira abana? Komeza ubabaze kugirango bakubwire n’ibindi. d. What are the challenges you are facing to feed properly your children?/ Ni ibihe bibazo muhura nabyo bishobora gutuma mutagaburira abana banyu neza? e. What can be done to improve men participation to NW sessions in the community?/ Hakorwa iki kugirango abagabo barusheho kwitabira icyumweru cy’imirire mu mudugudu? f. What can be done to improve NW participation and to implement successfully NW sessions in the community? / Ni iki cyakorwa kugira ngo icyumweru cy’imirire kirusheho kwitabirwa no gushyirwa mu bikorwa neza mu mudugudu? FGD Guide with Modified Care Groups a. What are your main responsibilities in Community health?/Ni izihe nshingano z’ingenzi mufite kubijyanye n’ubuzima bw’abaturage? b. How do you collaborate (Binome CHW & ASM & Religious & Local Leaders) to mobilize community for behavior change? Probe to get details and more examples on their collaboration. /Mukorana mute (n’abajyanama b’ubuzima n’abahagarariye amadini ndetse n’abayobozi b’inzego z’ibanze) kugirango mushishikarize abantu guhindura imyifatire? Komeza ubabaze kugira ngo baguhe ubusobanuro n’ingero zifatika zijyanye n’uko bakorana. c. How do you appreciate the CG member’s attendance? Probe to estimate the attendance?/ Mubona mute ubwitabire bw’abagize itsinda ? Komeza ubabaze kugirango umenye ikigereranyo cy’ubwitabire. d. What are the main barriers that prevent volunteers to attend CG trainings? What can be done to improve CG attendance? / Ni izihe mbogamizi zituma abagize amatsinda batitabira cyane? Hakorwa iki kugira ngo ubwitabire bwiyongere? e. To what extend people or families apply in their lives the health messages they received from CHWs? What is the most challenging health behavior? How do you face to that challenge? / Ni gute mubona imiryango ishyira mu bikorwa inyigisho z’ubuzima bigishijwe n’Umujyanama w’ubuzima? Ni uwuhe mwifato mubona uruhije guhindura kuruta iyindi? Mubyifatamo gute? f. In what ways has the CG training impacted you and your family’s health? Probe to learn more changes occurred? / Ni gute inyigisho muhabwa mu matsinda zagize impinduka kuri mwe no ku miryango yanyu? Komeza ubabaze kugirango bavuge n’izindi mpinduka zabaye. g. Based on the report provided by the CHWs, the # of households visited monthly is still low. What are the main challenge CG members are facing that prevent them to accomplish more home visits? Probe to learn more about how the CG members share the HHs, and if no many HHs per each./ Duhereye kuri raporo zitangwa n’abajyanama b’ubuzima, umubare w’ingo zisurwa mu kwezi uracyari hasi. Ni ibihe bibazo bibangamira abagize amatsinda bikababuza gusura ingo nyinshi ? Komeza ubabaze neza kugirango umenye uburyo abagize amatsinda bagabana ingo no kumenya niba badafite ingo nyinshi. Rwanda ICSP Final Evaluation Report September 2015 Page 375 of 997 Program Implementation Review Meeting Guide with Health Center and Hospital staff a. Have you observed any health changes in the community since last year? What? Probe to learn more. /Uhereye umwaka ushize kugeza ubu, haba hari ibyo mwabonye byahindutse mungo? Ni ibihe? Komeza ubabaze kugirango bakubwire ibyahindutse byose. b. Have you visited NW? How many visit this year? (Only for Kaduha participants) / Mwigeze musura amatsinda yo mu cyumweru cy’imirire? Mwayasuye incuro zingahe muri uyu mwaka? (iki kibazo kibazwa ab’i Kaduha gusa). c. Since NW began in your community what changes have you notice? (Only for Kaduha participants)/ Kuva icyumweru cy’imirire cyatangira mu midugudu yanyu, Hari impinduka mumaze kubona?(iki kibazo kibazwa ab’i Kaduha gusa). d. Have you visited CGs? How many visit in last three months?/ Mwaba mwarasuye amatsinda y’ubuzima (C.G) ? Mwayasuye inshuro zingahe mu mezi atatu ashize? e. What are the main barriers that prevent you to supervise CHWs effectively? What can be done in order to improve supervisions to CHWs?/ Ni izihe nzitizi zituma rimwe na rimwe mudasura uko bikwiye ibikorwa by’ abajyanama b’ubuzima? Ni iki cyakorwa murwego rwo kuzamura ikurikirana bikorwa ry’abajyanamab’ubuzima? f. What community health concerns do you believe need to be better addressed?/ Ni ibihe bibazo by’ubuzima bw’abaturage mubona bikwiye kwitabwaho by’umwihariko? g. What can be done to better involve communities in health promotion? Hakorwa iki kugira ngo abaturage barusheho kugira uruhare mu bukangurambaga bw’ubuzima mu mudugudu? h. What can be done to better train communities in Health promotion?/ Ni iki cyakorwa kugirango abantu bigishwe kurutaho ku bijyana n’ubuzima i. What can be done to sustain community health programs?/ Ni iki cyakorwa ngo ibikorwa by’ubuzima mu mudugudu birusheho kuramba? Guide for Program Implementation Review Meeting with Sector and Cell Leaders/ Ibibazo bizifashishwa mu nama n’abayobozi b’akagali n’umurenge a. Now, what are your responsibilities in community health?/ Ubu ni izihe nshingano mufite kubirebana n’ubuzima bw’abaturage? Rwanda ICSP Final Evaluation Report September 2015 Page 376 of 997 b. Since BCC and NW began in your sector, what changes have you observed? Probe to learn more. / Guhera aho ubukangurambaga na gahunda z’icyumweru cy’imirire zatangiriye mu murenge wanyu, ni izihe mpinduka mwabonye. Komeza ubabaze kugira ngo ubashe kumenya byinshi. c. Have you visited CGs ? NW? How many visits in last three months? / Mwigeze musura amatsinda y’ubuzima (CG)? Icyumweru cy’imirire? Mwasuye inshuro zingahe mu mezi atatu ashize? d. What are the main barriers that prevent you to supervise CG or NW effectively? What can be done in order to improve supervisions to CHWs?/ Ni izihe nzitizi muhura nazo mu gusura amatsinda y’ubuzima (CG) cyangwa gusura amatsinda y’icyumweru cy’imirire uko bikwiye? Ni iki cyakorwa kugirango ibikorwa by’isura birusheho kugenda neza? e. What is an area of need for health promotion in your sector/cell?/ Ni iki mwifuza ko cyatezwa imbere byumwihariko kubirebana n’ubukangurambaga bw’ubuzima muri uyu murenge/akagali? f. What could be done differently to meet your sector need?/ Ni ibihe bikorwa bitandukanye byakorwa kugira ngo haboneke ibisubizo by’ibibazo umurenge wanyu ufite? g. What are if any barriers faced when addressing your sector about health promotion? / Ni izihe nzitizi mwahuye nazo mu guteza imbere ubuzima mu murenge wanyu? h. What can be done to sustain community health programs?/ Ni iki cyakorwa kugira ngo hashimangirwe gahunda y’ubuzima bw’abaturage mu buryo burambye? Guide for Program Implementation Review Meeting with Religious Leaders Ibibazo bizifashishwa mu nama n’abahagarariye amatorero a. As the church leaders, how are you involved in health promotion activities? Nk’abantu bahagarariye amatorero/amadini, mwibona cyangwa mwisanga gute mu bikorwa byo guteza imbere ubuzima bw’abaturage? b. In your community health role, with who do you collaborate more? And How? Ku birebana n’inshingano zanyu mu by’ubuzima bw’abaturage, ni bande mukorana kenshi? Kandi mukorana mute? c. Since BCC and NW began in your community r, what changes have you observed? Probe to learn more./ Kuva aho ubukangurambaga na gahunda z’icyumweru cy’imirire zatangiriye mu midugudu, ni izihe mpinduka mwabonye? Komeza ubabaze kugira ngo urusheho kumenya byinshi. d. What are the main challenges you are facing to promote health? What did you do or can be done to respond to the challenges?/ Ni izihe ngorane zikomeye muhura nazo mu guteza imbere ubuzima? Ni iki mwakoze cyangwa mubona cyakorwa kugira ngo izo ngorane zikemuke? e. What can be done to sustain community health programs?/ Ni iki cyakorwa kugira ngo hashimangirwe gahunda y’ubuzima bw’abaturage mu buryo burambwe? Focus Group Discussion Guide with CHWs on NW implementation/ Ibibazo bigenewe abajyanama b’ubuzima ku mirimo y’icyumweru cy’imirire Rwanda ICSP Final Evaluation Report September 2015 Page 377 of 997 a. Have you learned about NW? What did you like about the Nutrition Week? Benefits? What did you not like about the Nutrition Week? /MWigeze MUbona inyigisho zijyanye n’icyumweru cy’imirire? Ni iki cyabashimishije ku bijyanye n’icyumweru cy’imrire? Ni iki kitabanyuze mu bijyanye n’icyumweru cy’imirire? b. What did you change in your family based on training received in NW? / Nyuma yo guhabwa amahugurwa kubijyanye n’icyumweru cy’imirire, ni iki mwahinduye mu muryango? c. What are the challenges you are facing to implement NW in your community? Probe to know all challenges. How do you respond to each challenge? / Ni izihe ngorane muhura nazo mugushyira mubikorwa icyumweru cy’imirire mu mudugudu? Komeza ubababaze kugirango bavuge ingorane zose. Ni iki mukora kuri buri kibazo? d. What need of training you feel in order to improve your skills for leading NW activities? e. Mwumva mwahabwa ayahe mahugurwa murwego rwo kongera ubushobozi bwanyu mu bikorwa by’icyumweru cy’imirire? f. Who support you more during the implementation of the five-day NW? or from whom you ask advice for implementing NW? How often he/she visited you during the last implementation of NW? / Ninde ubaha ubufasha cyane mugihe cy’iminsi itanu y’icyumweru cy’imirire? Ninde musaba inama zibafasha muri gahunda y’icyumweru cy’imirire? Yabasuye kangahe mu cyumweru cy’imirire giheruka? g. After NW, have you visited the families that attended NW? What are the behaviors taught they applied more and what behaviors they did not apply? h. Nyuma y’icyumweru cy’imirire mwaba mwarasuye ingo zacyitabiriye? Ni ibiki mwasanze bakora cyane, Ni ibiki mwabonye badakora? i. Is there anything you would like to tell me about how to improve NW? We are very interested in your opinions to change to make it better./ Ni ikihe gitekerezo mwatanga mu rwego rwo kurushaho gutunganya icyumweru cy’imirire? Twifuza cyane kumenya ibitekerezo byanyu byatuma icyumweru cy’imirire kirushaho kugenda neza Focus Group Discussion Guide with I CSP Staff/Ibibazo bibazwa abakozi ba ICSP Tangiraneza a. What are the main ICSP accomplishments have you observe in the project areas? What were the big challenges?/ Ni ibihe bikorwa by’ingenzi umushinga ICSP wagezeho? Ingorane zikomeye mwahuye nazo ni izihe? b. How the I CSP planning process was and what effect did this have on the implementation process?/Ese iteganyabikorwa ry’umushinga ryari rimeze gute? Ese ryagize uruhe ruhare mu gutangiza ibikorwa? Rwanda ICSP Final Evaluation Report September 2015 Page 378 of 997 c. To what extent was the work plan practical? What could be added to the Work Plan that would have strengthened the implementation? / Ese iteganyabikorwa mwabonye kurishyira mubikorwa bikoreka? Ni iki cyakongerwa ku iteganya bikorwa gishobora kongerera ingufu ibirebana no gutangiza ibikorwa? d. What were the gaps in the Work Plan and how were they addressed by the project staff? / Ni ibihe bibazo mwahuye nabyo mu iteganyabikorwa kandi mwabyitwayemo gute? e. What change is there in the knowledge, skills and competencies of the project and Partner’s staff? Is there evidence that the staff has applied these skills both within the project?/ Ni ibiki byahindutse mu bumenyi n’ubushobozi by’abakozi b’umushinga ndetse n’abafatanyabikorwa? Ese hari icyemeza ko abakozi bakoresheje neza ibyo bize mu mushinga? f. What will you do differently in terms of planning, training, partnership, human resources, financial management in order to improve the program delivery quality? Ni iki mwakora (kinyuranye n’ibyo mwakoraga) kubijyanye no Guteganya, Guhugura,ubufatanya bikorwa, kuyobora abakozi no gucunga umutungo kugirango ibikorwa bya porogaramu birusheho kugenda neza? g. What are some strategies that can be used to help strengthen the link between community and facility in delivering MCH programs in a sustainable way? Ni izihe ngamba zafatwa kugirango ubufatanye bw’ikigo nderabuzima n’abaturage bugire ingufu mu rwego rwo kubungabunga ubuzima bw’umwana n’umubyeyi mu buryo burambye? h. What are some strategies for effectively engaging churches, and other behavioral influencers in health promotion? / Ni izihe ngamba zafatwa kugirango itorero hamwe n’abandi bafite ubushobozi bwo guhindura barusheho kuzamura ubuzima mugiturage? Focus Group Discussion with I CSP Manager a. How has the project contributed to improving MCH coverage in Nyamagabe District? / Ni gute umushinga wagize uruhare mu kugeza gahunda zo kwita ku buzima bw’umwana n’umubyeyi mu karere ka Nyamagabe. b. The project wants to facilitate health staff and District staff in the implementation of the behavior change strategies through CG and NW interventions. Do you think using the modified CG , Church leaders and community leaders have been effective to promote new behaviors? What were the strengths and the weaknesses?/ Umushinga urashaka gufasha abakozi b’ibigo nderabuzima n’ab’akarere gushyiraho ingamba zo guhindura imyifatire binyujijwe mu matsinda (CG) no muri gahunda z’icyumweru cy’imirire. Mutekereza ko kwifashisha amatsinda, abahagarariye amadini n’abayobozi b’inzego z’ibanze byaba byarafashije mu gutuma habaho impinduka nshya? Ibyagenze neza ni ibihe? Ibitaragenze neza ni ibihe? c. How can the project more effectively facilitate the Health staff to integrate all MCH activities at the community-level through modified CG network in order to reduce missed opportunities? / Ni gute umushinga warushaho gufasha abakozi ba Ministeri y’ubuzima mu gushyira mu bikorwa ibikorwa birebana no kwita ku buzima bw’umwana n’umubyeyi ku rwego rw’umudugudu binyujijwe mu matsinda (CG) kugira ngo hatagira ikiburizwamo? Rwanda ICSP Final Evaluation Report September 2015 Page 379 of 997 d. What are the overall lessons learned from the project, in terms of integrating CCM, MNC, Nutrition and crosscutting Community Mobilization and M&E interventions?/ Ni ayahe masomo mwigiye ku mushinga ku bijyanye no guhuriza hamwe ibi bikorw: (Ubuvuzi bw’ibanze, Kwita ku buzima bw’umwana n’umubyeyi, Imirire, ubukangurambaga no kugenzura no gukurikirana ibikorwa? e. What are some other strategies that can be used to help strengthen the link between community and facility in implementing Nutrition Weeks? / Ni ubuhe bundi buryo bwakoreshwa kugirango hongerwe imbaraga mu guhuza imidugudu n’amavuriro mu gushyiraho icyumweru cy’imirire? f. What are some strategies for effectively engaging churches, and other behavioral influencers in MCH activities? / Ni ubuhe buryo bwakoreshwa kugira ngo amatorero n’abandi bavuga rikijyana bagire ibikorwa by’ubuzima bw’umwana n’umubyeyi ibyabo? Year 4 KPC Survey Questionnaire with Translation World Relief Rwanda Tangiraneza Innovation Child Survival Project, 2014 i. RESPONDENT IDENTIFICATION/ UMWIRONDORO W’USUBIZA 0) Hospital catchment area / Aho ibitaro bikorera Kigeme…………….. 1 Kaduha……………. 2 i1) Cluster No. / Nimero y’itsinda |___|___| i2) Household No. / Nimero y’urugo |___|___|___|___| i4) Interviewer Name/ Amazina y’ubaza ______________________________ i5) Sector/ Umurenge i6) Cell/ Akagali Rwanda ICSP Final Evaluation Report September 2015 Page 380 of 997 i7) Village/ Umudugudu i8) Health center/ Ikigo Nderabuzima i9) Date of Interview/ Itariki y’ibazwa 2015 - ___ ___ - ___ ___ MM - DD i10) Was consent received? Ubazwa yabyemeye? Yes/ Yego……………………………….1  i12 No/ Oya…………………………………..2 i11) If no, why not? Niba ari Oya, kubera iki? Unavailable/ Ntaboneka………………..1 End/ Iherezo Unwilling/ Ntameze neza……………….2 End/ Iherezo Child not Home/ Umwana ntahari……3 End/ Iherezo Other/ Ibindi…………………….…………4 End/ Iherezo ________________________________ (Specify/ Sobanura) i12) What are the name, sex, and date of birth of your youngest child that is still alive? Umwana wawe muto ufite yitwa nde? Yavutse ryari? Igitsina cye ni ikihe? i12a) NAME OF THE CHILD LESS THAN 24 MONTHS AMAZINA Y’UMWANA URI MUNSI Y’AMEZI 24 ____________________________________________ i12b) SEX OF CHILD (1=MALE, 2=FEMALE/ Rwanda ICSP Final Evaluation Report September 2015 Page 381 of 997 IGITSINA CY’UMWANA( 1=GABO, 2=GORE)……1……..2 i12c) DATE OF BIRTH IGIHE YAVUKIYE ___ ___ ___ ___/___ ___/ ___ ___ Y Y Y Y / M M / D D i12d) AGE OF THE CHILD (IN MONTHS) |___|___| IMYAKA Y’UMWANA (MU MEZI) i13) Ask the mother: What is your name? / Baza umubyeyi w’umwana: Witwa nde? ____________________________________________ i14) Ask the mother: What is your age in years? / Baza umubyeyi w’umwana: Ufite imyaka ingahe? |___|___| i15) Are you the biological mother of the child? / Ni wowe wabyaye uyu mwana? YES/ YEGO………………………..1 NO/ OYA…...………………….…...0 i16) Time interview began / Isaha ibazwa ryatangiriye AM/ Mbere ya saasita ___ ___:___ ___ PM/ Nyuma ya saasita ___ ___:___ ___ SECTION I: SOCIO-DEMOGRAPHICS / IGICE CYA 1: IMIBEREHO RUSANGE INSTRUCTIONS: Ask the questions exactly as they are written. Do not read responses unless directed to do so. Words in Italics are instructions for the interviewer and should not be read aloud. Follow skip patterns as directed. Write answers in the box unless otherwise directed. AMABWIRIZA: Baza ibibazo nkuko byanditse. Irinde kumu somera ibisubizo. Amagambo yanditse mu Rwanda ICSP Final Evaluation Report September 2015 Page 382 of 997 buryo buberamye ni amabwiriza y’ubaza ntabwo ugomba kuyasomera ubazwa. Aho ugomba gu simbuka hasimbuke. Andika igisubizo mu kazu kabugenewe. Rwanda ICSP Final Evaluation Report September 2015 Page 383 of 997 # Questions Ibibazo Responses Ibisubizo bishoboka Skip Simbu ka Ans wer/I gisu bizo atan ze 1. Have you ever attended school? Mwaba mwarageze mu ishuri? Yes/ Yego……….....……….1 No/ Oya…………….......…....2 Don’t know/ Simbizi………88 S 3 3 2. If yes, then ask: What is the highest grade or level of school you have completed? Niba ari yego, mubaze uti: Warangije ayahe mashuri? None/ Did not complete primary Ntayo/Ntiyarangije amashuri abanza.................................................0 Primary/ Amashuri abanza ……….....1 Secondary/ Amashuri yisumbuye.….2 Past Secondary/ Amashuri makuru…3 Other/ Ibindi………………………….………..…4 ________________________________ (Specify/ Sobanura) 3. How many people live in your household? Muri uru rugo mubamo muri bangahe? Number/ Umubare………………….…|___|___| Don’t know/ Simbizi…………………….....88 4 What is your ubudehe category according to the participatory poverty assessment as defined by MINALOC? Read options if needed. 1. Umutindi nyakujya (those in abject poverty)…………1 2. Umutindi (the very poor)…..........2 Rwanda ICSP Final Evaluation Report September 2015 Page 384 of 997 Mwashyizwe mu kihe cyiciro cy’ubudehe nyuma y’ubushakashatsi bwakozwe na MINALOC kubijanye n’ubukire cyangwa ubukene? Musomere ibyiciro niba atabizi If the category is unknown, the interviewer should check the list at the health center so that data is entered for every household. If there is debate, use the category assigned by MINALOC. Niba ubazwa atazi icyiciro arimo, ubaza ajye kureba kuri lisiti yo ku Kigo Nderabuzima iriho ibyiciro by’ingo zose, Niba ubazwa ajya impaka ku cyiciro yashyizwemo, koresha icyiciro kiri ku ilisiti ya MINALOC Are you using health insurance? Ese waba uri mu bwisungane mu kwivuza? If yes: Can I see your member card? Niba ari yego, nshobora kureba ikarita yawe y’ubwisungane mu kwivuza? 3. Umukene (the poor) …….………..3 4. Umukene wifashije (the resourceful poor..………...…4 5. Umukungu (the food rich)…….....5 6. Umukire (the money rich).……….6 8. Simbizi (don’t know).………..…88 (Source: Government of Rwanda Poverty Reduction￾Strategy Paper,June 2002 – p.15.) Yes/ Yego………………………………1 No/ Oya……………………….………...0 Card available/ Ikarita irahari….…….1 No card/ Ikarita ntayo afite…….……..0 5 SECTION II: MATERNAL AND NEWBORN CARE/ IGICE CYA KABIRI KWITA K’UMUBYEYI NURUHINJA Rwanda ICSP Final Evaluation Report September 2015 Page 385 of 997 # Questions Ibibazo Responses/ Ibisubizo bishoboka Skip Simb uka Answ er/Igi subiz o atanz e 5 How long should you wait after the birth of your child before you try to become pregnant again? Uzategereza igihe kingana iki kugirango wongere gusama indi nda? LESS THAN 2 YEARS MUNSI Y’IMYAKABIRI..……...1 2 TO 5 YEARS HAGATI Y’IBIRI N’ITANU….…..2 MORE THAN 5 YEARS HEJURU Y’IMYAKA ITANU…...3 DON’T KNOW SIMBIZI……………….………. 88 6 What are the risks of getting pregnant too soon after the birth of a child? Ni izihe ngorane zishobora kuboneka mugihe umubyeyi akurikije hakiri kare? DO NOT READ RESPONSES. RECORD ALL THAT ARE MENTIONED. IRINDE KUMUSOMERA IBISUBIZO. ANDIKA IBYO AGUSUBIJE BYOSE. BABY BORN TOO SMALL….……A UMWANA AVUKANA IBIRO BIDASHYITSE BABY BORN TOO EARLY………..B UMWANA AVUKA ATAGEJEJE KU GIHE MOTHER CAN DIE……………..…..C UMUBYEYI ASHOBORA GUPFA MOTHER CAN HAVE MISCARRIAGE…………………….D UMUBYEYI ASHOBORA GUKURAMO INDA MOTHER CAN SUFFER ANEMIA……………….……….…...E UMUBYEYI ASHOBORA KUBURA AMARASO OTHER / IBINDI...............................X ______________________________ (SPECIFY/ SOBANURA) 7 Are you currently doing something or using any method to delay or avoid getting pregnant? Hari uburyo ukoresha ngo wirinde gusama? YES/ YEGO…….…………...……………………1 NO/ OYA…………...………………..…………….0 Rwanda ICSP Final Evaluation Report September 2015 Page 386 of 997 Which method are you (or your husband/ partner) using? Ni ubuhe buryo ukoresha (cyangwa umugabo wawe)? DO NOT READ RESPONSES. CODE ONLY ONE RESPONSE. IRINDE KUMUSOMERA IBISUBIZO. SHYIRA AKAMENYETSO KUCYO AKUBWIYE. IF MORE THAN ONE METHOD IS MENTIONED, ASK, / NIBA AKUBWIYE UBURYO BURENZE BUMWE, MUBAZE UTI What is your MAIN method that you (or your husband/ partner) use to delay or avoid getting pregnant?” Ni ubuhe buryo, wowe cyangwa umugabo wawe mukoresha kurusha ubundi kugirango wirinde gusama? IF REPONDENT MENTIONS BOTH CONDOMS AND STANDARD DAYS METHOD, CODE “12” FOR STANDARD DAYS METHOD. AGAKINGIRIZO N’UBURYO BWA KAMERE SHYIRA AKAMENYETSO KURI “12” IF RESPONDENT MENTIONS BREASTFEEDING, FEMALE STERILIZATION KWIFUNGISHA BURUNDU KU MUGORE …..….1 MALE STERILIZATION KWIFUNGISHA BURUNDU KU MUGABO………………………….……………..………..2 PILL/ IBININI….………………………………………….3 IUD/ AGAPIRA MU MUMURA……….……………..4 INJECTABLES URUSHINGE.……………………..…5 IMPLANTS/ AGAPIRA MU KABOKO.............……6 CONDOM AGAKINGIRIZO K’ABAGABO ………………………..7 FEMALE CONDOM AGAKINGIRIZO K’ABAGORE………………..….…….8 DIAPHRAGM AGAPIRA KO KU NKONDO Y’UMURA…..…….…..9 FOAM/JELLYAMAVUTA…….…………………..…10 LACTATIONAL AMEN. METHOD KONSA GUSA………………………………………….…11 STANDARD DAYS METHOD/ CYCLEBEADS KUBARA IMINSI Y’UBURUMBUKE…………….…...12 RHYTHM METHOD (OTHER THAN STANDARD DAYS) Rwanda ICSP Final Evaluation Report September 2015 Page 387 of 997 CODE “15” FOR OTHER AND RECORD BREASTFEEDING./NIBA AVUZE UBURYO BWO KONSA SHYIRA AKAMENYETSO KURI “15 “KANDI UBYANDIKE NO MUMAGAMBO IF RESPONDENT MENTIONS ABSTINENCE OR ISOLATION, CODE “15” FOR OTHER AND RECORD RESPONSE IN SPACE PROVIDED. NIBA AVUZE UBURYO BWO KWIFATA SHYIRA AKAMENYETSO KURI “15” KANDI UBYANDIKE NO MUMAGAMBO. UBUNDI BURYO BWO KUBARA…………………..……13 WITHDRAWAL/KWIYAKANA………….……………14 OTHER/ IBINDI………………………..……….……….15 _______________________________________ (SPECIFY/ BISOBANURE) 9 During your pregnancy with (Name), did you see anyone for antenatal care? Mugihe wari utwite Kanaka (Izina ry’ umwana muto) waba warigeze wipimisha inda ? YES/ YEGO………….....……………………1 NO/ OYA……………………..…………...….0 9 IF YES: Whom did you see? Anyone else? NIBA AVUZE YEGO MUBAZE UTI : Ninde wagusuzumye ? Ntawundi? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN. MUSOBANUZE NEZA WUMVE NIBA YARASUZUMWE N’UMUNTU UBUFITIYE UBUSHOBOZI DOCTOR/MEDICAL ASSISTANT MUGANGA/ UMUFASHA WE………………A NURSE/UMUFOROMO……..…………....B MIDWIFE/ UMUBYAZA…………………….C TRADITIONAL BIRTH ATTENDANT UMUBYAZA WA GIHANGA……………….D OTHER / ABANDI____________________........X (SPECIFY/ BAVUGE) NO ONE NTA NUMWE…………………………………Y 16 Rwanda ICSP Final Evaluation Report September 2015 Page 388 of 997 1 During your pregnancy with (Name), where did you receive antenatal care? Mugihe wari utwite Kanaka ( Izina ry’umwana muto ) ni hehe wipimishirije inda? CIRCLE ALL MENTIONED. SHYIRA AKAZIGA KUGISUBIZO AGUHAYE IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. NIBA ARI KUBITARO, KUKIGO NDERABUZIMA CYANGWA KU IVURIRO RYIGENGA ,ANDIKA UKO HITWA. MUSOBANUZE NEZA KUGIRA NGO WANDIKE IGISUBIZO CY’UKURI _________________________________ (NAME OF PLACE/ IZINA RYAHO YABYARIYE) HOME/ MURUGO YOUR HOME/ IWAWE ……………….A MIDWIFE/TBA HOME/ MURUGO RW’UMUBYAZA……........B OTHER HOME/ MURUNDI RUGO.....C PUBLIC SECTOR/ IVURIRO RYA LETA HOSPITAL/ IBITARO ……………..…D HEALTH CENTER IKIGO NDERABUZIMA……………....E HEALTH POST IVURIRO RYUNGIRIJE ……………....F OUTREACH/ KU MUDUGUDU/ STRATEGIE AVANCEE……………………………...G OTHER PUBLIC ANDI MAVURIRO YA LETA…..................H (SPECIFY/SOBANURA____________) PRIVATE SECTOR/ AMAVURIRO YIGENGA PRIVATE HOSPITAL IBITARO BYIGENGA ………………….I Rwanda ICSP Final Evaluation Report September 2015 Page 389 of 997 PRIVATE CLINIC KIRINIKE YIGENGA ……………….J OTHER PRIVATE IRINDI VURIRO RYIGENGA……….....K (SPECIFY/ RIVUGE______________) OTHER/ AHANDI................................................X (SPECIFY/ HAVUGE_____________) 1 During your pregnancy with (Name), how many months pregnant were you when you first received antenatal care? Mugihe wari utwite kanaka (Izina ry’umwana) wagiye kwipimisha bwa mbere inda ifite amezi angahe? MONTHS/ AMEZI………….… DON’T KNOW/ SIMBIZI…………….88 1 During your pregnancy with (Name), how many times did you receive antenatal care?/Mugihe wari utwite kanaka (Izina ry’umwana) wipimishije inda inshuro zingahe ? TIMES/ INSHURO…………..…. DON’T KNOW/ SIMBIZI……………88 1 As part of your antenatal care during this pregnancy, were any of the following done at least once? Hari ibintu by’ingenzi bakorera umugore utwite iyo agiye kwipimisha,inda,muri ibi bikurikira ni iki baba baragukoreye nibura inshuro imwe ? A. Was your height taken?/ Bagupimye uburerebure? B. Was your blood pressure measured? Bagufatiye umuvuduko w’amaraso? C. Did you give a urine sample?/ Wigeze YES/YEGO NO/OYA A. HEIGHT/ UBUREBURE……….1 …….0 B. BP/ UMUVUDUKO W’AMARASO …………………..….1 ……..0 C. URINE/ INKARI………………….1 …….0 D. BLOOD/ AMARASO……………1 ..…….0 Rwanda ICSP Final Evaluation Report September 2015 Page 390 of 997 utanga ikizami cy’inkali? D. Did you give a blood sample?/Hari ikizami cy’amaraso wigeze utanga? 1 During (any of) your antenatal care visits, were you told about the signs of pregnancy complications? Mugihe wajyaga kwipimisha inda bigeze bakubwira ibimenyetso mpuruza kumugore utwite ? YES/ YEGO…………………………..…1 NO/ OYA……………………………..….0 DON’T KNOW/ SIMBIZI……………....88 16 16 1 Were you told where to go if you had any of these complications? Bigeze bakubwira aho wajya mugihe ubonye kimwe muri ibyo bimenyetso? YES/ YEGO………………………….…1 NO/ OYA…………………………….….0 DON’T KNOW/ SIMBIZI…………….88 1 During pregnancy, woman may encounter severe problems or illnesses and should go or be taken immediately to a health facility. Iyo umugore atwite ashobora guhura n’ibibazo cyangwa se uburwayi bishobora gutuma yihutira kujya kwa muganga. What types of symptoms would cause you to seek immediate care at a health facility (right away)? Ni ibihe bimenyetso by’uburwayi bishobora kugutera kwihutira kujya kwa muganga mu gihe utwite? ASK: Anything else? VAGINAL BLEEDING KUVIRA KU NDA………………...…….A FAST/DIFFICULT BREATHING/ GUHUMEKA BIMUGOYE………….....B FEVER/ UMURIRO…….…………..….C SEVERE ABDOMINAL PAIN/ KUBABARA MU NDA CYANE……….D HEADACHE/BLURRED VISION KURIBWA UMUTWE/ KUTABONA NEZA…………………………………….E CONVULSIONS/ KUGAGARA…..………….…………...F FOUL SMELLING DISCHARGE/FLUID FROM VAGINA Rwanda ICSP Final Evaluation Report September 2015 Page 391 of 997 BAZA UTI: Nta bindi? DO NOT READ RESPONSES. RECORD ALL THAT ARE MENTIONED. IRINDE KUMUSOMERA IBISUBIZO, SHYIRA AKAMENYETSO KU BISUBIZO AGUHAYE BYOSE. KUZANA IBINTU BY’URUZI BINUKA………………………………....G BABY STOPS MOVING INDA NTIYONKA…………………...….H LEAKING BROWNISH/GREENISH FLUID FROM THE VAGINA KUZANA IBINTU BY’URUZI BISA N’IKIGINA CYANGWA ICYATSI KIBISI……………………………………..I OTHER / IBINDI …………………….......X ______________________________ (SPECIFY/ BISOBANURE) 1 During your pregnancy with (Name of the child) did you receive an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth? Mugihe wari utwite kanaka (Izina ry’umwana) wigeze ubona urukingo ku kaboko rukingira umwana tetanus(agakwega) kugagara? YES/ YEGO……………………….……1 NO/ OYA ..………………….………….0 DON’T KNOW/ SIMBIZI………………88 19 19 1 While pregnant with (name of the child), how many times did you receive such an injection? Igihe wari utwite kanaka (Izina ry’umwana muto) urwo rukingo warutewe inshuro zingahe? ONE/ RIMWE………………………...….1 TWO/ KABIRI………….……..…………2 THREE OR MORE INCURO 3 CYANGWA ZIRENGA……3 DON’T KNOW/ SIMBIZI…………..…..88 1 Did you receive any tetanus toxoid injection at any time before that pregnancy, including during a previous pregnancy or between pregnancies? Mbere yo gutwita (Izina ry’umwana muto) wigeze uhabwa urukingo rwa YES/ YEGO……………..………….……1 NO/OYA………………………………...0 DON’T KNOW/ SIMBIZI……..……….88 21 21 Rwanda ICSP Final Evaluation Report September 2015 Page 392 of 997 tetanus ushyizemo mu gihe wari utwite iyabanjirije iy’uyu mwana cyangwa se mu gihe cyo hagati y’izo nda? 2 Before the pregnancy with (Name of the child), how many times did you receive a tetanus injection? Mbere yo gutwita kanaka (izina ry’umwana muto) urwo rukingo warutewe inshuro zingahe? ONE/ RIMWE………………………...….1 TWO/ KABIRI……………………………2 THREE OR MORE INCURO 3 CYANGWA ZIRENGA……3 DON’T KNOW/ SIMBIZI………………..8 21 If biological mother (i15) ask: During your pregnancy with (Name), were you given or did you buy any iron tablets/syrup? Mubaze iki kibazo niba ariwe wabyaye uyu mwana (i15): Mu gihe wari utwite (izinary’umwana muto) wigeze uhabwa cyangwa ugura ibinini/umushongi bya feri byongera amaraso? SHOW TABLETS/ BIMWEREKE YES/ YEGO……………...………….1 NO/ OYA…………………………….0 DON’T KNOW/ SIMBIZI...……….88 29 29 29 22 During the whole pregnancy, for how many days did you take the tablets/syrup? If the answer is not numeric, probe for the approximate number of days. Igihe wari utwite, ibyo binini bya feri wabifashe mu minsi ingahe? Niba igisubizo aguhaye Atari umubare, komeza umubaze agereranye mu mibare. DAYS/ IMINSI……………..…|___|___| DON’T KNOW/ SIMBIZI……….….888 23. Who assisted with the delivery of (Name)? Ni nde wakubyaje kanaka(izina DOCTOR/ DOGITERI…………...……..A Rwanda ICSP Final Evaluation Report September 2015 Page 393 of 997 ry’umwana muto) ? Anyone else?/Ntawundi PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED. KOMEZA UMUBAZE KUGIRA NGO UMENYE NIBA YARABYAJWE N’UMUNTU WABIHUGURIWE IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY. NIBA AVUZE KO NTAWE, KOMEZA UMUBAZE UMENYE NIBA HARI UMUNTU MUKURU WARI UHARI MU GIHE YABYARAGA. NURSE/ UMUFOROMO ……..….........B MIDWIFE/ UMUBYAZA…..…..……….C AUXILIARY MIDWIFE/ UMUFASHA W’UMUBYAZA…….............................D OTHER HEALTH STAFF W/ MIDWIFERY SKILLS UNDI MUFOROMO UZI KUBYAZA …E TRAINED TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA WAHUGUWE.........................F TRAINED COMMUNITY HEALTH WORKER/UMUJYANAMA W’ UBUZIMA WAHUGUWE……………....G TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA UTARAHUGUWE………………...…….H COMMUNITY HEALTH WORKER UMUJYANAMA W’UBUZIMA UTARAHUGUWE……………………....I RELATIVE/FRIEND/ UWO MUGIRA ICYO MUPFANA/INSHUTI/ UMUTURANYI ………………………….J NO ONE/ NTA N’UMWE.……………...Y 24. Was (NAME) dried (wiped) immediately after birth before the placenta was delivered? Nyuma y’uko kanaka(Izina ry’umwana) avuka,yaba yarahanaguwe, agafubikwa ako kanya nyuma yo kuvuka mbere yuko iyanyuma isohoka? YES/YEGO………………………………1 NO/ OYA………………………………...0 Rwanda ICSP Final Evaluation Report September 2015 Page 394 of 997 DON’T KNOW/ SIMBIZI………….….88 25. Was (NAME) wrapped in a warm cloth or blanket immediately after birth before the placenta was delivered? Kanaka (Izina) yaba yarafubitswe mubintu bishyushye(Imyenda cg ikiringiti ) akimara kuvuka? YES/YEGO……...………………………1 NO/ OYA………………………………...0 DON’T KNOW/ SIMBIZI……………. 88 26. After (Name) was born, did any health care provider or traditional birth attendant check on (Name’s) health? Nyuma yo kuvuka kwa, Kanaka hari ibindi uwagufashije/uwafashije nyina amubyara yaba yarakoreye uwo mwana mu rwego rwo kwita ku buzima bwe? YES/YEGO………………………………1 NO/ OYA………………….……………...0 29 27. How many hours, days or weeks after the birth of (Name) did the first check take place? Kanaka (amazina) yaba yarasuzumwe nyuma y’igihe kingana iki amaze kuvuka? IF LESS THAN ONE DAY, CIRCLE 0 AND RECORD HOURS; IF ONE TO SIX DAYS CIRCLE 1 AND RECORD DAYS; IF MORE THAN 6 DAYS CIRCLE 2 AND RECORD WEEKS. NIBA ARI MUNSI Y’UMUNSI UMWE SHYIRA AKAMENYETSO KURI “0” KANDI WANDIKE “Amasaha”, NIBA ARI HAGATI Y’IMINSI UMWE KUGERA KURI ITANDATU SHYIRA AKAMENYETSO KURI RIMWE HOURS / AMASAHA 0 DAYS/ IMINSI 1 WEEKS/ IBYUMWERU 2 DON’T KNOW/ SIMBIZI…………..…88 Rwanda ICSP Final Evaluation Report September 2015 Page 395 of 997 WANDIKE “Iminsi”, NIBA ARI HEJURU Y’IMINSI ITANDATU SHYIRA AKAMENYETSO KURI 2 KANDI WANDIKE IBYUMWERU. 28. Who checked on (Name’s) health at that time? Muri icyo gihe ninde wasuzumye uko ubuzima bwe bumeze? Anyone else?/Ntawundi? PROBE FOR THE MOST QUALIFIED PERSON AND RECORD ALL MENTIONED.KOMEZA UMUBAZE WUMVE KO ARI UMUNTU UBIFITIYE UBUMENYI WAMUSUZUMYE KANDI ABO AKUBWIRA BOSE UBANDIKE. DOCTOR/ DOGITERI…………...……..A NURSE/ UMUFOROMO……...............B MIDWIFE/ UMUBYAZA…….......…….C AUXILIARY MIDWIFE/ UMUFASHA W’UMUBYAZA……....…D OTHER HEALTH STAFF WITH MIDWIFERY SKILLS. / UNDI MUFOROFO UZI KUBYAZA …………E TRAINED TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA WAHUGUWE………………............….F TRAINED COMMUNITY HEALTH WORKER/ UMUJYANAMA W’UBUZIMA WAHUGUWE .....................................G TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA UTARAHUGUWE………...........……..H COMMUNITY HEALTH WORKER/ UMUJYANAMA W’UBUZIMA UTARAHUGUWE……………………...I RELATIVE/FRIEND/ UWO MUGIRA ICYO MUPFANA/ INSHUTI/ UMUTURANYI………………………...J Rwanda ICSP Final Evaluation Report September 2015 Page 396 of 997 NO ONE/ NTA N’UMWE …………….Y SECTION III: BREASTFEEDING AND CHILD NUTRITION / KONSA NO KUGABURIRAUMWANA 29 Did you ever breastfeed (NAME)? Wigeze wonsa (izinary’umwana muto)? YES/ YEGO....................................... 1 NO/ OYA ......................................... 0 36 30 How long after birth did you first put (NAME) to the breast? IF LESS THAN 1 HOUR, CIRCLE ‘000’ HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. Ukimara kubyara kanaka (izinary’umwana muto) wamwonkeje bwa mbere amaze igihe kingana iki avutse? NIBA ARI MUNSI Y’ISAHA IMWE SHYIRA AKAZIGA KURI 000,NIBA ARI MUNSI Y’AMASAHA 24, ANDIKA UMUBARE W’AMASAHA, NIBA ARI HEJURU Y’AMASAHA 24, ANDIKA IMINSI. Less than 1 hour / lgihe kitageze ku isaha ………….0 0 0 or / cyangwa Hours / Amasaha……………... |___|___| or / cyangwa Days / Iminsi …………………...|___|___| 31 During the first three days after delivery, did you give (NAME) the liquid that came from your breasts? Mu minsi itatu ya mbere umaze kubyara, waba waronkeje ( IZINA RY’UMWANA MUTO)? YES/ YEGO....................................... 1 NO / OYA ......................................... 0 DON’T KNOW/ SIMBIZI.................... 88 Rwanda ICSP Final Evaluation Report September 2015 Page 397 of 997 32 During the first three days after delivery, was (NAME) given anything to drink other than breast milk? Mu minsi itatu ya mbere umaze kubyara, hari ikinyobwa wahaye kanaka kitari amashereka? YES/ YEGO....................................... 1 NO / OYA ......................................... 0 DON’T KNOW/ SIMBIZI ................... 88  34  34 33 What else was (NAME) given to drink during the first three days? Ni ibihe binyobwa bindi wahaye (IZINA RY’UMWANA MUTO) mu minsi itatu ya mbere? Anything else? Nta kindi? DO NOT READ THE LIST NTUMUSOMERE IBISUBIZO. RECORD ALL MENTIONED BY CIRCLING LETTER FOR EACH ONE MENTIONED SHYIRA AKAZIGA KUCYO AKUBWIYE MILK (OTHER THAN BREAST MILK) AMATA (ATARI AMASHEREKA……A PLAIN WATER / AMAZI……...…......B SUGAR OR GLUCOSE WATER / AMAZI ARIMO ISUKARI………..…….C HOME REMEDY/ IMITI YATEGURIWE MU RUGO ITARI IYO KWA MUGANGA………………………………D SUGAR-SALT-WATER SOLUTION / AMAZI ARIMO UMUNYU N’ISUKARI…………………………….…E FRUIT JUICE/ UMUTOBE W’IMBUTO …………….....F INFANT FORMULA / AMATA Y’ABANA YO MU BIKOMBE…………………..….G TEA / ICYAYI………………………….....H HONEY/ UBUKI …………………………I OTHER/ IBINDI…………………….……X ________________________________ (SPECIFY/ SOBANURA) Rwanda ICSP Final Evaluation Report September 2015 Page 398 of 997 34 Was (NAME) breastfed yesterday during the day or at night? (Izinary’umwana muto) waramwonkeje ejo kumanywa cyangwa nijoro? YES/ YEGO ...................................... 1 NO / OYA .......................................... 0 DON’T KNOW / SIMBIZI .................. 88 36 35 Sometimes babies are fed breast milk in different ways, for example by spoon, cup or bottle. This can happen when the mother cannot always be with her baby. Sometimes babies are breastfed by another woman, or given breast milk from another woman by spoon, cup or bottle or some other way. This can happen if a mother cannot breastfeed her own baby. Did (NAME) consume breast milk in any of these ways yesterday during the day or at night? Rimwe n arimwe abana bahabwa amashereka mu buryo butandukanye, urugero: kukayiko, mu gikombe cg mu icupa. Ibyo bishobora kuba iyo umubyeyi adashoboye kuba ari kumwe n’umwana we. Bishobora no kuba iyo umubyeyi adashobora konsa umwana we. Mbese (KANAKA) yaba yarahawe amashereka ejo kumanywa cg nijoro hakoreshejwe bumwe muri ubwo buryo maze kukubwira? YES/ YEGO ...................................... 1 NO / OYA .......................................... 0 DON’T KNOW / SIMBIZI................... 88 36 Now I would like to ask you about some medicines and vitamins that are sometimes given to infants. Was (NAME) given any vitamin drops or other medicines as drops yesterday during the day or YES/ YEGO ...................................... 1 NO / OYA .......................................... 0 Rwanda ICSP Final Evaluation Report September 2015 Page 399 of 997 night? Ubu ndashaka kukubaza ibyerekeranye n’imiti cyangwa amavitamini ajya ahabwa abana. Ese (KANAKA) yaba yarahawe ibitonyanga bya vitamin cyangwa indi miti ejo ku manywa cg nijoro? DON’T KNOW / SIMBIZI. 88 37 Was (NAME) given ORS yesterday during the day or at night? Haba hari uruvange rw’imyunyu n’isukari(SRO) waba warahaye (izinary’umwanamuto) ejo kumanywa cg nijoro? YES/ YEGO ...................................... 1 NO / OYA .......................................... 0 DON’T KNOW / SIMBIZI................... 88 38 Did (NAME) drink anything from a bottle with a nipple yesterday or last night? (Izinary’umwana muto) yaba yaranywesheje bibero ejo kumanywa cyangwa iri joro? YES/ YEGO ...................................... 1 NO / OYA .......................................... 0 DON’T KNOW / SIMBIZI................... 88 Read out Q.39 below. Read the list of liquids one by one and mark ‘yes’ or ‘no’, accordingly. After you have completed the list, follow by asking Q. 40. [See far right hand column for those items (40B, 40C, and/or 40F) where the respondent replied ‘YES’.] Soma ibibazo biri hasi, Birebana n’ikibazo cya 39. Soma urutonde rw’ibinyobwa kimwe kimwe ushyireho yego cyangwa oya, nyuma yo kurangiza urutonde, komeza ubaze ikibazo cya 40 [reba ibyanditse iburyo ( 40B, na 40C/cyangwa 40F) aho igisubizo ari ‘YEGO’]. No. QUESTIONS AND FILTERS/ IBIBAZO CODING CATEGORIES/ IBISUBIZO BITEGEREJWE QUESTIONS AND CODING CATEGORIES/ IBIBAZO N’IBISUBIZO BITEGEREJWE 39 Next I would like to ask you about some liquids that (Name) may have had yesterday during the YES YEGO NO OYA DK SINZI 40 READ QUESTION 40 FOR ITEMS B, C AND F, IF CHILD CONSUMED THE Rwanda ICSP Final Evaluation Report September 2015 Page 400 of 997 day or at night. Did (Name) have any (ITEM FROM LIST)? READ THE LIST OF LIQUIDS STARTING WITH ‘PLAIN WATER.’ Noneho ndifuza kukubaza ibinyobwa waba wahaye umwana wawe ejo kumanywa cg nijoro. Hari ibyo waba wamuhaye? (IBIRI KU ILISTI) SOMA URUTONDE RW’IBINYOBWA UHEREYE KU “AMAZI GUSA”. ITEM. RECORD 88 for DON’T KNOW. How many times yesterday during the day or at night did (Name) consume any (ITEM FROM LIST)? SOMA IKIBAZO CYA 40 KU BISUBIZO B, C NA F, NIBA UMWANA YARABINYOYE. WANDIKE 88 AHO YASHUBIJE SIMBIZI. Ibi binyobwa kanaka (izinary’umwanamuto) yabifashe inshuro zingahe ku munsi haba ku manywa cyangwa nijoro? A Plain water? Amazi ? 1 0 88 B Infant formula such as Kigozi, Rinda and others? Amata y’abana yo mu bikombe nka Kigozi, Rinda n’andi? 1 0 88 B. TIMES/ Inshuro I__I__I C Milk such as tinned, powdered or fresh animal milk? Amata yo mu dukarito, ay’ifu cyangwa inshyushyu( y’inka, ihene)? 1 0 88 C. TIMES/ Inshuro I__I__I D Juice or juice drinks? Umutobe w’ibitoke cyangwa ubundi bwoko bw’imitobe? 1 0 88 Rwanda ICSP Final Evaluation Report September 2015 Page 401 of 997 E Clear broth? Isupu imeze nk’amazi? 1 0 88 F Yogurt? Yawurute? 1 0 88 F. TIMES/ InshuroI__I__I G Thin porridge? Igikoma kidafashe? 1 0 88 H Any other water-based liquids such as (insert local) sorghum juice? Ibindi binyobwa nk’ umusururu ? 1 0 88 I Any other liquids? Ibindi binyobwa? 1 0 88 41 Please describe everything that (NAME) ate yesterday during the day or night, whether at home or outside the home. a) Think about when (Name) first woke up yesterday. Did (NAME) eat anything at that time? IF YES: Please tell me everything (NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. IF NO, CONTINUE TO QUESTION b). b) What did (NAME) do after that? Did (NAME) eat anything at that time? IF YES: please tell me everything (NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. REPEAT QUESTION b) ABOVE UNTIL RESPONDENT SAYS THE CHILD WENT TO SLEEEP UNTIL THE NEXT DAY. c) IF RESPONDENT MENTIONS MIXED DISHES LIKE A PORRIDGE, SAUCE OR STEW, PROBE: What ingredients were in that (MIXED DISH)? PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. Rwanda ICSP Final Evaluation Report September 2015 Page 402 of 997 AS THE RESPONDENT RECALLS FOODS, UNDERLINE THE CORRESPONDING FOOD AND CIRCLE ‘1’ IN THE COLUMN NEXT TO THE FOOD GROUP. IF THE FOOD IS NOT LISTED IN ANY OF THE FOOD GROUPS BELOW WRITE THE FOOD IN THE BOX LABELLED ‘OTHER FOODS.’ IF FOODS ARE USED IN SMALL AMOUNTS FOR SEASONING OR AS A CONDIMENT, INCLUDE THEM UNDER THE CONDIMENTS FOOD GROUP. ONCE THE RESPONDENT FINISHES RECALLING FOODS EATEN, READ EACH FOOD GROUP WHERE ‘1’ WAS NOT CIRCLED, ASK THE FOLLOWING QUESTION AND CIRCLE ‘1’ IF RESPONDENT SAYS YES, ‘0’ IF NO AND ‘8’ IF DON’T KNOW: Yesterday during the day or night, did (NAME) drink/eat any (FOOD GROUP ITEMS)? Mwatubwira ibiribwa (IZINA RY’UMWANA MUTO) yagaburiwe ejo hashize kumanywa na nijoro murugo cyangwa ahandi a) Tekereza mugihe (kanaka) yamaragakubyuka ,hari icyo kurya yaba yarahawe? NIBA ARI YEGO watubwira buri kimwe cyose yaba yarariye muri icyo gihe? KOMEZA UMUBAZE UTI: Nta kindi? KUGEZA UBWO ASUBIZA KO NTA KINDI. NIBA NTACYO, KOMEZA KUKIBAZO CYA b). b) Nyuma yibyo (kanaka) yakoze iki? Hari ikintu (Kanaka) yariye muri icyo gihe? NIBA ARI YEGO: watubwira buri kimwe cyose yaba yarariye? KOMEZA UMUBAZE UTI: Nta kindi? KUGEZA UBWO ASUBIZA KO NTA KINDI. SUBIRAMO IKIBAZO CYA b) CYO HARUGURU KUGEZA UBWO UBAZWA AKUBWIRA KO UMWANA YAGIYE KURYAMA AGAKANGUKA K’UWUNDI MUNSI. c) NIBA AGUSHUBIJE IBYO KURYA BIVANGAVANZE NK’IGIKOMA, ISOSI CYANGWA IBINDI BIRYO BITETSE, KOMEZA UMUBAZE UTI: Ni ibihe biribwa byari muri iyo MVANGE y’ibiryo? KOMEZA UMUBAZE UTI: Nta cyindi yariye? KUGEZA UBWO ASUBIZA KO NTA KINDI. UKO USUBIZA AGENDA YIBUKA IBIRYO UMWANA YARIYE, UGENDE USHYIRAHO IKIMENYETSO KUCYO BIHUJE KANDI UZENGURUTSE AKAZIGA KURI”1” MU KUMBA KEGEREYE ITSINDA RY”IBIRIBWA. NIBA IBIRYO AVUZE BITARI KU ILISITI IRI HASI HANO, IBIRYO AVUZE UBYANDIKE AHAGENEWE “IBINDI BIRYO” NIBA HARI IBIRIBWA BYAKORESHEJWE MU KURYOSHYA IBIRYO NK’IBIRUNGO, UBISHYIRE Rwanda ICSP Final Evaluation Report September 2015 Page 403 of 997 AHAGENEWE ITSINDA RY’IBIRUNGO. MU GIHE USUBIZA ARANGIJE KUVUGA IBIRYO BYOSE UMWANA YARIYE< SOMA BURI KICIRI CY’IBIRYO AHO UTIGEZE USHYIRA AKAZIGA KURI “1” , UBAZE IKIBAZO GIKURIKIRA HANYUMA USHYIRE AKAZIGA KURI “1” NIBA ASHUBIJE YEGO, KURI “0” NIBA ASHUBIJE OYA, KURI “88” NIBA ASHUBIJE SIMBIZI: Ejo kumanywa cyangwa nijoro, ese (Kanaka) yaba yarariye cyangwa yaranyoye ibiryo biri muri ibi biryo ngiye kukubaza (IBIRYO MU BYICIRO)? OTHER FOODS: PLEASE WRITE DOWN OTHER FOODS IN THIS BOX THAT RESPONDENT MENTIONED BUT ARE NOT IN THE LIST BELOW IBINDI BIRIBWA: ANDIKA IBINDI BIRIBWA YAVUZE BITAGARAGARA KURUTONDE RWO HASI. NO. QUESTIONS AND FILTERS/ IBIBAZO CODING CATEGORIES/ IBISUBIZO BITEGEREJWE YES/ YEGO NO/ OYA DK/ SIMBIZI A Thicker porridge, bread, rice, noodles, or other foods made from grains Igikoma gifashe, umugati, umuceri, amakaroni, cyangwa ibindi biribwa bikomoka kubinyampeke 1 0 88 B Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside Ibihaza, karoti, ibijumba by’ umuhondo cyangwa bya orange 1 0 88 C White potatoes, white yams, cassava, or any other foods made from roots Ibirayi, ibikoro, imyumbati, cyangwa ibindi biribwa bikomoka kubinyabijumba. 1 0 88 D Any dark or green leafy vegetables Imboga z’icyatsi kibisi cyane, Imboga rwatsi 1 0 88 E Ripe mangoes, ripe papayas or ripe guava 1 0 88 Rwanda ICSP Final Evaluation Report September 2015 Page 404 of 997 Imyembe ihishije,ipapayi ihishije, cyangwe amapera ahishije F Any other fruits or vegetables (such as avocado) Hari izindi mbuto cyangwa imboga uha umwana zitavuzwe haruguru (nka avoka) 1 0 88 G Liver, kidney, heart or other organ meats Umwijima, impyiko, umutima, cyangwa izindi nyama zo munda 1 0 88 H Any meat, such as beef, pork, lamb, goat, chicken or duck Izindinyama / Iz’inka, ingururube, intama, ihene, inkoko cyangwa imbata 1 0 88 I Eggs / Amagi 1 0 88 J Fresh or dried fish, shellfish or seafood Amafi mabisi cyangwa yumye,isambaza ,injanga/indagara 1 0 88 K Any foods made from beans, peas, lentils, nuts or seeds Ibindi biribwank’ibishyimbo, amashaza, lantiye, ubunyobwa 1 0 88 L Cheese, yogurt, or other milk products foromage,yawurute,cyangwa ibindi bikomoka ku mata 1 0 88 M Any oil, fats or butter, or foods made with any of these Andi mavuta,ibinure cyangwa mayonese, cyangwa ibiribwa bikomoka kubyo tuvuze. 1 0 88 N Any sugary foods such as chocolates, sweets, candies, pastries cakes or biscuits Ibindi biribwa birimo isukari nka shokora, bombo, shikareti, gato cyangwa biswi 1 0 88 O Condiments for flavor, such as chilies, spices, herbs or fish powder 1 0 88 Rwanda ICSP Final Evaluation Report September 2015 Page 405 of 997 ibiribwaby’ibirungo nk’urusenda, utundi twatsi, ifu y’indagara P Grubs, snails or insects inswa ,isenani cyangwa utundi dusimba duto tuguruka 1 0 88 Q Foods made with red palm oil, red palm nut or red palm nut pulp sauce Ibiribwa byatekeshejwe amamesa 1 0 88 R Other foods not recorded on the list Ibindi biryo bitavuzwe haruguru 1 0 88 Check categories A-Q / GENZURA IBYICIRO A-Q IF ALL “NO” or “DK”  GO TO 42 IF AT LEAST ONE “YES”  GO TO 43 NIBA BYOSE ARI “OYA” CYANGWA “SIMBIZI” JYA KURI 42 NIBA BYIBUZE KIMWE MURI BYO ARI “YEGO” JYA KURI 43 42 Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night? IF ‘YES’ PROBE: What kind of solid, semi-solid, or soft foods did (NAME) eat? Ese (KANAKA) yigeze arya ibiryo bikomeye , bidakomeye cyane cyangwa byoroshye ejocyangwa ijoro ryakeye? YES/ YEGO ……………………...1 NO / OYA ……………………......0 DON’T KNOW/ SIMBIZI……….88 GO BACK TO Q41 AND RECORD 44 Rwanda ICSP Final Evaluation Report September 2015 Page 406 of 997 NIBA ARI YEGO KOMEZA UBAZE UTI: Ni ubuhe bwoko bw’ ibiryo bikomeye , bidakomeye cyane cyangwa byoroshye yafashe? FOODS EATEN THEN CONTINUE. Subira kukibazo cya 41 umusubiriremo byabibazo nyuma ukomeze 44 43 How many times did (NAME) eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night? Such as pureed cassava, potatoes, avocado or other pureed foods? WE WANT TO FIND OUT HOW MANY TIMES THE CHILD ATE ENOUGH TO BE FULL. SMALL SNACKS AND SMALL FEEDS SUCH AS ONE OR TWO BITES OF MOTHER’S OR SISTER’S FOOD SHOULD NOT BE COUNTED. LIQUIDS DO NOT COUNT FOR THIS QUESTION. DO NOT INCLUDE THIN SOUPS OR BROTH, WATERY GRUELS, OR ANY OTHER LIQUID. USE PROBING QUESTIONS TO HELP THE RESPONDENT REMEMBER ALL THE TIMES THE CHILD ATE YESTERDAY Ibiryo bikomeye ,bidakomeye cyane cyangwa ibindi biryo byoroshye ariko bitarink’amazi yabifashe inshuro zingahe ejo kumanywa cyangwa nijoro? Urugero: Ese mwamuhaye inombe y’imyumbati, y’ibijumba? Y’avoka? Cyangwa inombe y’ibindi biryo? TURIFUZA KUMENYA UMUBARE W’INSHURO UMWANA AGABURIRWA KUGEZA AHAZE. NTUBARIREMO UTWO GUHUGENZA UMWANA N’UTUNDI TUNTU DUTO ASHOBORA GUHABWA NA NYINA CYANGWA BAKURU BE. IBINYOBWA NTIBIBARWA MURI IKI KIBAZO. NTUBARIREMO AMASUPU AMEZE NK’AMAZI N’IBINDI BIRYO BIMEZE NK’AMAZI CYANGWA BINYOBWA. KOMEZA UMUBAZE KUGIRA NGO UMUFASHE KWIBUKA No. OF TIMES/ INSHURO………………...|___|___| DON’T KNOW/ SIMBIZI ……….88 Rwanda ICSP Final Evaluation Report September 2015 Page 407 of 997 INSHURO ZOSE UMWANA YAGABURIWE UMUNSI W’EJO. 44 (If yes to 41 or 42) At what age did (NAME) begin eating solid, semi-solid, or soft foods? (NIBA ARI YEGO)( kanaka) yanganaga iki mutangira kumuha ibiryo bikomeye cyangwa bidakomeye cyane cyangwa byoroshye? Age (months)/ Imyaka mumezi………….|___|___| DON'T KNOW/ SIMBIZI………………….…….88 44a (If yes to 41 or 42) Does (NAME) eat from his/her own separate bowl/cup? (Niba ari yego) Ese (Izina ry”umwana) yaba arira cyangwa agaburirwa ku gasahane/ mu gakombe ke? YES/ YEGO……….…………..…..1 NO/ OYA…………….…………..…0 45 Are you or someone in your family helping (NAME) eat? (ie. physically feeding them) Ujya ufasha (IZINA RY’UMWANA MUTO) kurya cyangwa hari undi wo mu muryango umufasha? YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 46b 46a IF NO: At what age did (NAME) start eating by himself/herself? NIBA ARI OYA: ni ku yahe mezi izina ry’umwanamuto ) yatangiye kwigaburira ubwe? Age (months)/ Imyaka mumezi………....|___|___| DON'T KNOW/ SIMBIZI……………………….….88 46b Do you encourage (NAME) to eat/feed (including when you breastfeed)? Mbese ujya ushishikariza (IZINA RY’UMWANA) kurya (no mu gihe umwonsa)? YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 47. Has (NAME) ever received a vitamin A dose (like this/any of these)? Kanaka (IZINA RY’UMWANA MUTO) yigeze ahabwa ikinini YES/ YEGO...................................... 1 49 Rwanda ICSP Final Evaluation Report September 2015 Page 408 of 997 cya Vitamini A? SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS MWEREKE IKININI CYA VITAMINI A GISANZWE GIKORESHWA NO/ OYA ........................................ 0 DON’T KNOW/ SIMBIZI .................. 88 49 48. If Yes, did (NAME) receive a vitamin A dose within the last 6 months? Niba ari Yego kanaka( izina ry’umwana muto) hari ubwo yahawe akanini ka Vitamini A mu mezi atandatu ashize YES/ YEGO ..................................... 1 NO/ OYA .......................................... 0 DON’T KNOW/ SIMBIZI................... 88 49. Has (NAME) taken any drug for intestinal worms in the past 6 months? Kanaka (izinary’umwana Muto) yaba hari utunini tw’inzoka zomunda yahawe mu mezi atandatu ashize? Show example of drug for worms Mwereke urugero rw’ibinini by’inzoka YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 DON’T KNOW / SIMBIZI……….88 49.a Has (NAME) ever received any MNP packets, like these? Kanaka (izinary’umwana Muto) yaba hari udupaki twa Ongera intungamubiri nk’utu yahawe? YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 DON’T KNOW / SIMBIZI……….88 50 50 49b. If yes, did (NAME) receive it in the last 3 months? Niba ari Yego kanaka( izina ry’umwana muto) hari ubwo yahawe Ongera intungamubiri mu mezi atatu ashize? YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 DON’T KNOW / SIMBIZI……….88 SECTION IV: INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS/ Rwanda ICSP Final Evaluation Report September 2015 Page 409 of 997 UBUVUZIBUKOMATANIJEBW’INDWARAZ’ABANA A. DANGER SIGNS/IBIMENYETSO MPURUZA 50. Sometimes children get sick and need to receive care or treatment for illnesses. What are the signs of illness that would indicate your child needs treatment? Rimwe na rimwe abana bajya barwara bagakenera ubufasha cyangwa kuvurwa, ni ibihe bimenyetso byakwereka ko umwana wawe urwaye akeneye kuvuzwa? RECORD ALL MENTIONED. ANDIKA IBYO AKUBWIYE BYOSE. Don’t Know/ Simbizi …………...….A Looks Unwell Or Not Playing Normally/Kwigunga cg kudakina n’abandi............................................B Not Eating Or Drinking/Ntabasha kurya/kunywa……………………....C Lethargic Or Difficult To Wake Gucika intege bikabije…......................D High Fever/ Umuriro mwinshi….….E Fast Or Difficult Breathing/ Guhumeka insigane cg bimugoye......................................F Vomits Everything/ Kuruka ibintu byose…………………………….G Convulsions/ Kugagara…..……….H Gets worse despite home care Kurushaho kuremba .…………... I Looks dehydrated (dry mouth or no tears)/Amazi yamushizemo (iminywa Rwanda ICSP Final Evaluation Report September 2015 Page 410 of 997 yumye, cg nta turira)…………………....J Other/ Ibindi ____________________K (Specify/ Sobanura) B. CONTROL OF MALARIA/GUKURIKIRANA MALARIYA 51. Has (Name) been ill with fever at any time in the last 2 weeks? Kanaka ( izina ry’umwana muto ) yigeze agira umuriro mubyumweru bibiri bishize? YES/ YEGO .......................................1 NO/ OYA .......................................... 0 DON’T KNOW/ SIMBIZI ......................88 57 57 52. Did you seek advice or treatment for (NAME’S) fever? Waba waragiriwe inama cyangwa waravuje kanaka (izina ry’umwana muto) igihe yari afite umuriro? YES/ YEGO........................................1 NO/ OYA ........................................... 0 57 53 Where did you first go for advice or treatment for fever? Nihe wabanje kujya kugisha inama cyangwa kumuvuza? Hospital/ Ku bitaro bikuru ……......01 Health Center Ku kigo nderabuzima………..……..02 Health Post/ Poste de Sante ….......03 Community Health Worker Umujyamana w’ubuzima binome...04 Traditional Practitioner Umuvuzi wa gihanga………………05 Shop/ Mu Isoko………………….….06 Rwanda ICSP Final Evaluation Report September 2015 Page 411 of 997 Pharmacy/ Farumasi………..……...07 Friend/Relative Inshuti/Abavandimwe ………………08 Other/ Ahandi_________________09 (Specify/ Sobanura) 54. How long after you noticed (NAME’S) fever did you seek treatment? Wamuvuje amaze igihe kingana iki afashwe n’umuriro? Same Day/ Uwo munsi……………...0 Next Day/ Umunsi ukurikiyeho……1 Two Days/ Nyuma y’iminsi 2………2 Three Or More Days/ Nyuma y’iminsi 3/irenga ……..……3 Don’t Know/ Simbizi ……………...88 55. At any time during the illness, did (Name) take any drugs for the fever? Hari imiti y’umuriro Kanaka (Izina ry’umwana) yahawe mu gihe yari arwaye? YES/ YEGO .......................................…….1 NO/ OYA ........................................... …….0 DON’T KNOW/ SIMBIZI……..……..88 57 57 56. Which medicines were given to (NAME) for his/her fever? Ni iyihe miti yahawe kubera impanvu z’umuriro? CIRCLE ALL MEDICINES THAT WERE GIVEN. SHYIRA AKAZIGA KU MUTI WOSE AKUBWIYE KO ANTI-MALARIAL DRUGS/IMITI IRWANYA MALARIYA A. Coartem/ Primo……0 1 2 3 8 Rwanda ICSP Final Evaluation Report September 2015 Page 412 of 997 YAHAWE IF MOTHER IS UNABLE TO RECALL DRUG NAME(S), ASK HER TO SHOW THE DRUG(S) TO YOU. IF SHE IS UNABLE TO SHOW YOU THEM, SHOW HER TYPICAL ANTI-MALARIALS AND HAVE HER IDENTIFY WHICH WERE GIVEN. NIBA UMUBYEYI ADASHOBOYE KUKUBWIRA IYO MITI, MUSABE AYIKWEREKE, NIBA ADASHOBOYE KUYIKWERERA MWEREKE IMITI YA MALARIYA ITANDUKANYE AKWEREKE IYO YAKORESHEJE. FOR EACH ANTI-MALARIAL MEDICINE ASK: KURI BURI MUTI WA MALARIYA, MUBAZE UTI: How long after the fever started did (NAME) start taking the medicine? Yatangiye kuwufata amaze igihe kingana iki afashwe n’umuriro? CIRCLE THE APPROPRIATE CODE/ SHYIRA AKAZIGA KU GISUBIZO AKUBWIYE . CODES/ KODE: SAME DAY/UWO MUNSI= 0 NEXT DAY AFTER THE FEVER UMUNSI UKURIKIYEHO = 1 TWO DAYS AFTER THE FEVER NYUMA Y’IMINSI 2 = 2 THREE OR MORE DAYS AFTER THE FEVER B. Quinine/kinini………..0 1 2 3 8 Other Drugs/ Indi miti C. Paracetamol Parasitamolu………....0 1 2 3 8 D. Unknown Drug/ Ntuzwi…0 1 2 3 8 E. Other/ Undi_________0 1 2 3 8 _______________________________ (Specify/ Sobanura) Rwanda ICSP Final Evaluation Report September 2015 Page 413 of 997 NYUMA Y’IMINSI 3 CYANGWA IRENGA = 3 DON’T KNOW/ SIMBIZI =88 57. Does your household have any mosquito nets that can be used while sleeping? Mu rugo rwawe mufite inzitiramibu mukoresha? YES/ YEGO........................................1 NO/ OYA .......................................... 0 62 58. Who slept under a bed net last night? Ni bande baraye mu nzitiramibu iri joro ryakeye? RECORD ALL MENTIONED SHYIRA IKIMENYETSO KU BO AKUBWIYE IF ANYONE OTHER THAN THE CHILD OF INTEREST IS MENTIONED, CIRCLE “OTHER.” NIBA HARI ABANDI BAYIRAYEMO BATARI UWO MWANA, SHYIRA IKIMENYETSO KURI “ABANDI” No One/ Nta numwe…………..…… 0 Child (Name)/ Umwana…..………...1 Nyina w’umwana……………………..2 Other/ Undi………………………..…..3 62 59 59. Which brand of bed net did (Name) sleep under last night? Ni ubuhe bwoko bw’inzitiramibu kanaka (amazina y’umwana) yarayemo iri joro ryakeye? READ THE PIECE OF PAPER ON THE BEDNET WHICH SHOWS THE BRAND OF THIS BEDNET SOMA KU GAPAPURO KARI KU NZITIRAMIBU GASOBANURA UBWOKO BWAYO BRAND OPTIONS NEED TO MATCH WHAT IS LOCALLY AVAILABLE IN EACH CATEGORY. THE PURPOSE OF LONG LASTING NET/ INZITIRA MIBU IKORANYWE UMUTI Permanet…………………..….1 Olyset…..……………………..2 Netprotect………………….…3 DON’T KNOW/ SIMBIZI …..88 PRETREATED NETS/ INZITIRAMIBU IKARISHYWA 62 62 Rwanda ICSP Final Evaluation Report September 2015 Page 414 of 997 THIS QUESTION IS TO IDENTIFY WHAT TYPE OF NET IS BEING USED BURI BWOKO BWOKO KURI IYI LISTI BUGOMBA GUHUZWA N’UBWOKO BW’ INZITIRAMIBU BUBONEKA MURI AKO GACE. IMPAMVU Y’IKI KIBAZO NI UKUGIRA NGO TUMENYE NEZA UBWOKO BW’INZITIRAMIBU BUKORESHWA No tag/Nta gapapuro………...4 DON’T KNOW/ SIMBIZI …….88 OTHER NET (UNTREATED)/ IZINDI NZITIRAMIBU ZIDAKARISHIJE OTHER NET/ IZINDI………...…5 Specify/ Sobanura ……………6 DON’T KNOW/ SIMBIZI …....88 62 60. Was the bed net that (Name) slept under last night ever soaked or dipped in a liquid treated to repel mosquitoes or bugs? Inzitiramibu kanaka (amazina y’umwana) yarayemo iri joro yigeze ikarishywa? YES/ YEGO .......................................1 NO/ OYA .......................................... 0 DON’T KNOW/ SIMBIZI .... …….88 62 62 61. How long ago was the net last soaked or dipped in a liquid treated to repel mosquitoes or bugs? Iyo nzitiramibu imaze igihe kingana iki ikarihijwe? IF LESS THAN ONE MONTH AGO, RECORD 00 MONTHS. NIBA IMAZE IGIHE KIRI MUNSI Y’UKWEZI KUMWE, ANDIKA AMEZI 00 IF LESS THAN 2 YEARS AGO, RECORD MONTHS AGO. PROBE FOR EXACT NUMBER OF MONTHS. NIBA ICYO GIHE KIRI MUNSI Y’IMYAKA IBIRI, ANDIKA UMUBARE W’AMEZI ASHIZE. KOMEZA UMUBAZE MONTHS/ AMEZI I___I___I MORE THAN 2 YEARS AGO/ HEJURU Y’IMYAKA IBIRI …………2 DON’T KNOW/ SIMBIZI………….…88 Rwanda ICSP Final Evaluation Report September 2015 Page 415 of 997 UMENYE NEZA UMUBARE W’AMEZI ASHIZE. C. PNEUMONIA/GUKURIKIRANA UMUSONGA 62. Has (Name) had an illness with a cough that comes from the chest at any time in the last two weeks? Kanaka (Amazina y’umwana) yaba yarigeze arwara inkorora no kubabara mu gatuza igihe icyo aricyo cyose mu byumweru bibiri bishize? YES/ YEGO……………………...........1 NO/ OYA..............................….0 DON’T KNOW/ SIMBIZI …...88 66 66 63. When (Name) had an illness with a cough, did s/he have trouble breathing or breath faster than usual with short, fast breath? Mu gihe kanaka (izina ry’umwana muto) yari arwaye inkorora, yahumekaga insigane cyangwa yahumekaga bimugoye? YES/ YEGO........................................1 NO/ OYA .......................................... 0 DON’T KNOW/ SIMBIZI ………………..88 66 64. Did you seek advice or treatment for the cough/fast breathing? Wigeze usaba inama cyangwa ushaka umuti w’ inkorora, guhumeka insigane cyangwa guhumeka bimugoye? YES/ YEGO........................................1 NO/ OYA ......................................... 0 66 65. Who gave you advice or treatment? Anyone else? Record all mentioned. Ninde waba yarakugiriye inama cyangwa akaguha umuti? Ntawundi? ANDIKA ABO AKUBWIYE BOSE. Doctor/ Dogiteri………………………….A Nurse/ Umuforomo……………………….B Community Health Worker Umujyanama w’ubuzima binome…....C Other/Undi_______________________D Sobanura Rwanda ICSP Final Evaluation Report September 2015 Page 416 of 997 D. CONTROL OF DIARRHEAL DISEASES/GUKURIKIRANA INDWARA Z’IMPISWI 66. Has (NAME) had diarrhea in the last 2 weeks? Kanaka ( izina ry’umwana muto ) yigeze arwara impiswi mu byumweru bibiri bishize Bavugako umwana arwaye impiswi iyo agiye ku musarane inshuro zirenze 3 ku munsi kandi yituma umusarani w’amazi. YES/ YEGO ....................................... 1 NO/ OYA ........................................... 0 DON’T KNOW/ SIMBIZI …………………...88 76 76 67. What was given to treat the diarrhea? Ni iki wamuhaye kugira ngo impiswi ihagarare ? Anything else?/Ntakindi ? If answer pill or syrup, show local packaging for zinc and ask if the child received this medicine. Niba ari ibinini cg imiti y’amazi, mwereke ibinini bya zinc noneho umubaze niba umwana yarahawe iyo miti. RECORD ALL MENTIONED. ANDIKA IBO AVUZE BYOSE. NOTHING/ NTACYO……………………………….A FLUID FROM ORS PACKET/ URUVANGE RW’IMYUNYU……………………………………....B HOME-MADE FLUID/ IBYO KUNYWA BITEGURIWE IMUHIRA ………………………..…C PILL OR SYRUP,ZINC/ IKININI,UMUTI W’ AMAZI, ZINC ……………………………………...D PILL OR SYRUP, NOT ZINC/ IBININI,UMUTI W’AMAZI NTA ZINC…………………………….….E INJECTION/ URUSHINGE…………………………F (IV) INTRAVENOUS/ SERUMU…………….…….G HOME REMEDIES/ HERBAL MEDICINES/ IMITI Y’IBYATSI……………………………………….…...H OTHER/ IBINDI_________________________ X (SPECIFY/ BISOBANURE) Rwanda ICSP Final Evaluation Report September 2015 Page 417 of 997 68. If the child is exclusively breastfed (only taking breastmilk), ask only this question and then skip to Q 71 Niba umwana yonka gusa baza gusa iki kibazo noneho uhite ujya ku kibazo cya 71 When (name of child) was sick, was s/he offered more breastmilk than usual, about the same amount, or less than usual? Mu gihe Kanaka (izina ry’umwana muto) yari arwaye, yonkejwe inshuro nyinshi kuruta ubusanzwe, zingana cyangwa nkeya kubusanzwe? Less than usual/Nkeya k’ubusanzwe...A Same amount/ Zingana …………………B More than usual/ Ziruta ubusanzwe ….C 69. When (NAME) had diarrhea, was he/she offered less than usual to drink, about the same amount, or more than usual to drink? Mu gihe Kanaka (izina ry’umwana muto) yari arwaye impiswi, yahawe ibinyobwa bike, bingana cyangwa biruta ibyo yarasanzwe anywa? Less than usual/Nkeya k’ubusanzwe...A Same amount/ Zingana …………………B More than usual/ Ziruta ubusanzwe …..C 70. When (name of child) was sick, was s/he offered more than usual to eat, about the same amount, or less than usual to eat? Mu gihe Kanaka (izina ry’umwana muto) yari arwaye impiswi, yahawe ibyo kurya bike, bingana cyangwa biruta ibyo yarasanzwe arya? Less than usual/Nkeya k’ubusanzwe...A Same amount/ Zingana …………………B More than usual/ Ziruta ubusanzwe ….C 71. Was s/he given any of the following to drink at any time s/he started having diarrhea? Mugihe Kanaka yari atangiye kugira impiswi hari ibyo wamuhaye muri ibi binyobwa bikurikira: A fluid made from a special packet called (local name for ORS packet) Uruvange rw’imyunyu (SRO)……………..…...A Rwanda ICSP Final Evaluation Report September 2015 Page 418 of 997 Read the choices to the mother and circle all mentioned: Bimusomere maze ushyire akaziga kubyo akubwiye byose Cereal based ORT (rice water, maize water) Amazi avura impiswi (Amazi y’umuceri)........B Other home available fluids/ Ibindi binyobwa byateguriwe imuhira ………..C Bisobanure 72. Did you seek advice or treatment from someone outside of the home for (NAME’S) diarrhea? Igihe Kanaka yari arwaye impiswi,wigezeushaka inama cyangwa umuti hanze y’urugo? YES/ YEGO................................. 1 NO/ OYA ..................................... 2 75 73. Where did you first go for advice or treatment? 3 Washakiye inama cyangwa wamuvurije he bwa mbere? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. NIBA AHO YAKUYE IMITI ARI KUBITARO,KU KIGO NDERABUZIMA CG MU IVURIRO RYIGENGA , ANDIKA IZINA RYAHO. _____________________________________ _________________________ HEALTH FACILITY/ AMAVURIRO HOSPITAL/ IBITARO BIKURU ……………….01 HEALTH CENTER/ IKIGO NDERABUZIMA ………………………..02 HEALTH POST/ IVURIRO RYUNGIRIJE ……………….……….03 CHW / UMUJYANAMA W’UBUZIMA ……….06 OTHER HEALTH FACILITY/ IRINDI VURIRO _____________________________________07 (SPECIFY/RISOBANURE) OTHER SOURCE/ AHANDI YAKUYE IMITI Rwanda ICSP Final Evaluation Report September 2015 Page 419 of 997 (NAME OF PLACE/ IZINA RY’AHO HANTU) TRADITIONAL PRACTITIONER UMUVUZI WA GIHANGA…………………....08 SHOP/ MU IDUKA.…………………….…..…09 PHARMACY/ FARUMASI………………..…10 FRIEND/RELATIVE INSHUTI CG UMUVANDIMWE ……..…….12 OTHER/ ABANDI____________________88 (SPECIFY/ BAVUGE) 74. Who decided that you should go there for (NAME’S) diarrhea? Ninde wafashe icyo cyemezo cyo kumujyanayo (kumuvuza)? RECORD ALL MENTIONED. ANDIKA IBYO AKUBWIYE BYOSE. RESPONDENT/ USUBIZA……………………. A HUSBAND/PARTNER/ UMUGABO………… ..B RESPONDENT’S MOTHER/ NYINA W’USUBIZA………………………………………. C MOTHER-IN-LAW NYIRABUKWE W’USUBIZA … ………………..D FRIENDS/NEIGHBORS INSHUTI/ABATURANYI ……………………….E OTHER/ABANDI______________________ X (SPECIFY/ BASOBANURE) 75. Since (NAME) has been recovering from diarrhea, did you give him/her less than usual to eat, about the same to eat, or more than usual to eat? Mugihe umwana yari akimara gukiruka impiswi, mbese mwamuhaye ibyo kurya LESS/ BIKE……………………………………1 SAME/ BINGANA……………………………..2 Rwanda ICSP Final Evaluation Report September 2015 Page 420 of 997 bike, bingana cyangwa byinshi kuruta ibyo yari asanzwe ahabwa? MORE/ BIRUTA…………………………..……3 STILL HAS DIARRHEA/ ARACYAHITWA ... 4 DON’T KNOW/ SIMBIZI………………………88 SECTION V: WATER & SANITATION / AMAZI N’ISUKURA 76. Do you treat your water in any way to make it safer for drinking? Hari uburyo mukoresha mu gutu nganya amazi yokunywa? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………...…0  78 77. IF YES: What do you usually do to the water to make it safer to drink? Niba ariYego: ubikora ute ngo wize reko amazi ari meza yokunyobwa? (ONLY CHECK MORE THAN ONE RESPONSE, IF SEVERAL METHODS ARE USUALLY USED TOGETHER, FOR EXAMPLE, CLOTH FILTRATION AND CHLORINE) SHYIRA IKIMENYETSO KU GISUBIZO KIRENZE KIMWE Let It Stand And Settle/ Sedimentation kuyatereka akiyungurura……….A Strain It Through Cloth Kuyayunguruza agatambaro……………………...B Boil/ kuyateka………………………………………..C Add Bleach/Chlorine Kuyashyiramo sur’eau/kolorine………………….D Water Filter (Ceramic, Sand, Composite) Kuyayunguruza filitire(iyakizungu, amakara, umucanga…………………..….……………………..E Solar Disinfection/ Kwica udukoko ukoresheje izuba………………...F Rwanda ICSP Final Evaluation Report September 2015 Page 421 of 997 NIBA AKORESHA UBWO BURYO BWOSE ICYARIMWE, URUGERO: KUYAYUNGURURA UKORESHEJE CHLORINE CYANGWA AGATAMBARO. Don’t Know/ simbizi…………………………….….G Other/ Ikindi______________________________H (Specify/ Sobanura) 78. When do you wash your hands? Ni ryari ukaraba intoki? DO NOT PROMPT. CIRCLE ALL MENTIONED. NTUMUHAGARIKE, KOMEZA WUMVE IBYO AKUBWIRA USHYIRE AKAMENYETSO KU BYO AKUBWIRA BYOSE. Never / nta narimwe …………..……………………….A Before Food Preparation / Mbere yogutegura amafunguro.………………………………………….….B Before Feeding Child / Mbere yo konsa/ mbereyo kugaburira umwana………………………………..…C After Defecation/Visiting The Toilet / Nyuma yo ku kuva ku musarane …………………………………...D After attending to a child who has defecated/soiled / Nyuma yo gutunganya/guhanagura umwana umaze kwituma…………………………….……………………E Other/ Ikindi ihe.____________________________F (Specify/ Sobanura) 81 79 Can you show me where you usually wash your hands and what you use to wash hands? Mushobora kunyereka aho mukarabira intoki n’icyo mukoresha mukaraba intoki? ASK TO SEE AND OBSERVE Inside/Near Toilet Facility/ Mu musarane imbere cyangwa hafi yawo…….….1 Inside/Near Kitchen/Cooking Place/ mu gikoni, Iruhande rwacyo/ aho batekera……………….…. 2 Elsewhere In Yard Ahantu aho ari ho hose mu rugo………………....3 Outside Yard/ inyumay’urugo………….…....…….4 Rwanda ICSP Final Evaluation Report September 2015 Page 422 of 997 MUSABE ABIKWEREKE NAWE WITEGEREZE. No Specific Place Nta mwanya wihariye uhari…………………….…..5 No Permission To See Ntakwemereye kuhareba …………………….……8 80a. OBSERVATION ONLY: Is there soap or detergent or locally used cleansing agent? This item should be either in place or brought by the interviewee within one minute. If the item is not present within one minute check none, even if brought out later. (ONLY CHECK MORE THAN ONE IF SEVERAL CLEANING AGENTS ARE USED) ITEGEREZE GUSA: Hari isabune cyangwa ibindi bikoreshwa mu gukaraba intoki? Icyo gikoresho gishobora kuba gihari cyangwa kikazanwa n’umubyeyi mu gihe cy’umunota umwe gusa. Niba kitabonetse mu munota umwe, kibarwa nk’ikidahari. (SHYIRA IKIMENYETSO KU GIKORESHO CYOSE Soap/ Isabune isanzwe………………….…………A Detergent/ Isabune y’ifu nka omo………………..B Ash/ Ivu…………………………………………….…C Mud/Sand/ Icyondo/ Akabuye………………….…D None/ Ntanakimwe………………………………....E Other/ Ikindi______________________________F (Specify/ Sobanura) Rwanda ICSP Final Evaluation Report September 2015 Page 423 of 997 YIFASHISHA AKARABA INTOKI ) 80b OBSERVATION ONLY: Specify what kind of hand washing facility is used, if any? (ONLY CHECK MORE THAN ONE IF SEVERAL FACILITIES ARE USED) ITEGEREZE GUSA: Bakoresha ibihe bikoresho bakaraba? (SHYIRA IKIMENYETSO KU GIKORESHO CYOSE YIFASHISHA AKARABA INTOKI ) Tippy tap / Kandagira ukarabe ……………………A Basin/ Ibase…………………………………….…… B Jerry can / jug: injerekani / ijage…………………C Pan / pot / : Isafuliya/ Inkono ……………………D Sink / Lavabo ……………………………………...E None/ Nta nakimwe ……………………………..…F Other/ Ikindi_____________________________G (Specify/ Sobanura) 80c. (If pan, pot, bowl, or basin) What else, if anything, are you using this receptacle for other than hand washing? (ONLY CHECK MORE THAN ONE IF SEVERAL ARE PRACTICED) (Niba ari isafuliya,inkono cyangwa ibase ) mubaze undi murimo akoresha ibi bikoresho utari gukaraba Nothing else/ Ntakindi……………………………A Food preparation/ Gutegura Amafunguro……B Laundry/ Kumesa………………….……………..C Other/ Ibindi____________________________D (Specify/ Sobanura) Rwanda ICSP Final Evaluation Report September 2015 Page 424 of 997 intoki? (SHYIRA IKIMENYETSO KU BYO AKUBWIYE BYOSE) 81. What kind of toilet facility do you have? Can I see it? Umusarane mukoresha umeze ute? Nshobora kuwureba ? No toilet facility/ Nta musarane ………………….1 Open latrine/ Umusarane udapfundikiye ………2 Closed latrine/ umusarane upfundikiye……..….3 Flush toilet/ umusarane wa kizungu…………..…4 No permission to see/ ntiyakwemereye kureba….5 82. The last time (NAME) passed stools, where were the feces disposed of? Igihe cyashize (izina ry’umwana) amaze kwituma umwanda we wawushyize he? Probe to find the location. Komeza umubaze wumve aho yaba ashyira umwanda w’umwana. Disposed into a latrine or toilet facility Yawushyize mu musarane ………………………....1 Disposed into a garbage/ trash bin yawushyize mu kintu kijyamo imyanda cyangwa ahagenewe imyanda…………………....….2 Dug and buried – near the house or in the yard?/ Yawushyize iruhande rwinzu cyangwa kure yayo ……………………………………………………...3 Dug and buried – far from the house or yard?/ Yawushyize cyangwa yawutabye kure yinzu cyangwa ahandi..........................................................4 Did not bury – near the house or yard / Ntiyawutabye hafi yinzu cyangwa ahandi……………………………………….………..…...5 Did not bury – far from the house or yard / Ntiyawutabye kure yinzu cyangwa ahandi …….....6 Rwanda ICSP Final Evaluation Report September 2015 Page 425 of 997 Don’t know/ Simbizi……………………..……............7 Other/ Ahandi______________________________8 (Specify/ Sobanura) SECTION VI: IMMUNIZATION/ IKINGIRA 83. Did you receive a card or child health booklet where (name of child’s) vaccinations and Vitamin A doses can be written down? If so, can I see the card? Ese ufite igipande kanaka(izina ry’umwana) yakingiriweho, yanahereweho vitamine A? Niba gihari wakinyereka? Yes, interviewer sees the card Yego, ubaza abonye igipande ……………….A Yes, but card is missing or lost Yego, ariko igipande ntagihari ……………….B No, never had a card Oya, nta gipande afite.…………………………..C Don’t know / Simbizi …………….…………....…D 86 86 86 84. Date of Immunization/ Itariki y’ikingira DAY/ UMU NSI MONT H/UKW EZI YEAR/UMW AKA BCG/ IGITUNTU POLIO 0 / IMBASA 0 (POLIO GIVEN AT BIRTH OR BEFORE 6 WEEKS URUKINGO RW’IMBASA RUTANZWE UMWANA Rwanda ICSP Final Evaluation Report September 2015 Page 426 of 997 AKIVUKA CYANGWA MBERE Y’IBYUMWERU BIBIRI) POLIO 1 POLIO 2 POLIO 3 PENTA-1 PENTA-2 PENTA-3 HEPATITE B 1 HEPATITE B 2 HEPATITE B 3 Measles/ Iseru Vitamin A (most recent dose Akanini aherutse kubona) Vitamin A (previous dose Akanini kabanjirije agaheruka) 85. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations given during immunization campaigns? Kanaka hari urundi rukingo yaba yarahawe Yes/ Yego .........................................1 No/ Oya............................................. 0 93 Rwanda ICSP Final Evaluation Report September 2015 Page 427 of 997 rutari kugipande, ushyizemo n’izo yaherewe mu ikingira rusange? Don’t Know/ Simbizi..................... 88 93 86. Please tell me if (NAME) received any of the following vaccinations: Ndabasaba kumbwira niba (KANAKA ) yarahawe izi nkingo zikurikira: BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar? Urukingo rw’igituntu, rumwe bakingira umwana kukaboko cg ku rutugu rukamusigiraho inkovu? Yes/ Yego ........................................ 1 No/ Oya ............................................ 0 Don’t Know/ Simbizi ...................... 88 87. Polio vaccine, that is, drops like these, in the mouth? Urukingo rw’imbasa Igitonyanga baha umwana mukanwa? SHOW THE EXAMPLE OF POLIO DROPS MWEREKE URUGERO RW’ IGITONYANGA. Yes/ Yego ........................................ 1 No/ Oya ............................................ 0 Don’t Know/ Simbizi ...................... 88 90 90 88. When was the first polio vaccine received? [In the first two weeks after birth or later? Niryari umwana yahawe urukingo rwa mbere rw’imbasa?(Mu byumweru bibiri bya mbere amaze kuvuka cg nyuma yabyo) First Two Weeks After Birth Mubyumweru bibiri bya mbere avutse ……1 Later/ Nyuma yaho……………………………..2 Don’t Know/ Simbizi……………………………88 89. How many times was the polio vaccine received? Number Of Times/ Incuro ........... Rwanda ICSP Final Evaluation Report September 2015 Page 428 of 997 Urukingo rw’imbasa yarubonye inshuro zingahe? Don’t Know/ Simbizi…………………………88 90. DTP vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops? Urukingo batera ku kibero akenshi batangira rimwe n’urw’imbasa yararuhawe? Yes/ Yego ........................................ 1 No/ Oya ............................................ 0 Don’t Know/ Simbizi ...................... 88 92 92 91. How many times? Yaruhawe inshuro zingahe? Number Of Times/ Incuro............ Don’t Know/ Simbizi…………………………88 92a. Did (name of child) ever receive an injection in the arm to prevent Measles? Ese Kanaka (Izina ry’umwana muto) yaba yarakingiwe urukingo rw’iseru? Yes/ Yego ........................................ 1 No/ Oya ............................................ 0 Don’t Know/ Simbizi………………..88 92b. Did (name of child) ever receive a dose of vitamin A? Ese Kanaka (Izina ry’umwana muto) yaba yarahawe ikanini cya Vitamini A? Yes/ Yego ........................................ 1 No/ Oya ............................................ 0 Don’t Know/ Simbizi ………………88 93 93 92c. When was the last dose of vitamin A? Ikinini cya vitamin A aherutse kugihabwa ryari? Less than 6 months/ Amezi 6 ntarashira……1 More than 6 months/ Amezi 6 ararenga……2 Don’t Know/ Simbizi…………………..………88 SECTION VII: ANTHROMPOMETRICS/ IBIPIMO Rwanda ICSP Final Evaluation Report September 2015 Page 429 of 997 93 May I weigh (name of child)? Nshobora gupima (izinary’umwana muto) ibiro? Measure twice. If difference in weight is more than 0.5 KG, measure a third time. Pima umwana inshuro ebyiri ,niba ikinyuranyo cy’ibiro by’umwana ari inusu( 500 gs) ongera umupime bwa gatatu Yes/ Yego ……………….1st __________ Kilograms/ Ibiro 2nd __________ Kilograms/ Ibiro 3rd __________ Kilograms/ Ibiro No/ Oya…………….0 94 May I use MUAC Tape with (name of child)? Nshobora gupima umuzenguruko w’ikizigira (izinary’umwanamuto)? Measure twice. If difference in length is more than 0.5 CM, measure a third time. Pima umwana inshuro ebyiri ,niba ikinyuranyo cy’umuzenguruko w’ikizigira by’umwana ari 0.5 cm ongera umupime bwa gatatu Yes / Yego……………1st ____________ cm/ santimetero 2nd ____________ cm/ santimetero 3rd ____________ cm/ santimetero No/ Oya…………….0 Rwanda ICSP Final Evaluation Report September 2015 Page 430 of 997 95. May I measure length for (name of child)? Nshobora gupima uburebure bw’umwana? Measure twice. If difference in length is more than 0.5 CM, measure a third time. Pima umwana inshuro ebyiri ,niba ikinyuranyo cy’uburebure bw’umwana ari 0.5 cm ongera umupime bwa gatatu Yes / Yego……………1st ____________ cm/ santimetero 2nd ____________ cm/ santimetero 3rd ____________ cm/ santimetero No/ Oya…………….0 95a. Check if (name of child) has oedema in both feet / Suzuma urebe niba (Izina ry’umwana muto) yaba afite edeme ku maguru yombi. Yes/ Yego……………………………………………..1 No/ Oya………………………………………………..0 96 May I use MUAC Tape with you? Nshobora gupima umuzenguruko w’ikizigira cy’akaboko kawe? Measure twice. If difference in length is more than 0.5 CM, measure a third time. Pima umubyeyi inshuro ebyiri ,niba ikinyuranyo cy’umuzenguruko w’ikizigira cy’umubyeyi ari 0.5 cm ongera umupime bwa gatatu Yes / Yego…………..1st ____________ cm/ santimetero 2nd ____________ cm/ santimetero 3rd ____________ cm/ santimetero No/ Oya…………….0 SECTION VIII: BEHAVIOR CHANGE COMMUNICATION/IKIGANIRO KIGAMIJE GUHINDURA IMYITWARIRE Rwanda ICSP Final Evaluation Report September 2015 Page 431 of 997 97. In the past 6 months, have you participated in a week-long training on child feeding and food preparation? Mu mezi 6 ashije , waba warigeze witabira inyigisho zimara icyumweru zijyanye no kugaburira umwana no gutegura amafunguro mu mudugudu? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0 DON’T KNOW / SIMBIZI……..........88  101  101 98. IF YES: How many times? NIBA ARI YEGO: wazigiyemo inshuro zingahe ? Once/ Rimwe………………………………1 Twice/ Kabiri…………………………....…2 Three or more/ Gatatu cyangwa karenga…………………………………….3 99. When was the most recent time you participated in such a week-long training? Ni ryari uherutse gukurikirana izo nyigisho zimara icyumweru? Month/Ukwezi ______________________ Year/ Umwaka ______________________ 100. The most recent time, how many of the days did you participate? Izo uherutse wazitabiriye iminsi ingahe? Number / Umubare………………|___|___| Don’t know/ Simbizi………………..…88 No response/ Nta gisubizo………….99 101. Did you receive a visit related to health in the past month? Hari uwaba yaragusuye mu byerekeranye YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0 DON’T KNOW / SIMBIZI……..........88 Rwanda ICSP Final Evaluation Report September 2015 Page 432 of 997 n’ubuzima mu kwezi gushize? 101a. If yes, who visited you? Niba ari yego ni nde? Do not prompt; Circle all that apply. Wimuca mu ijambo andika ibyo akubwiye aho bigomba kujya. Care group member/ Uri mu itsinda ry’ubuzima (care group)……………….A Health facilities staff/ Umukozi w’ivuriro………………………..B Local government staff/ Umuyobozi mu nzego z’ibanze………..C Others?/ Abandi?__________________D (Specify/ Sobanura) 102 If yes, can you tell me what the purpose of the visit was? Niba ari yego, wambwira icyamugenzaga? Do not prompt; Circle all that apply. Wimuca mu ijambo andika ibyo akubwiye aho bigomba kujya. A. FOLLOW UP ON SICK CHILD GUKURIKIRANA UMWANA URWAYE B. PROVIDE HEALTH EDUCATION ON MALARIA PREVENTION GUTANGA INYIGISHO ZO KWIRINDA MALARIYA C. PROVIDE HEALTH EDUCATION ON DIARRHEA PREVENTION GUTANGA INYIGISHO ZO KWIRINDA IMPISWI D. PROVIDE HEALTH EDUCATION ON PNEUMONIA GUTANGA INYIGISHO KUNDWARA Y’UMUSONGA E. PROVIDE HEALTH EDUCATION ON NUTRITION GUTANGA INYIGISHO KU MIRIRE F. PROVIDE HEALTH EDUCATION ON IMMUNIZATION GUTANGA INYIGISHO KU IKINGIRA G. OTHER/ IKINDI: ____________________ (Specify/ Sobanura) Rwanda ICSP Final Evaluation Report September 2015 Page 433 of 997 103. Did you receive any health information from a CHW in the last month? If yes, where did you receive that health information? Hari inyigisho wigeze uhabwa n’umujyanama w’ubuzima muri uku kwezi gushize? Niba ari yego, izo nyigisho waziboneyehe? A. Home visit Mu isura ry’ingo…………………..A B. Community Meeting/Mu nama y’umudugudu cg iy’Akagali………B C. Health Facility Ku Kigo Nderabuzima………………C D. Growth Monitoring and Counseling Mu gihe cyo gukurikirana imikurire y’abana mu Akagali…………………..D E. Nutrition Week/ Mu cyumweru cy’Imirire……………………………….E F. Other/Ahandi.....................................F ________________________________ (Specify/Sobanura) G. Did not receive any health information from a CHW last month. Ntabwo yigeze ahabwa inyigisho z’ubuzima n’Umujyanama w’ubuzima mu kwezi gushize………………….…………….G Time interview ended/ Igihe ibazwa ryarangiriye AM Mbere ya saasita ___ ___:___ ___ PM Nyuma ya saasita ___ ___:___ ___ Thank you. Murakoze. Rwanda ICSP Final Evaluation Report September 2015 Page 434 of 997 ANNEX IX. SOURCES OF INFORMATION Documents accessed for the evaluation include: 1. Project Proposal 2. 3rd Annual Report (FY2014) 3. USAID reporting template and Final Evaluation Guidelines 4. MCSP Theory of Change slides 5. DIP with baseline KPC 6. Midterm KPC report 7. Map of project area 8. Final KPC results and report 9. Preliminary final qualitative data and report 10. Operations Research Report and findings 11. Operations Research Protocol submitted to Rwanda National Ethics Committee Stakeholder FGDs and KII participants are detailed in the table below: Stakeholder Kigeme Kaduha Total Participants NW participants - Mothers (FGD) - 3 30 NW participants - Fathers (FGD) - 3 29 NW non-participants – Fathers (FGD) - 3 30 Fathers (FGD) 2 3 48 Mothers (FGD) 2 3 49 ICG members (FGD) 2 3 47 (25F, 22M) Village Nutrition Committee (FGD) - 3 13 (7F, 6M) Sector and Cell leaders (FGD) 2 3 42 (13F, 29M) Religious leaders (FGD) 2 3 48 (7F, 41M) Head of Health Center (KII) 2 3 5 (2F, 3M) Health Center Staff (FGD) 2 3 29 (17F, 12M) Hospital Teams (Director, nutritionist, in-charge of Community health) (FGD) 1 1 5 (1F, 4M) DHMT/Vice Mayor, District Health officer 2 1M, 1F NGO staff from CWW and WVI (KII) 1 2 Sites visited as part of the qualitative data collection are detailed below. For information on locations of data collection in the KPC survey, please see Annex IV. Rwanda ICSP Final Evaluation Report September 2015 Page 435 of 997 Hospital Zone Sector Cell Village Kigeme Cyanika Kiyumba Gikomero Kagarama Kitabi Mukungu Uwurunazi Karambi Kaduha Gatare Mukongoro Ruhereko Kageyo Mugano Ruhinga Gitarama Kabuye Mushubi Gashwati Muhembe Mushubi Rwanda ICSP Final Evaluation Report September 2015 Page 436 of 997 ANNEX X. DISCLOSURE OF ANY CONFLICTS OF INTEREST Rwanda ICSP Final Evaluation Report September 2015 Page 441 of 997 ANNEX XI. STATEMENT OF DIFFERENCES World Relief concurs with the evaluation, and does not have any differences to state. Rwanda ICSP Final Evaluation Report September 2015 Page 442 of 997 ANNEX XII. EVALUATION TEAM MEMBERS, AFFILIATION AND TITLE Names Organization Roles Melene KABADEGE World Relief MCH Regional Technical Advisor Debbie Dortzbach World Relief Director of Health Programs, WR Beatrice NYIRANZEYIMANA World Relief Tangiraneza Monitoring & Evaluation Officer Egide NKURIKIYINKA World Relief Tangiraneza Program Coordinator Camarade RUTAMBWE World Relief Tangiraneza Monitoring and Evaluation Officer Umutoni Grace Carmen World Relief Tangiraneza Project Manager Emily IYAKAREMYE World Relief WR Rwanda Documentation and Learning Specialist NGIRUWONSANGA Narcisse World Relief Tangiraneza Nutrition Officer Jean Marie Vianney World Relief Tangiraneza Promoter Ruth NSENGIYUMVA World Relief WR Monitoring and Evaluation Officer Germaine RUSAGARA World Relief Tangiraneza Maternal, Newborn & Child Health Officer Clemence NKURIKIYINKA World Relief WR Rwanda Research & Development Manager Jean HABYARIMANA World Relief Tangiraneza Promoter Christelle UMUHOZA World Relief Assistant to WRR Director of Programs Rhona MURUNGI World Relief WR Rwanda Director of Programs MUSAFILI Jean Baptiste World Relief Tangiraneza Maternal, Newborn & Child Health Officer FIDELE NTAWUKURIRYAYO World Relief Tangiraneza Community Mobilization Officer ERIC MUSEGIMANA UR Paulin NTIRUSHWA UR Jean de dieu IRANKUNDA UR Gloriose ABAYISENGA MCSP Theoneste MBAZIBOSE CECA Jean Claude RUTAJOGA Concern Worldwide Emmanuel NSENGIMANA CRS/ Caritas Gikongoro THEOGENE KIRENGA World Vision CELESTIN NZABAMWITA EAR Muse Parish Gaspard BIZIMUNGU Kigeme Hospital Innocent BISETSA Kaduha Hospital Bernard NKURUNZIZA Cyanika Sector Cecile MUKAMANA Mugano Sector Augustin HITIYAREMYE Mushubi sector Daniel TWAGIRAYEZU Gatare sector Bernadette HABWIMPUNDU Kitabi Sector Marcel IRADUKUNDA Nyamagabe District Anbrasi Edward Johns Hopkins University Final Evaluator [February 2015] 1 ANNEX 13. OPERATIONS RESEARCH REPORT Improvements in child feeding practices through Nutrition Weeks: a participatory community-based education initiative in Rwanda Tangiraneza (Start Well) Innovation Child Survival Project World Relief Nyamagabe, Rwanda Melene Kabadege, Senior Health and Nutrition Advisor, World Relief Judy McLean, PhD, University of British Columbia Dr. Alexis Muzindutsi, Rwanda Ministry of Health Nutrition Desk Rachel Hower, Senior Health and Nutrition Advisor, World Relief Allison Flynn, Health Advisor, World Relief Deborah Dortzbach, Director of Health and Social Development, World Relief October 2011 - September 2015 Tangiraneza (Start Well) Innovation Child Survival Project in Nyamagabe District, Rwanda is supported by the American people through the United States Agency for International Development (USAID) through its Child Survival and Health Grants Program. The Tangiraneza Innovation Child Survival Project is managed by World Relief Corporation under Cooperative Agreement No. AID-OAA-A-11-00056. The views expressed in this material do not necessarily reflect the views of USAID or the United States Government. [February 2015] 2 CONTENTS Executive Summary......................................................................................................................... 3 ACKNOWLEDGEMENTS................................................................................................................. 6 STUDY TEAM ............................................................................................................................... 6 Introduction................................................................................................................................... 6 Methods....................................................................................................................................... 9 DESIGN, PARTICIPANTS AND INFORMED CONSENT.......................................................................... 9 INTERVENTION ............................................................................................................................ 9 INTERVENTION MONITORING.......................................................................................................12 DEPENDENT MEASURES...............................................................................................................13 DATA COLLECTION METHODS & ANALYTIC STRATEGY ....................................................................14 Results ........................................................................................................................................15 INTERVENTION IMPLEMENTATION DATA.......................................................................................15 CHALLENGES IN MONITORING .....................................................................................................16 EQUIVALENCE OF GROUPS............................................................................................................16 KEY FINDINGS.............................................................................................................................17 Discussion and Recommendations.....................................................................................................19 PROGRAM IMPACT .......................................................................................................................21 PROGRAM RECOMMENDATIONS/IMPLICATIONS..............................................................................21 References........................................................................................................................................................................... 21 Annex: Final Operations Research Protocol................................................................................................................... 23 [February 2015] 3 Improvements in child feeding practices through Nutrition Weeks: a participatory community-based education initiative in Rwanda This operations research was funded by the U.S. Agency for International Development through the Child Survival and Health Grants Program from October, 2011- September, 2015 Background and Setting World Relief, with technical assistance from the University of British Columbia, conducted a quasi-experimental two-arm study comparing the standard MOH Community Based Nutrition Program to the CBNP plus an additional participatory nutrition education and practice intervention called Nutrition Weeks. Two hospital zones in Nyamagabe District, Rwanda each received the standard Community Based Nutrition Program (CBNP) interventions, implemented through Rwanda Ministry of Health Community Health Workers (CHWs) and community leaders organized into Integrated Care Groups. The zone with slightly weaker nutrition indicators (measured by the baseline knowledge, practice, and coverage (KPC) survey was assigned as the intervention area to receive Nutrition Weeks in addition to the standard CBNP. Nutrition Weeks targeted all pregnant women and mothers of children under two years. Problem Almost half (44%) of Rwanda’s children under five are stunted1 and the rate in Nyamagabe District is 53.5%.2 Stunting produces poor long-term health outcomes and affects brain development and cognition. In Rwanda 12.7% of all repetitions in primary school are associated with stunting, and these children achieve 1.1 fewer years in school than their Nutrition Week active feeding Key Findings: Nutrition Weeks is an effective, feasible community-based nutrition approach. Compared to control group, interventions achieved: • 23% increase in acceptable diet • 30% increase in diet diversity OPERATIONS RESEARCH EXECUTIVE SUMMARY [February 2015] 4 non-stunted counterparts.3 Interventions and Methods All households with pregnant women or children under two were targeted with the additional Nutritional Weeks interventions three times per year. This involved participatory small group education sessions for two hours every day for five days. Caregivers learned and practiced ideal feeding and health practices to prevent malnutrition and improve nutritional status. A quasi-experimental, two-arm study compared two approaches to nutrition interventions implemented in two hospital catchment areas of the same district. The comparison area implemented the standard Community Based Nutrition Program (CBNP) utilized by the Ministry of Health (MOH) Community Health Workers (CHWs). Community leaders and CHWs were organized into supportive groups called Integrated Care Groups (ICG), an adaptation of the Care Group Model. The intervention area utilized the same CBNP program with an additional intervention called Nutrition Weeks. Annual cross-sectional surveys were conducted from 2012 to 2015 using cluster sampling in each zone to measure key indicators, such as Minimum Acceptable Diet (MAD), Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF), Age￾appropriate Introduction of Complementary Foods (AICF) and Responsive Feeding practices (RF). A difference-in-differences approach was used by applying linear probability models in Stata 10 to compare the change in each outcome in the intervention and comparison areas. All p-values <.05 are reported as statistically significant. Findings Out of five main outcomes, three demonstrated significant differences between intervention and comparison areas: MAD, MDD and RF. The two other main outcomes changed in a positive direction, but were not significantly different. The probability of achieving MAD was 23% greater when a child was exposed to Nutrition Weeks (p<0.001). Likewise, compared to not being exposed to NW, the probability of achieving MDD was 30% greater when a child was exposed to NW (p<0.001). While RF in the NW intervention area increased to 100% at endline, the amount of improvement was greater in the comparison area due to a lower baseline level; thus, compared to not being exposed to NW, the probability of achieving RF was 14% lower when a child was exposed to NW (p<0.001) Two indicators were not statistically significant between the intervention and comparison area, although they demonstrated positive change. MMF increased from 7% to 67% in the intervention area and 7% to 66% in the comparison area, and AICF increased from 52% to 93% in the intervention area and 59% to 87% in the comparison area. Conclusions Nutrition Weeks is an effective and feasible community-based nutrition program implemented by CHWs and community leaders to improve key infant and young child feeding (IVCF) practices. Nutrition Weeks can improve MAD and MDD more than the standard CBNP alone, likely due to the mothers’ hands-on practice cooking foods and feeding young children in a new way. Opportunity cost for MOH staff (due to time spent training and supervising CHWs implementing Nutrition Weeks), financial investment, and [February 2015] 5 magnitude of expected improvements in nutrition indicators should be considered in weighing decisions for scale up. Future research should investigate barriers to dietary diversity and explore the effectiveness of Nutrition Weeks when implemented by MOH CHWs and community leaders who are not organized into Integrated Care Groups. Recommendations Nutrition Weeks approach should be considered to improve IYCF practices and nutrition outcomes. Opportunity cost for MOH staff (training, supervision of CHWs implementing Nutrition Weeks), financial investment, and magnitude of expected improvements in nutrition indicators should be considered in scale ups. Future research should investigate barriers to dietary diversity and explore the effectiveness of Nutrition Weeks when implemented by MOH CHWs and community leaders who are not organized into Integrated Care Groups. Use of Evidence • Integration of Nutrition Weeks into community-based nutrition programming • Use of Integrated Care Group approach to strengthen community engagement and capacity and effectiveness of MOH CHW nutrition interventions. The Tangiraneza Innovation Child Survival Project in Nyamagabe District, Rwanda is supported by the American people through the United States Agency for International Development (USAID) through its Child Survival and Health Grants Program. The Tangiraneza Innovation Child Survival Project is managed by World Relief Corporation under Cooperative Agreement No. AID-OAA-A-11-00056. The views expressed in this material do not necessarily reflect the views of USAID or the United States Government. For more information about World Relief visit: www.worldrelief.org [February 2015] 6 ACKNOWLEDGEMENTS This operations research was funded by the U.S Agency for International Development through the Child Survival and Health Grants Program. This study was made possible through the support and collaboration of the Rwanda Ministry of Health, the University of British Columbia, the government leaders, community health workers, health center staff and people of Nyamagabe District, the hospital staff of Kaduha and Kigeme Hospitals and World Relief. Special thanks to final evaluator, Dr. Ambrasi Edwards, Bloomberg School of Public Health, Johns Hopkins University. STUDY TEAM Dr. Judy McLean, University of British Columbia, Primary Investigator, Dr. Alexis Munzindutsi, Rwanda Ministry of Health Nutrition Desk, Co-Investigator, Melene Kabadege, Co-Investigator, Rachel Hower, Allison Flynn and Deborah Dortzbach, World Relief, Dr. Alexis Muzindutsi, Co-Investigator, Rwanda Ministry of Health Nutrition Desk, Dr. Fidele Ngabo, former PI and Director of MCH, Rwanda Ministry of Health, and Dr. Alphohinse Nyiransabimana, former Co-Investigator and Head of Rwanda Ministry of Health Nutrition Desk Introduction Almost half (44%) of Rwanda’s children under five are stunted4 and the rate in Nyamagabe District is even higher at 53.5%.5 There is much evidence connecting stunting and poor long-term health outcomes, affecting not only one’s height, but also brain development and cognition—in fact, in Rwanda 12.7% of all repetitions in primary school are associated with stunting, and these children achieve 1.1 fewer years in school than their non-stunted counterparts.6 The annual cost of undernutrition is 503.6 billion Rwandan Francs—equivalent to 11.5% of GDP.7 Under-nutrition in Rwanda is not just a problem of poverty or food insecurity; more than a quarter (26%) of children in the richest households are stunted.8 This indicates that the issue may also be due to caring practices and illness. Stunted women are more likely to have stunted children.9 Therefore, if stunting can be prevented, the children of today will have a better chance of having healthy children whose growth is not interrupted. The prevalence of stunting in Rwanda peaks at 55% in children 18-23 months, with little reduction as they reach age five.10 The first thousand days of a child’s life—from conception to 23 months—is a key time in a child’s life when stunting can be prevented through healthy behaviors surrounding nutrition.11 The Government of Rwanda (GoR) has put great emphasis on eliminating malnutrition, which has contributed to the nation’s rates of acute malnutrition falling from 3.9% in 200512 to only 3% in 2012.13 Among the priorities of the Rwanda National Multi-Sectoral Strategic Plan to Eliminate Malnutrition (NSEM) is to “strengthen and scale-up community-based nutrition interventions/programs [including the Community Based Nutrition Program, or CBNP] to prevent and manage malnutrition in children under the age of five years, with particular focus on those aged less than two years, and in pregnant and lactating mothers.”14 The CBNP, developed and implemented by the Ministry of Health (MOH) and UNICEF based on best practices from UNICEF experience in the region, includes training government CHWs in nutrition education and growth monitoring and promotion (GMP). However, the quality and amount of training that CHWs receive varies by region. CHWs are responsible to conduct GMP sessions monthly in their communities where they share information with a large group of mothers and children that can be reinforced at an individual level after weighing each child and/or during home visits. Along with a group education session, GMP sessions include cooking demonstrations for mothers to learn about optimal [February 2015] 7 complementary feeding practices. UNICEF and the MOH commissioned an external evaluation of CBNP15 which showed uneven implementation due to lack of protocols and district support. Most importantly, the evaluation showed that while CBNP appears to have reduced wasting in the districts where it has been implemented, it had no impact on the rate of stunting. To strengthen implementation of the CBNP and other community-based health interventions, WR introduced an Integrated Care Group (ICG) structure to both hospital zones of Nyamagabe District. Existing MOH CHWs, other government-recognized community volunteers, and religious leaders were organized into groups for peer support and enhanced behavior change communication (BCC) targeting every household in the target population in the district. A traditional Care Group (CG), after which this ICG is modeled, is a group of 10-15 volunteer community-based health educators who regularly meet together with project staff for training and supervision.16 This project modified the structure by using existing MOH CHWs and government-appointed volunteers rather than drawing new volunteers from the community. Meeting together monthly at the village level for training, coordination, supervision and peer support, the members of the ICGs divided up geographic responsibility for monthly home visits. In this way, every household with a pregnant woman or children under two was reached without overburdening CHWs. To fill in the gaps of the CBNP and focus on the prevention of stunting, World Relief (WR), in partnership with MOH, designed an intervention called Nutrition Weeks that is based on Positive Deviance (PD)/Hearth, but with the goal to prevent, rather than treat, malnutrition. PD/Hearth is an established approach to community-based nutrition rehabilitation used successfully in many countries that brings mothers of malnourished children together in a supportive small group to learn healthy feeding behaviors. The mothers cook a rehabilitative meal together using local foods and feed it to their malnourished children every day for two weeks.17 PD/Hearth is used to rehabilitate malnourished children rather than prevent malnutrition, although there is some evidence that PD/Hearth can play a role in preventing malnutrition in the younger siblings of those treated with it.18,19,20, 21 Use of participatory techniques to improve nutrition is supported by data. Results of a meta-analysis of 16 nutrition programs, successful in improving infant growth in different countries, showed that a key factor for success was that the programs not only gave messages on what to feed, but also included counseling, home visits or other activities that showed mothers how to feed their child.22 In Rwanda, between 2008 and 2010, WR rehabilitated 90% of 2,204 children with Moderate Acute Malnutrition (MAM) who participated in a PD/Hearth program. While WR measured success only in terms of recuperation, other studies have looked at additional impact. In Vietnam, Save the Children’s prospective study using PD/Hearth with 232 children documented behavior changes in hygiene practices which led to significantly lower rates of morbidity.23 A study conducted with Emory University funded by the LINKAGES project, found that mothers participating in PD/Hearth resulted in adoption of positive feeding behaviors including frequency, quantity, and type of foods that mothers sustained one year later.24 In a review of their nutrition programs worldwide, Child Fund International (then Christian Children’s Fund) documented that PD/Hearth cycles held just once a year in West Bengal, India were sufficient to change feeding and hygiene behaviors. Severe malnutrition was eliminated and moderate malnutrition (weight for age) was significantly reduced during the following 11 months in all but the most food insecure communities.25 The intervention, Nutrition Weeks, incorporated many of the techniques of PD/Hearth. However, the goal was to prevent malnutrition, so it did not target children who were already malnourished. Rather, Nutrition Weeks targeted all households in the 1,000 day period—pregnant women and children under two years. Three times per year, households came together in small groups of 10-12 mothers for two hours every day for five days. During these education sessions caregivers learned and practiced ideal [February 2015] 8 feeding and health behaviors aimed at improving nutrition status and preventing malnutrition. In addition, rather than just inviting primary care givers, Nutrition Weeks involved fathers and grandmothers to increase family support. We believed that the hands-on practical learning and the family support of new behaviors would result in improvements in five indicators that served as a proxy for nutritional status: Minimum Acceptable Diet (MAD), Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF), Age-appropriate Introduction of Complementary Foods (AICP) and Responsive Feeding (RF). Due to the relatively short duration of the Nutrition Weeks intervention (three years), we did not expect to see measurable differences in stunting rates. Justification: Current approaches had not adequately addressed stunting. WR designed and tested an intervention known as Nutrition Weeks to fill gaps in the CBNP and improve feeding practices that could prevent stunting. Nutrition Weeks used supportive small groups for participatory nutrition education as well as hands-on cooking and feeding practice. Objectives: The objective was to determine if the addition of community-based participatory education sessions known as Nutrition Weeks improved key Infant and Young Child Feeding practices among children 6-23 months more than standard CBNP interventions alone in Nyamagabe District, Rwanda. Proxy indicators for nutrition status used were: 1. Proportion of infants and young children age 6m-23m fed according to the Minimum Acceptable Diet, as defined by the WHO.* (Primary Outcome) 2. Proportion of infants and young children age 6m-23m fed according to the Minimum Dietary Diversity.† 3. Proportion of infants and young children age 6m-23m fed according to the Minimum Meal Frequency. ‡ 4. Proportion of infants and young children having age-appropriate introduction of complementary foods.§ 5. Proportion of infants and young children who are actively fed (whether someone assists the child with feeding).** * WHO 2008 Definition: BF children 6-23 months who had at least the minimum dietary diversity and minimum meal frequency during previous day. Non-BF children who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the min meal frequency during previous day † Proportion of children 6-23 m who consume at least 4 of the following food groups the previous day: 1 Grains, roots and tubers, 2 Legumes and nuts, 3 Dairy products (milk, yogurt, cheese), 4 Flesh foods (meat, fish ,poultry and liver/organ meats), 5 Eggs, 6 Vitamin-A rich fruits and vegetables, 7 Other fruits and vegetables ‡ Proportion of BF and non-BF children 6-23 m who receive solid, semi-solid, or soft foods the minimum number of times or more the previous day. For BF children, the minimum number of times varies with age (2 times if 6-8 mos.; 3 times if 9-23 mos.). For non-BF children, the number of times does not vary by age (4 times for all non-BF children 6-23 mos.) Dairy products only count toward the numerator for the non-BF children. § Proportion of infants 6–8 months of age who receive solid, semi-solid or soft foods ** Percent of Caregivers who assist child when eating (of children who consume soft, semi-solid or solid foods) [February 2015] 9 Methods DESIGN, PARTICIPANTS AND INFORMED CONSENT World Relief, with technical assistance from the University of British Columbia, conducted a quasi-experimental two-arm study comparing the standard MOH Community Based Nutrition Program to the CBNP plus an additional participatory nutrition education and practice intervention called Nutrition Weeks. The two hospital zones of Nyamagabe District each received the standard MOH CBNP interventions, implemented through CHWs and community leaders organized into Integrated Care Groups. The zone with slightly weaker nutrition indicators (measured by the baseline KPC survey) was assigned as the intervention area to receive Nutrition Weeks in addition to the standard CBNP. Nutrition Weeks targeted all pregnant women and mothers of children under two years. Fathers and grandmothers were also invited to participate. Institutional Review Board (IRB) approval for the study was applied for and granted annually by the Rwanda National Ethics Committee, and participation in the intervention was voluntary. A community meeting was held before each Nutrition Weeks cycle (implemented three times per year) to introduce the intervention to families, including mothers, fathers and grandparents. Written consent was given by beneficiaries when selected to participate in annual KPC surveys, focus group discussions and exit interviews about their participation in the intervention. Population data for Nyamagabe District can be found in Table 1. Table 1. Population data (2011) for Nyamagabe district by hospital catchment area Kaduha Zone Kigeme Zone Nyamagabe District Total Population Source: Nyamagabe District Statistics 2011 161,743 168,767 330,510 WRA 15-49* .613 x .55 x population 54,531 56,900 111,431 Children 0-59m** .125 x population 20,218 21,096 41,314 0-11m 4,044 4,219 8,263 12-23m 4,044 4,219 8,263 24-59m 12,132 12,657 24,789 *2007 Census reported that 55% of Nyamagabe District population was female and 61.3% ages 15-49; these proportions were applied to the population figures from Nyamagabe District Statistics 2011. **2007 Census reported that 12.5% of Nyamagabe District population was under five years of age; no data were provided on the relative breakdown of children under five—for simplicity it was assumed above to be equally divided amongst each 12-month sub-age category. INTERVENTION The tested intervention, Nutrition Weeks, targeted all pregnant women and mothers of children under two, bringing together small groups of 10-12 women. The groups met for two hours a day for five days, three times per year. During the Nutrition Weeks sessions, the women learned and practiced ideal feeding behaviors and healthy practices aimed at improving nutrition status and preventing malnutrition. In addition, fathers and grandmothers were included in some activities to increase family support. The project set the stage for Nutrition Weeks by first strengthening the CBNP. The project established 536 Integrated Care Groups (ICP), one in each village of Nyamagabe District, including both the intervention and comparison areas, to support CBNP activities. ICG members included ten members. Three of the members were MOH CHWs. Two of the CHWs, one male and one female, known as Binomes, were trained in child health. Another CHW, the animatrice de santé maternelle (ASM), was trained in and primarily responsible for maternal and newborn health. Additional members included community representatives most closely associated with behavior change. These were the Social Affairs In-Charge at village level (under the Ministry of Local Government [MINALOC]), the elected village [February 2015] 10 leader (usually male), the village Information and Training In-Charge, the village Community Development Leader, the Women's Group Leader, a member of the Village Hygiene Club, and a religious leader. The ICG members met together monthly to support each other. They also divided up the households in their village to make monthly home visits for purposes of health education to every home with pregnant women or children under the age of 2. The project facilitated extensive trainings for MOH staff, CHWs, and village leaders. Early in the project, all 1,072 child health CHWs in both the intervention and comparison areas were trained for 10 days in the MOH Maternal, Infant and Young Child Feeding (MIYCF) curriculum. Later they were given an additional five-day refresher training to strengthen the monthly CBNP activities in both intervention and comparison areas. Additionally, CHWs were trained in behavior change communication (BCC) for 3 days at the beginning of the project and attended ongoing quarterly refresher trainings with health center staff, the In-Charge of Socio-economic Development and project staff. CHWs led monthly ICG meetings in which they trained the other ICG members in the BCC lessons they had learned in the aforementioned quarterly meetings. Topics included nutrition, maternal and newborn care, malaria, diarrhea, pneumonia. The ICGs and trainings strengthened the quality of CNBP activities and helped to ensure fidelity to the CNBP design in both zones. Thus, both zones received support for monthly GMP sessions for children under five and pregnant and lactating women using the MOH MIYCF curriculum. Additional interventions during GMP sessions included measuring weight, MUAC screening and referrals of women and children, individualized nutrition counseling (done when the child was weighed), provision of micronutrient powder (MNP), hygiene education and monthly supervision of CHWs by the MOH In￾Charge of CHWs and WR staff (after the project ended, the MOH staff and the In-Charge of Social Affairs continued this supervision). The CHWs also promoted kitchen gardens and taught health and nutrition lessons from the MOH curriculum during GMP sessions, but since all mothers with children under five assemble for GMP, the groups were usually too large (about 30 mothers) to hear well or conduct participatory discussions. The project supported the CBNP cooking demonstrations that occurred during the monthly GMP sessions by providing pots and utensils. In the intervention areas, the cooking demonstrations were conducted monthly except when the cooking component of Nutrition Weeks replaced them three times per year in the intervention area. In both the intervention and comparison areas, the project helped the mothers of children discovered to be malnourished at the project midterm to form associations for the production or purchase of food for their children. The project also provided fruit trees in both areas. See Table 2 for a comparison of activities between the two zones. Table 2. Project Activities by Intervention and Comparison Area Activities Comparison Area (Kigeme) Intervention Area (Kaduha) Integrated Care Groups   Monthly Growth Monitoring and Promotion sessions, nutrition counseling and MNP   MUAC screening and appropriate referral for children and pregnant women   Promotion of kitchen gardens   Provision of fruit trees   MOH Maternal, Infant and Young Child Feeding Curriculum   [February 2015] 11 Monthly supervision by MOH in charge of CHWs and WR staff   Formation of associations for food production for mothers of children found to be malnourished at midline   Nutrition Weeks  Formation of associations among some (about 17%) Nutrition Weeks members for food production or purchase (unintended activity)  To identify the key nutrition messages and practices to be incorporated into the Nutrition Weeks curriculum, the project engaged in a rigorous formative research process, including positive deviance inquiry, market assessments, and focus group discussions with care givers. Input was also obtained from the Primary Investigators and Co-Investigators, the national Nutrition Technical Working Group and District stakeholders. The Nutrition Weeks curriculum was then developed, field tested, and revised. Key messages identified for Nutrition Weeks: • Prepare thicker porridge with palm oil and three different kinds of flour • Give animal foods if possible • Increase feeding frequency Key practices identified: • Making and eating thicker porridge • Eating fat and animal-based foods • Increasing frequency of meals • Eating a variety of foods • Improving hygiene practices • Infant stimulation and feeding • Increasing food intake for pregnant women • Increasing rest for pregnant women When the Nutrition Weeks curriculum was ready, it was taught in a cascade fashion in the intervention area only. Health facility Master Trainers trained the In Charges of CHWs at the Health Center level who in turn trained the 566 CHWs in the intervention area. The CHWs trained the members of the Village Nutrition Committees. Village Nutrition Committees are part of Rwanda’s MOH structure and are made up of the village leader, village-level Social Affairs representative and the three CHWs, all of whom were also members of the ICGs. The Village Nutrition Committees also received a one day refresher training before each Nutrition Weeks cycle. The remaining ICG members who were not part of Village Nutrition Committees were trained in key nutrition messages as part of routine monthly ICG meetings. In the intervention area, Nutrition Weeks was implemented by CHWs with the support of the other members of the Village Nutrition Committee. Three times per year, pregnant women and mothers of children under two were brought together in small groups of 10-12 for two hours every day for five days. During each session, mothers engaged in a participatory nutrition lesson, cooked a nutritious dish together and practiced responsive feeding with their children. Mothers attended daily sessions, with fathers and grandmothers (and other alternate caregivers) invited for specific days of the Nutrition Weeks session to participate and learn. [February 2015] 12 Nutrition Weeks provided repeated, hands-on skills building with group support—a key element that helps bring about changes in social norms related to child care. The focus was the use of local foods, responsive feeding and the improvement of hygiene practices. With the support and encouragement of the CHW, the mothers prepared the food using a simple approach of colors or food groups with local measures of ingredients to plan the menus. This was an approach that the mothers could continue to follow at home. At the end of the week, participants were given a small poster as a reminder about the feeding behaviors they practiced during the Nutrition Weeks sessions. These posters included images of a variety of foods and also showed meal frequency suggestions as per child’s age. During the Nutrition Weeks session, the mothers practiced good hygiene and responsive feeding techniques with their children, building self-efficacy in the process. By working together in small groups, mothers had opportunity to discuss among themselves solutions to barriers they faced in feeding their children or practicing key behaviors. Through repeated daily practice, they learned to prepare nutritious food and practice skills in related topics like hand washing. The project initially provided ingredients for the participatory cooking activities in Nutrition Weeks, but phased this out after one year of implementation. Households were responsible to bring the ingredients after the first year to decrease dependency and work towards sustainability. As a result, some Nutrition Weeks participants (about 17%) formed community associations to produce and purchase ingredients for the Nutrition Weeks sessions. These were not planned as part of the intervention, but developed organically from the community to respond to this felt need. Community mobilization was conducted throughout the intervention area to encourage participation in Nutrition Weeks, especially concentrated around the three annual cycles. Pastors and religious leaders (some of whom were members of the village ICG) encouraged women to attend Nutrition Weeks. Male members of the ICG used their relationship with fathers of children under two and husbands of pregnant women to encourage their participation on select days. Furthermore, community meetings were held before each Nutrition Weeks cycle to explain the activity to the community and get buy-in from household decision makers so women could attend. The added value of Nutrition Weeks as compared with the CBNP program alone lies in the hands-on practice with real foods (as opposed to listening to a flip-chart lecture or watching a cooking demonstration), the interaction and communication among mothers (not only from the teacher to the mothers), and a realistic acknowledgement and discussion of the barriers most mothers face in adopting recommended IYCF practices. INTERVENTION MONITORING The project employed a number of methods to monitor implementation of the Nutrition Weeks intervention. Attendance and participation was tracked at trainings and Nutrition Weeks sessions, and qualitative data collection was done to see a bigger picture of how implementation was proceeding, allowing for course correction of the intervention as needed. Attendance at various trainings of trainers (master trainers, HC staff, CHWs, Village Nutrition Committees) was recorded. CHWs and Village Nutrition Committee members were given pre- and post-tests from their trainings on Nutrition Weeks to assure transfer of knowledge and that they had the knowledge they needed to lead Nutrition Weeks sessions. Meetings were held to solicit feedback on the pilot training experience and gather suggested revisions for scale up to all of the Kaduha catchment area. Qualitative methods were used along with experiences from Village Nutrition Committees, CHWs, MOH staff and World Relief staff to identify how Nutrition Weeks could be improved after each cycle. [February 2015] 13 Project records were kept to track who attended Nutrition Weeks sessions (percentages of pregnant women, children, lactating women, mothers, fathers and grandmothers attending Nutrition Weeks) and the number of days they attended. Fathers and grandmothers were targeted for fewer days. Exit interviews were conducted on the last day of each Nutrition Weeks cycle and one month later to capture the experience of mothers who attended, to understand what they learned and to note reported behavior changes in the home as a result of Nutrition Weeks. ICG members made home visits to more than half (usually about 60%) of Nutrition Weeks participants at the conclusion of each Nutrition Weeks cycle to reinforce recommended feeding practices, identify barriers and track the new behaviors. Focus group discussions were also held with Nutrition Weeks participants (mothers and fathers) and with fathers in households that did not participate in Nutrition Weeks. Interviews and focus groups were conducted annually with CHWs, hospital and health center staff, ICSP staff, sector and cell leaders and religious leaders. Table 3 contains further information on qualitative data collection. Table 3. Qualitative Monitoring of Intervention When Conducted Number of Groups/ Interviews/ Visits Respondent/ Participant Year 1 Year 2 Year 3 Focus Group Discussions Annually 112 128 144 Pregnant women and mothers and fathers of children under two years (participating and non￾participating) Annually 45 20 20 CHWs and Village Nutrition Committee members (Nutrition Weeks implementers) Annually 28 32 36 ICG members Annually 38 38 20 HC and hospital staff participating in monitoring Nutrition Weeks sessions Annually 12 12 12 ICSP staff training and monitoring Nutrition Weeks sessions Annually 53 30 15 Religious leaders Annually 60 60 30 Sector and cell leaders Exit Interviews The last day of each Nutrition Weeks cycle 9 4 4 Selected mothers of children under 2 who participated in Nutrition Weeks 1 month after each Nutrition Weeks cycle 9 4 4 Selected mothers of children under 2 who participated in Nutrition Weeks Home Visits Within 2 months after each Nutrition Weeks cycle 4035 7644 5791 Households who participated in Nutrition Weeks DEPENDENT MEASURES The key dependent variables for this OR are as follows: 1. Proportion of infants and young children age 6m-23m fed according to the Minimum Acceptable Diet, as defined by WHO. (Primary Outcome) 2. Proportion of infants and young children age 6m-23m fed according to the Minimum Dietary Diversity. [February 2015] 14 3. Proportion of infants and young children age 6m-23m fed according to the Minimum Meal Frequency. 4. Proportion of infants and young children having age-appropriate introduction of complementary foods. 5. Proportion of infants and young children who are actively fed (someone assists the child with feeding). The primary outcome of the OR is the 2008 WHO indicator for Minimum Acceptable Diet, based on minimum dietary diversity and minimum meal frequency for children 6-23 months, according to child’s age and breastfeeding status. This captures the dietary diversity in the diet of infants and young children which has been shown to be associated with undernutrition, particularly stunting.26 DATA COLLECTION METHODS & ANALYTIC STRATEGY These outcomes were measured by annual household KPC surveys. Each year, two KPC surveys were done (one in the intervention area, one in the comparison area) to assure enough power to accurately compare the two groups. The surveys used cluster sampling, which consisted of 30x12 clusters at baseline and final and 30x10 clusters in monitoring years (Table 4). Survey data were entered into an Excel database and were then transferred into Stata 10 for analysis. New variables were created for composite indicators. A design effect of two was used to calculate confidence intervals as this is most conservative. Epi Info Emergency Nutrition Assessment (ENA) for anthropometry was used to obtain z-scores. A linear probability model (LPM) was used for comparing differences in MDD, MMF, MAD, RF and AICF from baseline to endline between Kaduha (intervention area) and Kigeme (comparison area). Robust standard errors were used to correct for misspecification caused by using a linear model for binary outcomes. All five nutritional outcomes were also assessed according to the child’s age group and socioeconomic status (SES) using logistic regression. Children were divided into three age groups (6-11 months, 12-17 months, and 18-23 months) and households were divided into four SES categories.†† Chi-squared tests and t-tests were used to compare other independent variables between populations. Table 4. Summary of Data Collection Methods Data Collection Method When Collected Respondent/ Participant Sample Size Household KPC Survey including OR questions and anthropometry Baseline Mothers of children under two 720 (two 30x12 cluster surveys) Year 2 Mothers of children under two 600 (two 30x10 cluster surveys) Year 3 Mothers of children under two 600 (two 30x10 cluster surveys) Endline Mothers of children under two 720 (two 30x12 cluster surveys) †† Although there were six SES categories, the three highest levels were combined due to the small number of respondents in those categories for this analysis. [February 2015] 15 Results INTERVENTION IMPLEMENTATION DATA Overall, the intervention went largely as planned. Tangiraneza aimed to reach 80% of the population of the Kaduha zone with the Nutrition Weeks intervention. This was measured in the annual KPC as the proportion of respondents who had participated in a Nutrition Week cycle in the prior six months for at least four of the five days. The proportion of participants increased from 53% in the first two years of implementation to 75.6% of mothers in the EOP survey. See Table 5 for further detail. Table 5. Planned Versus Actual Interventions Planned Intervention Actual Intervention Establish 536 Integrated Care Groups (one per village in Nyamagabe District) 536 Integrated Care Groups established MOH Maternal, Infant and Young Child Feeding (MIYCF) training for all 1,072 child health CHWs—10 Day initial training, 5 day refresher 1,072 CHWs trained (& refresher trained) in MIYCF (10 day training, 5 day refresher) Conduct formative research to identify key messages for Nutrition Weeks curriculum development PD Inquiry, Market Assessment and focus group discussions completed in intervention area, advice given by National Nutrition Technical Working Group Field Testing of Nutrition Weeks Curriculum Nutrition Weeks pilot held in one village of Kaduha in December 2012 3 day Master training for HF trainers 3 day Master training for HF trainers held 2 day training of in-charge of CHWs at Health Center level (by HF Master Trainers) 2 day training of CHW in-charge at HC led by HF Master Trainers 5 day CHW Nutrition Week training (by In-Charge of CHWs from Health Center) 5 day Nutrition Weeks trainings held for all CHWs, led by CHW in-charge (566 CHWs from 283 villages) 2 day training for Village Nutrition Committees (all of whom are ICG members) to support CHWs to lead Nutrition Weeks sessions in each cycle 2 day trainings for Village Nutrition Committees in each sector completed, included post-test to confirm knowledge transfer 1 day refresher training for Village Nutrition Committees prior to each Nutrition Weeks cycle 1 day refresher training given to half of the Village Nutrition Committee members prior to each Nutrition Weeks cycle (alternating the members quarterly) ICG members not part of Village Nutrition Committee trained in nutrition messages during routine ICG meetings and attend Nutrition Weeks sessions ICG members trained in nutrition messages during regular monthly ICG meetings prior to each Nutrition Weeks cycle and attend Nutrition Weeks sessions to support Village Nutrition Committees Nutrition Weeks implemented three times a year in each village of intervention area Nutrition Weeks held in all 283 villages of Kaduha zone three times each year Supervision of Nutrition Weeks and follow-up by MOH in charge of CHWs and WR staff MOH In-Charge of CHWs accompanied WR staff to supervise Nutrition Weeks, conduct follow-up supervision on CHWs after Nutrition Weeks reinforcing lessons learned Follow up home visits to Nutrition Weeks participants ICG members visit Nutrition Weeks participants at home to reinforce new behaviors and identify barriers Pre and Post-Tests for CHWs and Social Affairs CHWs and Village SA completed pre/post tests [February 2015] 16 Post- Nutrition Weeks interviews with CHWs, MOH staff and CSP staff Post- Nutrition Weeks interviews conducted with CHWs, HC/HF staff, CSP Staff27 Exit interviews with Nutrition Weeks participants, FGDs with mothers, fathers (participating and non￾participating), Village Nutrition Committee, sector and cell leaders, religious leaders Exit interviews completed with Nutrition Weeks participants and relevant FGDs held (see ARs for results) CHALLENGES IN MONITORING After the first Nutrition Weeks cycle, FGDs with Nutrition Weeks supervisors revealed challenges in monitoring the large number of groups, so subsequent Nutrition Weeks sessions used about 25% fewer groups and staggered them over a longer time to improve supervision and intervention quality. FGDs with Nutrition Weeks participants appreciated and accepted the key practice of making thicker porridge.. However, families could not afford the recommended combination of three different types of flours, so the project reviewed the ingredients and allowed the use of just one type of flour (whichever was available) in a thicker porridge in order to address the financial barrier. Interviews were done annually with husbands of women who did not participate in Nutrition Weeks. After the first year of implementation, these interviews found that the men did not see the value of Nutrition Weeks. To address this as well as low attendance of fathers in the Nutrition Weeks sessions, the project engaged community leaders to mobilize men through community meetings that encouraged participation in Nutrition Weeks. In response to low attendance in some groups, Nutrition Weeks facilitators began visiting the household of each Nutrition Weeks participant at least once during the Nutrition Weeks cycle to encourage their participation and attendance improved. After two years of implementation, the Nutrition Weeks curriculum was reviewed in light of the qualitative inquiry and was revised to include new lessons on breastfeeding and family planning. EQUIVALENCE OF GROUPS The two groups had no significant differences in measured characteristics. T-tests showed no significant differences in mothers’ age (p=0.25) or household size (p=0.057). A chi-squared test showed that there was no significant difference in education level (p=0.068) or poverty level (p=0.188) between groups. Table 6 contains data on the equivalence of groups at baseline. Table 6. KPC survey demographics at baseline by catchment area Kigeme (Comparison) Kaduha (Intervention) Baseline Baseline Mean Age of Mother 28.59 29.49 Mean Household Size 5.26 5.11 Poverty level (Ubudehe category)* 1. Those in abject poverty 6.4% 6.9% 2. The very poor 33.9% 32.5% 3. The poor 46.9% 51.7% 4. The resourceful poor 12.2% 8.6% 5. The food rich 0.6% 0% [February 2015] 17 6. The money rich 0% 0.3% Education Levels No education/ Did not complete primary 38.3% 44.6% Primary 47.6% 47.9% Secondary 13.4% 7.2% Past Secondary 0.7% 0.3% * as designated by the Rwanda Ministry of Local Government KEY FINDINGS Nutrition Weeks interventions significantly influenced MAD and MDD—two major indicators used as a proxy to nutritional status. MMF increased in both project areas, but the differences between the two were not significant. Children in the Nutrition Week intervention area were 23% more likely to reach MAD and 30% more likely to reach dietary diversity from baseline to endline. See Table 7 for complete results and data points for each primary outcome. After three years of implementation, the intervention area saw statistically significant improvement in Minimum Acceptable Diet among infants and young children 6-23 months compared to the comparison area (Figure 1). Compared to not being exposed to Nutrition Weeks, the probability of achieving the MAD was 23% greater when a child was exposed to Nutrition Weeks (p<0.001), controlling for time and location. Minimum Dietary Diversity (MDD) more than doubled in the intervention area from baseline to endline, but declined in the comparison area (Figure 2). The change in MDD from baseline to endline in the intervention area was 30% greater than the comparison area (p<0.001), controlling for time and location. The proportion of infants and young children who were responsively fed (RF) increased in both areas (Figure 3). While RF in the NW intervention area increased to 100% at endline, the amount of improvement was greater in the comparison area due to a lower baseline level; thus, compared to not being exposed to NW, the probability of achieving AF was 14% lower when a child was exposed to NW (p<0.001), controlling for time and location. Figure 1 Figure 2 [February 2015] 18 Figure 3 Figure 4 Minimum Meal Frequency (MMF) increased in both areas, but the difference between intervention and comparison areas was not statistically significant (see Figure 4). The change in MMF from baseline to endline in the intervention area was 4% greater than the comparison area (p=0.482), controlling for time and location. Age-appropriate introduction of complimentary foods (AICF) increased in both areas. Though not statistically significant, the change in AICF from baseline to endline in the intervention area was 6% greater than the comparison area (p=0.612), controlling for time and location. The study analyzed each nutritional outcome by socio-economic status and age. Across all nutrition indicators, with one exception, children in older age groups (12-17 months and 18-23 months) achieved greater results than younger children (6-11 months), controlling for time and location. Children in older age groups appeared to be less likely to be actively fed, but this was not statistically significant. Children in higher SES categories appeared to have better nutritional outcomes than children in lower SES categories, but, with the exception of the third SES category (“the poor”), there was no statistically significant difference between the groups, mostly due to power limitations. Children in the third SES category were more likely than the lowest SES category to achieve AICF (p=0.04) and MDD (p=0.008). The project did not conduct an in depth cost analysis. However, using estimated costs of Nutrition Weeks inputs, a rough cost-per-beneficiary was calculated. The estimated costs for the following Nutrition Weeks expenses were included: printing and transporting Nutrition Weeks materials, introductory meetings with the community, trainings and meetings for Village Nutrition Committees including CHWs, trainings and meetings with Nutrition Weeks supervisors, supervision activities (including communication fees provided to partners and transport, accommodation and meals for staff monitoring in remote areas), and supplies (pots and spoons). Dividing this sum by the total number of participants in seven cycles of Nutrition Weeks yielded an estimated cost-per-beneficiary household of Figure 5 [February 2015] 19 $2.74 per beneficiary per Nutrition Week cycle. Staff time for curriculum development and project support, and the costs of related activities that may have contributed to the impact of Nutrition Weeks, such as promotion of kitchen gardens, were not included. Table 7. Knowledge, Practice and Coverage Results for the Five Primary Outcomes Kigeme (Comparison) Kaduha (Intervention) EOP Target Baseline Endline Baseline Endline Proportion of infants and young children aged 6-23m fed according to the Minimum Acceptable Diet (Primary Outcome) 3.3% (1.19- 5.47) 19.0% (14.2- 24.7) 2.96% (0.92- 4.94) 40.4% (33.9- 47.1) 50% (both zones) Percentage of infants and young children age 6-23 months fed according to Minimum Dietary Diversity 38.9% (33.08- 44.7) 27.7% (22.0- 34.0) 21.85% (16.92- 26.78) 52.9% (46.1- 59.6) 60% (Kaduha) 55% (Kigeme) Percentage of infants and young children age 6-23 months fed according to the Minimum Meal Frequency 7.41% (4.07- 10.21) 65.8% (59.3- 71.9) 7.04% (3.99- 10.09) 68.6% (62.1- 74.6) 55% (Kaduha) 60% (Kigeme) Proportion of infants and young children having age appropriate introduction of complementary foods 58.5% (45.23- 71.77) 87.3% (75.5- 94.7) 52.0% (38.15- 65.85) 93.3% (77.9- 99.2) 75% (both zones) Proportion of infants and young children 6-23 months who are actively fed (someone assists the child with feeding) 79.05% (74.00- 84.10) 98.40% (96.82- 99.97) 95.51% (92.90- 98.12) 100.0% (100.0- 100.0) Discussion and Recommendations The study demonstrated that Nutrition Weeks is more effective than the standard CBNP alone at improving the diet of children under two years. Children 6-23 months in the intervention area achieved MAD, the primary outcome of this research, at twice the rate of children in the comparison area. Forty percent of children in the intervention area achieved MAD. Minimum Acceptable Diet is a composite indicator made up of MMF and MDD. While the two areas achieved similar increases in MMF, there were significant differences in MDD. Minimum Dietary Diversity more than doubled in the intervention area, but decreased in the comparison area, although not significantly in the latter, where the 95% confidence intervals from baseline to endline overlapped. Dietary diversity is important because higher dietary diversity has been shown to reduce stunting.28 It is somewhat surprising that MDD declined in the comparison area, since indicators for other optimal feeding practices (MMF, AICF, RF) increased, which could suggest differences in food security between the two areas or differences in the effectiveness of the two intervention approaches to change this specific behavior. Though the poverty levels of the two areas were not statistically different at baseline, a food security comparison was not conducted. The two [February 2015] 20 areas had similar topography (located in the same district and sharing a border) and very similar nutrition indicators at baseline, so it is unlikely that food security was very different between the two. Alternatively, the difference may have been due to behavior rather than food availability. Likely the opportunity to practice cooking in a new way (using new, more varied ingredients) during Nutrition Weeks sessions reinforced nutrition lessons and enabled mothers to make greater behavior changes (including better incorporating new foods and styles of preparation) than mothers in the comparison area who passively listened to messages and simply observed demonstrations. Responsive Feeding improved to 100% in the intervention area and to 98% in the comparison area. The bigger change was in the comparison area because the baseline, while still relatively high at 79%, was lower there than in the intervention area. The results suggest that the CBNP and ICG structure are effective at achieving RF even without Nutrition Weeks. Nutrition Weeks enabled mothers to practice cooking with diverse local foods and responsively feed their children with peer support. The intervention was associated with a greater impact on feeding practices than that observed among mothers in the comparison area. This is consistent with findings from a study on a PD/Hearth program (daily cooking and feeding practice is part of PD/Hearth), where mothers participating in PD/Hearth adopted positive feeding behaviors including the types of foods used.29 Perhaps it was easier for the mothers in the comparison area to adopt other optimal feeding practices (RF, MMF, AICF) without hands-on practice, while some aspect of the behaviors needed to increase dietary diversity was more challenging. On aspect could be the perceived acceptability of new foods introduced in Nutrition Weeks. Nutrition Week sessions mostly used unique recipes, though MOH-curated recipes from GMP cooking demonstrations were incorporated toward the end of implementation. As children in the comparison area did not get to taste the recipes from Nutrition Weeks, their mothers did not have the opportunity to see if they liked the food, which might make mothers more apt to try and incorporate a greater variety of foods in their cooking. Future research could target barriers to dietary diversity in particular. The intervention and comparison areas both achieved large increases for MMF and AICF. Though slightly greater progress was made in the intervention area, the differences between the two areas were not statistically significant for these two indicators. This suggests that the CBNP and ICG structure are effective at affecting these behavior changes without Nutrition Weeks. While not directly comparable, the results of Nutrition Weeks are similar to PD/Hearth results, in that Nutrition Weeks is successful in improving child diet, which is a proxy measure for nutritional status, and PD/Hearth is successful in improving nutritional status measured directly. However, the level of impact of Nutrition Weeks is somewhat lower (40% success in reaching MAD, where WR’s PD/Hearth efforts have been successful in rehabilitating around 90% of acutely malnourished children‡‡ in a Rwandan context). It is difficult to speculate the reasons for this difference. Nutrition Weeks is less intensive than PD/Hearth—only one week instead of two (with two weeks of follow-up at home visits)—and the participants are different. It could be that mothers/households with children identified as malnourished (as with PD/Hearth) are more motivated to go to extraordinary lengths to improve their children’s diet as compared to mothers/households with children who are not specifically in a ‘crisis’ situation. Furthermore, stunting is more difficult to see than wasting or more visibly dramatic forms of malnutrition, and children may seem to be healthy though they are shorter than normal. Perhaps when mothers see their children as ‘healthy’ it is harder to be motivated to change feeding behaviors. Alternatively, PD/Hearth is not recommended in contexts with prolonged food insecurity30; ‡‡ “Acutely malnourished” was measured per weight-for-age or MUAC screening. See Rwanda EIP FE Report (2011) for details. [February 2015] 21 perhaps the context of the current research was less food secure than the context in which WR achieved high rates of rehabilitation with PD/Hearth. Another possibility is that children enrolled in PD/Hearth may be able to gain enough weight to be considered rehabilitated without eating the adequate number of meals and food groups required for MAD. Limitations of the study include its quasi-experimental design, contamination due to the geographic proximity of the intervention and comparison areas, and the fact that the study compared the intervention to an ideally implemented standard CBNP, rather than a typically implemented CBNP (as the CBNP in the comparison area was implemented with the support of the ICG structure), which may have obscured the impact of Nutrition Weeks. Nutrition indicators increased in both areas; improvement in some indicators may have been driven more by ICGs, and some more by Nutrition Weeks. The intervention and comparison areas shared a border, and Nutrition Weeks participants may have shared the new information and behaviors with their neighbors in the comparison zone nearby. In addition, health staff from both areas met quarterly for HC coordination meetings when Nutrition Weeks was often discussed. Health staff in the comparison area may have used Nutrition Weeks practices learned during these meetings in their monthly GMP sessions. Future research could investigate whether Nutrition Weeks is effective when implemented by CHWs who are not organized into Integrated Care Groups. PROGRAM IMPACT Final Operations Research results and KPC survey results were shared with stakeholder groups, as has been done annually. Furthermore, Nutrition Weeks has already been adapted for use in World Relief programming in Malawi and Indonesia. Results of this OR have been shared with the MOH, but it is not clear whether Nutrition Weeks will be added to the CBNP. This study provides evidence that CBNP with Nutrition Weeks is more effective than CBNP alone at improving MAD and MDD, however, competing health priorities will have to be considered when deciding whether to make an investment of this magnitude that is directed to one intervention. Nutrition Weeks and Care Groups were included in a 2015 USAID Rwanda Mission RFA for eight districts, so the feasibility of broad scale up may be tested in the near future. PROGRAM RECOMMENDATIONS/IMPLICATIONS The study suggests that Nutrition Weeks is a valuable addition to Rwanda’s standard CBNP for improving nutrition outcomes. After three years of implementation, Nutrition Weeks was twice as effective in improving the Minimum Acceptable Diet of children under two years as the standard CBNP. However, the time and financial costs of Nutrition Weeks may make it difficult to scale. Opportunity cost for MOH staff (due to time spent training and supervising CHWs implementing Nutrition Weeks), financial investment and magnitude of expected improvements in nutrition indicators should be considered in weighing the decision for scale up. 1 Rwanda Demographic and Health Survey, 2010. 2 Ibid. 3 United Nations World Food Program. 2013. The Cost of Hunger in Rwanda: The Social and Economic Impact of Child Undernutrition in Rwanda, Implications on National Development and Vision 2020. 4 Rwanda DHS, 2010 [February 2015] 22 5 Ibid. 6 United Nations World Food Program. 2013. 7 Ibid. 8 Rwanda DHS, 2010 9 United Nations World Food Program, 2013. 10 Rwanda DHS, 2010 11 The Thousand Days Partnership: http://www.thousanddays.org/ 12 Rwanda Demographic and Health Survey, 2005 13 United Nations World Food Program, 2013. 14 United Nations World Food Program. 2012. Comprehensive Food Security and Vulnerability Analysis and Nutrition Report Survey: Rwanda. 15 Rwanda Ministry of Health. December 2010. Official Community Based Nutrition Evaluation Report. 16 http://www.caregroupinfo.org/ 17 http://www.coregroup.org/our-technical-work/initiatives/diffusion-of-innovations/84 18 Bisits Bullen, P. A. 2011. “The positive deviance/hearth approach to reducing child malnutrition: systematic review.” Tropical Medicine & International Health, 16:1354–1366. doi: 10.1111/j.1365-3156.2011.02839.x 19 Mackintosh U, Marsh D & Schroeder D. 2002. “Sustained positive deviant child care practices and their effects on child growth in Vietnam.” Food and Nutrition Bulletin, 23(4 Suppl):18–27. 20 Sternin M, Sternin J & Marsh DL. 1997. “Rapid, sustained childhood malnutrition alleviation through a positive-deviance approach in Rural Vietnam: preliminary findings. In: Hearth Nutrition Model: Applications in Haiti, Vietnam, and Bangladesh.” (ed. O Wollinka, E Keeley, BR Burkhalter & N Bashir) Published for the U.S. Agency for International Development and World Relief Corporation by the Basic Support for Institutionalizing Child Survival (BASICS) Project, Arlington, pp. 59–73. Accessed 28 January 2011 at: http://pdf.usaid.gov/pdf_docs/ PNACA868.pdf 21 McNulty J & Pambudi ES. 2008. Report of the Pos Gizi assessment: suggestions for expanding the approach in Indonesia. Accessed 19 December 2010 at: http://www.positivedeviance.org/PD_Evaluation_ Report_for_DEPKES_FINAL.pdf 22 Caulfield, L, Huffman, S., Piwoz, E. 1999. “Interventions to improve intake of complementary foods by infants 6 to 12 months of age in developing countries: Impact on growth and on the prevalence of malnutrition and potential contribution to child survival.” Food and Nutrition Bulletin, 20(2). 23 Sripaipan, T., Schroeder, D., Marsh, D., et al. December 2002. “Effect of an integrated nutrition program on child morbidity due to respiratory infections and diarrhea in northern Vietnam.” Food and Nutrition Bulletin, 23(4). 24 Pachon, H.,Schroeder, D., Marsh, D. et al. December 2002. “Effect of an integrated nutrition program on complementary food intake of children in rural northern Vietnam.” Food and Nutrition Bulletin, 23(4):Supplement. 25 Christian Children’s Fund. 2007. Global Nutrition Strategy. Internal document. 26 Rah JH et al. December 2010 . “Low dietary diversity is a predictor of child stunting in rural Bangladesh.” European Journal of Clinical Nutrition, 64(12):1393-8. 27 Results can be found in Tangiraneza ICSP’s Annual Reports 28 Rah JH et al. 2010. “Low dietary diversity is a predictor of child stunting in rural Bangladesh.” European Journal of Clinical Nutrition, 64:1393-1398. 29 Pachon et al, 2002. 30 Nutrition Working Group, Child Survival Collaborations and Resources Group (CORE). December 2002. “Positive Deviance / Hearth: A Resource Guide for Sustainably Rehabilitating Malnourished Children.” Washington, D.C. [February 2015] 23 ANNEX 1. OPERATIONS RESEARCH PROTOCOL Report on the Protocol of Data Collection for Assessments and Operations Research Related To The World Relief Rwanda Innovation Child Survival Project Nyamagabe District, Rwanda Funding Agency and Duration USAID Child Survival and Health Grants Program October 2011-September 2015 Research Partners Ministry of Health University of British Columbia District of Nyamagabe Submitted to the National Ethics Committee Original: February 13, 2012; Corrected 29 March 2012; Amended: 14 May 2013, 21 May 2014 & 30 January 2015 [February 2015] 24 page intentionally left blank Contents i Contents I. Progress Report Form.......................................................................................................... 1 A. Main Form ...................................................................................................................... 1 B. Progress Report: Summary of Results........................................................................... 5 C. Evaluative Research Summary Findings – Year 3 .......................................................... 7 D. Monitoring and Evaluation Table-Summary of Year 3 Results for project and OR indicators ...................................................................................................................... 10 E. Evaluative Plan for Operations Research, IR3.............................................................. 32 II. Amendments to May 21, 2014 version of Protocol......................................................... 34 A. Summary of Changes................................................................................................. 34 C. Additional and Replacement Documentation ............................................................ 35 III. Previously Approved Amendments to May 13, 2013 & May 21, 2014 versions of Protocol........................................................................................................................... 118 A. Summary of Changes Made in 2013........................................................................ 118 B. Additional Tools for Year 2 Data Collection, Quantitative and Qualitative ........... 120 C. Additional and Replacement Documentation .......................................................... 173 IV. Prior Ethical Approval from RNEC ................................................................................ 193 APENDIX: Original Protocol from April 2012 – with minor updates............................................. 0 Acronyms and Abbreviations......................................................................................................... 4 Contact Persons........................................................................................................................... 5 Synopsis................................................................................................................................... 7 I. Background ........................................................................................................................... 8 A. Project Rationale 8 B. Problem Statement 9 C. Nutrition education, stunting, and self-efficacy 10 D. The innovation 10 E. Project/study location and population 11 II. Aims, Objectives& Strategy............................................................................................... 11 A. Aims 11 B. Objectives & Strategy 12 Contents i Table 1: Project Results Framework 12 Table 2: Key Activities for the Selected High Impact Technical Interventions 13 III.Conceptual Framework for Innovation ............................................................................. 14 IV. Operations Research, Formative Phase.......................................................................... 17 A. Formative Research Objective................................................................................... 17 B. Formative Research Questions ................................................................................. 19 C. Phases of formative research.................................................................................... 20 V. Operations Research, Evaluative Phase .......................................................................... 26 A. Operational Research Objective.................................................................................. 1 B. Operational Research Questions ................................................................................ 1 C. Type of study design.................................................................................................... 1 D. Limitations of the study ............................................................................................... 1 E. Hypothesis .................................................................................................................... 2 F. Study arms.................................................................................................................... 2 G. Study Population .......................................................................................................... 3 H. Evaluation Methods...................................................................................................... 3 VI. Process Documentation.................................................................................................... 6 VII. Ethical Considerations ...................................................................................................... 6 A. Confidentiality 6 B. Informed consent 6 C.Ethical approval 6 VIII. Logistics............................................................................................................................ 7 A. Distribution of responsibilities 7 B. Timetable 8 C. Budget 12 Annexes.................................................................................................................................. 13 Annex A: CVs for Principal Investigators and Co-Investigator.................................... 13 Personal Informations ............................................................................................................... 16 Education ........................................................................................................................... 16 Professional Work Experience .............................................................................................. 16 Annex B. Project Indicators............................................................................................. 21 C1. Written Consent form for Positive Deviance Inquiry 24 C2. Positive Deviance Inquiry Data Collection Forms ................................................... 27 Contents i Annex D: Maternal Exit Interview for Nutrition Weeks Innovation.......................................... 33 Annex E: Written Consent for KPC survey.................................................................... 35 Annex E: KPC Survey Draft Questionnaire ............................................................................... 37 Annex G: Population Lists of Communities by Hospital Catchment Area .................................... 80 Annex H: Baseline Characteristics of Study Arms..................................................................... 94 Annex I.Standard KPC Survey Methodology.................................................................. 96 Annex J: Letters of Support ............................................................................................ 99 Annex K: Changes to 2013 & 2014 versions of Protocol............................................ 101 National Ethics Committee Progress Report 1 I. Progress Report Form A. Main Form 1. Name of Principal Investigator (Co-Principal Investigators) • Dr. Judy McLean, University of British Columbia, Canada • Dr. FideleNgabo, Ministry of Health, Rwanda 2. Title of study: Data Collection for Assessments and Operations Research Related to the World Relief Rwanda Child Survival Project, Nyamagabe District, Rwanda 3. Date of RNEC approval: April 2, 2012, June 19, 2013 and July 12, 2014 4. Briefly describe the purpose of the study, 2 or 3 sentences in non- technical language: The protocol relates to 1) the monitoring and evaluation of the World Relief Rwanda Tangiraneza Child Survival Project overall (with interventions in Nutrition, Diarrhea, Pneumonia and Maternal and Newborn Care) and 2) Operations Research designed to evaluate “Nutrition Weeks,” an innovation that aims to prevent under-nutrition and stunting in children during the critical first 1000 days of life. 5. Has the study started? Yes Starting Date of Study: April 3, 2012 6. Number of local research sites recruited: Proposed: 1 – Nyamagabe District, Kigeme and Kaduha Hospital Catchment Areas Actual: 1- Nyamagabe District, Kigeme and Kaduha Hospital Catchment Areas 7. Number of participants recruited into study: KPC Survey The Year 3 KPC survey sampled a total of 600 mothers, half in Kaduha and half in Kigeme. The Survey also completed anthropometry on 600 children (300 in each study area) 0-23 months-old. National Ethics Committee Progress Report 2 Participants in Nutrition Weeks Intervention NW Participants Areas NW Sessions (NW) Lactati ng moth ers Lactating mothers (attendence: 4 days or more) Pregnant women # Fathers for Under 2 # Grand mothers Kaduha Hospital Zone NW 1 FY2013 5650 5528 898 1533 1290 NW 2 FY2013 3092 2982 566 1009 731 NW 1 FY 2014 4374 3918 894 1623 1352 NW 2 FY2014 5492 4815 1171 1673 1276 NW3 FY2014 5492 3154 854 1639 1003 NW1 FY2015 4596 4431 925 1966 1131 Exit Interviews Exit interviews with mothers who participated in Nutrition Weeks have been conducted with over 268 women in the first week following their participation. 8. Number of participants completing study:N/A Study is ongoing 9. Number of withdrawals: N/A There have not been any withdrawals in the study per se. As this is not a cohort study, we are not studying the same individuals over time. Rather, data is cross￾sectional. All invited participants in the KPC baseline survey agreed and continue to participate. National Ethics Committee Progress Report 3 Data (above) on completion of the Nutrition Weeks intervention by participants is one aspect of the process evaluation. 10. Have there been any difficulties in recruiting participants to the study? No If yes, please give details: N/A 11. Have there been any adverse events? No If yes, have these been notified to the committee? N/A Please give details: N/A 12. Have there been any amendments to the study? No If yes, have these been notified to the committee? N/A Please give details 13. Has the study been completed? No If no, what is the expected completion date? September 30, 2015 If the study will not be completed, please give reason(s)N/A 14. Results- please include details of outcomes and conclusions so far, attach a Separate page if necessary Findings thus far have been included in the third Annual Report covering the period from October 1, 2012-September 30, 2014. This report was submitted to USAID and shared with the Ministry of Health. This full report is available upon request. Please see below the summaries of selected results: • Formative Research summary findings • Evaluative Research o M&E table with baseline and Year 3 indicator data 15. Have the findings been disseminated? Yes If yes, how? Results from the project were shared at the National Nutrition Summit February 11-13, 2014. On March 8th, 2014 the ICSP Manager and WRR country director presented the ICSP progress at USAID Rwanda mission office in Kigali, to share project updates. On July 30, 2014, the Regional Technical Advisor presented the project, including NW methodology, to a graduate class from the Future Generations Master’s program peacebuilding class. On September 25, 2014, a Health Advisor from WR Home Office presented the project, including NW, to a Covenant College class on Women’s and Children’s health and Development. National Ethics Committee Progress Report 4 The Year 3 results were shared in the October 2014 Annual Report with USAID in Washington DC and USAID in Rwanda and while USAID staff were visiting ICSP on December 3 2014. All findings to date have been documented in reports shared with USAID with copies to Ministry of Health. The KPC results from years 1 and 2 have been shared with Church leaders; local leaders and Health leaders during the feedback meetings in order to get their comments and all of them were excited with the Nutrition week results. The KPC for year 3 will be shared with MOH Nutrition Technical Working Group meeting for Quarter two and with church, local and health leaders in February 2015. 16. Please give details of any publications and send copies when available The ICSP has been supporting the MOH to develop a nutrition recipes booklet. The first draft was developed by the ICSP and WR financed the workshop reviewing the first draft. The second draft was reviewed by MOH nutritionists and staff, the USAID nutrition specialist and the Family Health Project nutrition staff. The booklet was then presented to the Nutrition Technical Working Group. In collaboration with Global Communities, photos have been added; in collaboration with the Garden for Health, the booklet has been tested in the community. In December 2014 the booklet was approved by the Minister of Health and is ready for use at the national level. 17. Any complaints about the research? No Signature of Principal Investigator:……………………… Print name: Dr. Fidele Ngabo Postal Address:………………… Tel. No. 0788 304750 E-mail:ngabog@yahoo.fr Date of submission: May 22, 2014 National Ethics Committee Progress Report 5 B. Progress Report: Summary of Results 1. Operational Research : Formative Research The objective of the formative research phase of the OR study was to refine development of Nutrition Weeks intervention content, including the corresponding curriculums and reminder materials that were used to train CHW’s and mothers throughout the threeNutrition week cycles of the implementation happened during FY 2014. Complete findings from year three were included in the project’s Year 3 Annual Report, available upon request. a. Pre Nutrition Week meetings The ICSP Manager met with the Vice Mayer of Social Affairs, the health officer in charge of health at district and the district monitoring and evaluating officer. This meeting was to inform them of the upcoming Nutrition Week sessions and facilitate their involvement in the program. Before the implementation of each 2014 Nutrition week cycles, eighty TOT had a 1-day meeting since they had already been trained in 2013; Then these 80 TOT met with 562 VNC members for 1 day. The Pre-NW meeting provided training as well as opportunities for problem-solving, planning for community mobilization, and organizing contributions of soap, pans, some food, and other details. Cell-level and village-level pre-NW meetings for mothers, fathers and grandmothers were held to increase awareness of the upcoming NW. The Sector-level nutrion committee members were not TOT, but were important for mobilizing attendance at the Pre-NW meetings at cell and village level and at Nutrition week sessions. Nutrition Week sessions The three cycles of Nutrition were held in each village of Kaduha Hospital zone, 282 villages, for two hours each day, lasting five days. The mothers were very excited about some of the messages, such as the thicker porridges and are applying at home the skills gotten during Nutrition week sessions. The lactating mothers and pregnant women had very good attendance (average 89 % for lactating mothers; 79.5% for pregnant women in both NW Cycles) as did the grandmothers. The attendance rates to NW sessions for fathers have been increasing: 48 % & 50% &49% &63% respectively in 2014 NW cycle 1 & 2 &3 and 2015 NW Cycle 1. Assessing Nutrition Week sessions a. Supervision of Nutrition Week Supervision of Nutrition Week Pilot was done by 7 different individuals:  Social Affairs officer in charge of cell level National Ethics Committee Progress Report 6  Social affair officer in charge of sector level  Officer in charge of community health at health center level  Nutritionist at health center level  2 ICSP staff The supervision of nutrition week revealed some activities with the highest satisfaction including the presence of beneficiaries and their involvement; the contribution of food and other materials by participants was increasing; the community health workers with other VNC members were able to lead the nutrition week sessions appropriately, the attendance to NW for the father was steadily increasing and the improvement of hygiene was observable. However some challenges should be addressed such as the decrease in the attendance for pregnant women and some unexpected community activities that disturb the plan for NW sessions. Learning from previous cycles, there were fewer sites (only 2 per village) to make it easier for the CHW and VNC to supervise. Also, the number of participants was limited to 12 per site, to improve quality and make it more manageable. The timing was also different. Last year, WR selected skilled MOH staff to coordinate activities at the sector level. WR has been involving more partners as their capacity has been built—they are performing well and need less WR support, so it was possible to take only 1 week to implement NW sessions in each sector. b. Mothers exit Interview Maternal exit interviews had been conducted one week and one month after nutrition week sessions. They displayed a considerable amount of appreciation for the new behaviors learned. Mothers testified that they like the ambiance in the nutrition week sessions, the discussions and the collaborative problem solving. They love a lot the discussions with their husbands on child feeding and appreciate the husbands’ participation to the NW as well as the participation of grandmothers. Mothers testified that after NW trainings they had changed many things in they families such as Hygiene improved; they built kitchen garden, they are feeding their children with fruits. Following are quotations for two women after NW sessions “Even if we have a lot of duties to perform at home, now as I am pregnant I manage to take a short rest during the day. My husband supports me and helps me at home as we learnt together the topic about pregnant woman.” (Pregnant woman from Mugano sector, Yonde cell, Nyarusiza village) National Ethics Committee Progress Report 7 “After NW sessions things have changed at home, my husband purchases enough food for us, he helps me to cook food, he built kitchen garden; we are raising chicken and rabbits and he feed children with egg as he attended many NW sessions” (Lactating mother from Musange Sector, Masizi cell, Rwankango Village)C. C. Evaluative Research Summary Findings – Year 3 Summary of Monitoring Abridged KPC Survey (2014) Population of interest: Rwanda is a small, mountainous and densely populated country. The population is over 80% rural and most people rely on agriculture to meet their basic needs.8 The 2010 DHS Survey Final Report revealed that the Nyamagabe District has some of the highest rates of malnutrition, anemia and stunting nationwide9 . Moreover, rates of stunting, which is symptomatic of undernutrition during the key developmental period between conception and two years of age, commonly referred to as the ‘1000 days’, was reported by the DHS as 44% nationwide. Malnutrition of varying degrees gravely affects the cognitive and physical development of children and the well-being and productivity of women with serious consequences for the intergenerational cycle of poverty and undernutrition in Rwanda persisting without effective interventions being implemented10. The project and methodology: In October 2011, World Relief (WR) was awarded a four year grant from the United States Agency for International Development (USAID) Child Survival and Health Grants Program to improve the health and underlying nutrition of children under five and pregnant women in Nayamgabe District, Southern Province in Rwanda. The WR Innovation CSP is designed to help the government of Rwanda achieve it’s Millennium Development Goals (MGDs) related to maternal and child health, and particularly the elimination of malnutrition. The targeted population of Nyamagabe District is 330,510, according to Nyamagabe District Statistics 2011. The total number of women beneficiaries is 111,431 and total number of children under five years of age is 41,314 children (12.5% of total population in 2011). The estimated Level of Effort per intervention is: Nutrition 40%, Maternal Newborn Care 35%, Diarrhea 15%, and Pneumonia 10%. In Year 3, the project carried out an abridged Knowledge, Practices and Coverage (KPC) survey with a focus on nutrition and hygiene, for monitoring purposes. This survey used 30-cluster methodology to collect information from mothers of children 0-23 months in 8 US Department of State Background Note. Accessed November 14, 2011. http://www.state.gov/r/pa/ei/bgn/2861.htm 9 2010 DHS Survey Final Report, published in February 2012. 10Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What works? Interventions for maternal and child undernutrition and survival.Lancet. 2008; 371(9610): 417-40. National Ethics Committee Progress Report 8 June 2014. Two separate, 30x10 cluster samples were randomly selected in each of two hospital zones that comprise Nyamagabe District. The combined sample included 600 households. The primary objectives of the survey were: 1. To monitor indicators related to the project’s nutrition interventions, including USAID Key Indicators. 2. To collect monitoring values for USAID Rapid CATCH indicators related to nutrition (some of which overlap with the project indicators). 3. To collect monitoring data for indicators related to the project’s operations research on the Nutrition Weeks innovation. The innovation: Nutrition Weeks innovation has been introduced into the Community Based Nutrition Protocol (CBNP) in the intervention area, Kaduha hospital zone, while using the Kigeme hospital zone as the comparison group. This intervention is expected to improve the nutritional status of pregnant, lactating women, and children aged 0-23 months in the intervention area, as a result of enhanced Infant and Yong Child Feeding (IYCF) practices. CHWs have received training and a step-by-step guide to implement Nutrition Weeks, which is scheduled three times a year. Nutrition Weeks includes all women with children under two and pregnant women. Mothers participate in a week long, two-hour nutrition education session modeled after Hearth, with a goal of learning about foods, feeding practices, and other behaviors that will prevent under-nutrition. Results of Abridged KPC Survey: After 3 years of programming, there appear to be marked improvements in nutrition practices. In Kaduha, the Nutrition Weeks intervention area, Minimum Meal Frequency improved from 7% - 70% (in Kigeme from 7% - 61%). Furthermore, the percentages of children who met the minimum acceptable diet improved from was 3% to 39% in Kaduha and from 3% to 24% in Kigeme. Breastfeeding practices are extremely important for good infant and child nutrition. 11 The percentage of infant put to the breast within one hour of birth increased from 48% to 82% in Kaduha, and from 51% to 79% in Kigeme. Also measured was the rates of prelacteal feedings since introduction of liquids other than breast milk in early life can put a child at risk for infection.The percentage of infants given liquids before breastfeeding decreased from 11% to 4% in Kaduha and from 11% to 2% in Kigeme. Exclusive breastfeeding, a key 11Filteau SM. Role of breast-feeding in managing malnutrition and infectious disease.ProcNutr Soc. 2000; 59(4): 565-72. National Ethics Committee Progress Report 9 indicator corresponding to optimal growth of a child, remained high in both areas (93% Kaduha; 94% Kigeme). An indicator used to identify proper handwashing behavior was the percentage of mothers of children aged 0-23 months who washed hands with soap at the key four times. This behavior improved from 3% to 30% in Kaduha and from 5% to 15% in Kigeme. [February 2015] 10 D. Monitoring and Evaluation Table-Summary of Year 3 Results for project and OR indicators Rows shaded in gray are CSP objectives with targets. Additional indicators that will also be tracked for Rapid CATCH, or otherwise, are un-shaded. IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities I. Breastfeeding and Nutrition (40% LOE) IR3 Improve breastfeeding practices Immediate breastfeeding of newborns: Percent of children 0-23 months who were put to the breast within one hour of birth. (Key indicator MNC) (OR) OR; MTE KPC, FE KPC Annually Kaduha 48.32% (CI: 43.14- 53.50%) Kaduha 71.4% (CI: 66.26- 76.54%) Kadua 82.3% (CI: 76.6- 88.0%) 70% BCC through MCG, Churches, Community meetings, Home visit & NW Kigeme 51.1% (CI: 45.94- 56.26%) Kigeme 72.6% (CI: 67.52- 77.68%) Kigeme 78.7% (CI: 72.9-84.4%) 70% Prelacteal feeding Percent of children 0-23 months given liquids prior to the initiation of breastfeeding. OR; MTE KPC, FE KPC Annually Kaduha 10.99% (CI: 7.74- 14.24%) Kaduha 6.4% (CI: 3.6-9.1%) Kaduha 3.7% (CI : 0.8-6.5%) 3% BCC through MCG, Churches, Community meetings, Home visit & NW Kigeme 10.70% (CI:7.42- 13.92%) Kigeme 9.1% (CI: 5.8- 12.3%) Kigeme 2.0% (CI: 0.5-3.5%) 3% National Ethics Committee Progress Report 11 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities IR3 Exclusive Breastfeeding (tracking only) Percent of children age 0-5 months who were exclusively breastfed during the last 24 hours. (RC) OR; MTE KPC, FE KPC Annually Kaduha 91.11% (CI:85.23- 96.99%) By age: 0-1m: 64.0% 2-3m: 86.2% 4-5m: 63.6% 0-3m:87.0% Kaduha 90.1% (CI: 83.96- 96.24) By age: 0-1 m: 91.7% 2-3 m: 91.7% 4-5 m: 87.1% 0-3 m: 91.7% Kaduha 92.9% (CI: 85.1-97.3%) By age: 0-1 m: 91.4% 2-3 m: 94.3% 4-5 m: 84.0% 0-3 m: 93.1% N/A BCC through MCG, Churches, Community meetings, Home visit & NW Kigeme 98.89% (CI:96.73- 100.00%) 0-1m: 87.5% 2-3m: 96.8% 4-5m: 96.8% 0-3m: 98.2% Kigeme 83.8% (CI: 75.41- 92.19%) 0-1m: 87.5% 2-3m: 96.8% 4-5m: 96.8% 0-3m: 98.2% Kigeme 94.3% (CI: 86.0-98.4) By age: 0-1 m: 96.0% 2-3 m: 96.8% 4-5 m: 80.0% 0-3 m: 95.7% N/A IR3 Continued breastfeeding at 1 year (tracking only) Percent of children 12-15 months who are still breastfeeding. OR; MTE KPC, FE KPC Annually Kaduha 85.42% (CI:5.44- 95.40%) Kaduha 100.0% (CI: 100.0- 100.0%) Kaduha 93.0% (CI: 85.2-100%) N/A BCC through MCG, Churches, Community meetings, Home visit & NW Kigeme 93.44% (87.23- 99.65%) Kigeme 97.9% (CI: 93.8- 101.9%) Kigeme 98.0% (CI: 93.9-100%) N/A National Ethics Committee Progress Report 12 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities Continued breastfeeding at 2 years (tracking only) Percent of children 20-23 months who are still breastfeeding. Kaduha 86.79% (CI:77.67- 95.91%) Kaduha 97.4% (CI: 92.4- 102.3%) Kaduha 87.9% (CI: 75.8-99.9%) N/A Kigeme 90.91% (CI: 82.42- 99.40%) Kigeme 88.4% (CI: 78.8- 97.9%) Kigeme 93.3% (CI: 83.9-100%) N/A IR3 Improve Infant and Young Child Feeding Practices % infants and young children age 6-23 months fed according to the Minimum Dietary Diversity (OR) OR; MTE KPC, FE KPC Annually Kaduha 21.85% (CI: 16.92- 26.78%) By age: 6-11m: 0.0% 12-17m: 31.7% 18-23m: 40% Kaduha 38.8% (CI: 32.1- 45.4 %) By age: 6-11m: 32.2% 12-17m: 36.8% 18-23m: 51.9% Kaduha 49.4% (CI: 42.0-56.9%) By age: 6-11m: 41.0% 12-17m: 54.9% 18-23m: 54.8% 60% BCC through MCG, Churches, Community meetings, Home visit & NW Kigeme 38.89% (CI: 33.08- 44.70%) By age: 6-11m: 0.0% 12-17m: 50.6% 18-23m: 51.6% Kigeme 31.0% (CI: 24.9- 37.0%) By age: 6-11m: 22.2% 12-17m: 38.5% 18-23m: 34.2% Kigeme 39.3% (CI: 32.6-46.3%) By age: 6-11m: 36.3% 12-17m: 41.9% 18-23m : 38.5% 55% National Ethics Committee Progress Report 13 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities % infants and young children age 6-23 months fed according to the Minimum Meal Frequency (OR) Kaduha 7.04% (CI: 3.99- 10.09%) Kaduha 66.5% (CI: 58.7 -74.3%) Kaduha 70.4% (CI: 63.3-67.8%) 55% Kigeme 7.41% (CI: 4.07- 10.21%) Kigeme 50.9% (CI: 44.0-57.8%) Kigeme 60.6% (CI: 53.6-67.3%) 60% % infants and young children age 6-23 months fed according to the Minimum Acceptable Diet *WHO 2008 definition (OR, RC*) Kaduha 2.96% (CI: 0.92- 4.94%) Kaduha 32.5% (CI: 24.9-40.2%) Kaduha 38.6% (CI: 31.6 – 46.0%) 50% Kigeme 3.33% (CI: 1.19- 5.47%) Kigeme 22.8% (CI: 16.1-29.5%) Kigeme 24.5% (CI: 18.8-30.9%) 50% IR3 Consumption of iron-rich foods % infants 6–23 months of age who consumed food rich in iron. (Include micronutrient powders if/when program expands to Nyamagabe) OR; MTE KPC, FE KPC Annually Kaduha 15.19% (CI: 10.91- 19.47%) Kaduha 15.3% (CI: 10.4- 20.1%) Kaduha 25.4% (CI: 17.2-33.6%) 50% BCC through MCG, Churches, Community meetings, Home visit & NW Kigeme 23.33% (CI: 18.29- 28.37%) Kigeme 12.8% (CI: 8.4- 17.1%) Kigeme 12.0% (CI: 6.3-17.7%) 50% IR3 Age appropriate Proportion of infants OR; Annually Kaduha Kaduha Kaduha 75% BCC through National Ethics Committee Progress Report 14 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities introduction of semi-solid foods 6–8 months of age who receive solid, semi-solid or soft foods. MTE KPC, FE KPC 52.00% (CI: 38.15- 65.85%) 81.0% (CI: 69.1- 92.8)%) 78.9% (CI: 55.3-100%) MCG, Churches, Community meetings, Home visit & NW Kigeme 58.50% (CI: 45.23- 71.77%) Kigeme 79.1% (CI: 66.9- 91.2%) Kigeme 75.0% (CI: 57.5-92.5%) 75% IR3 Responsive feeding Percent of Caregivers who assist child when eating (of children who consume soft, semi-solid or solid foods) OR; MTE KPC, FE KPC Annually Kaduha 6.93% (CI:3.65- 10.21%) Kaduha 95.5% (CI: 92.6- 98.3)%) Kaduha 96.7% (CI: 93.8-99.6%) TBD BCC through MCG, Churches, Community meetings, Home visit & NW Kigeme 13.08% (CI:8.97- 17.37%) Kigeme 92.1% (CI: 88.4- 95.7%) Kigeme 95.0% (CI: 89.9-100%) TBD IR3 Self- Feeding (tracking only) Percent of children who consume soft, semi-solid or solid foods) who are self￾feeding Kaduha 94.81% (CI:91.95- 97.67%) Kaduha 4.5% (CI:1.6-7.3%) Kaduha 3.3% (CI: 0.4-6.2%) N/A BCC through MCG, Churches, Community meetings, Home visit & NW Kigeme 87.34% (CI: 83.11- 91.57%) Kigeme 7.9% (CI: 4.9- 11.5%) Kigeme 5.0% (CI: 0-10.1%) N/A IR3 Vitamin A Supplementation in the last 6 months Percent of children age 6-23 months who received a dose of Vitamin A in MCH week report OR report Bi-annually Kaduha 70.37% ( CI:64.92- 75.82%) Not included in abridged survey Not included in abridged survey N/A BCC through MCG, Churches, Community National Ethics Committee Progress Report 15 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities the last 6 months: card verified or mother’s recall. (RC 8, OR) Kigeme 77.04% (CI: 72.02- 82.06%) Not included in abridged survey Not included in abridged survey N/A meetings, Home visits NW; support to HC for MCH week Anthropometry IR3 Underweight for Age (tracking only) Percent of children 0-23 months who are underweight (-2 SD for the median weight for age, according to WHO reference population) Disaggregate underweight by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) (RC) Monthly Growth Monitor-ing, OR Monthly Annually Kaduha 17.8% (CI:14.00- 22.50%) Severe: 7.2% (CI: 4.8- 10.8%) Moderate: 10.6%(CI:7.9- 14.1%) Kaduha 21.7% (CI : 17.0 – 27.2%) Severe : 5.7% (CI : 3.3-9.6%) Moderate : 16.0% (CI : 11.9-21.1%) Kaduha : 10.8% (CI : 7.1-16.1%) Severe : 3.2% (CI : 1.5-6.9%) Moderate : 7.6% (CI :4.6-12.3%) Yr 3 indicator calculated for 6-23 mos N/A BCC through MCG, Churches, Community meetings, Home visit NW Counseling through GMP Kigeme 8.9% (CI:6.6- 15.0%) Severe: 2.2% (CI: 1.2- 4.2%) Moderate: 6.7%(CI:4.5- 9.9%) Kigeme 16.0% (CI: 11.4-22.1%) Severe: 3.0% (CI: 1.5-5.8%) Moderate: 13.0% (CI: 9.2-18.1%) Kigeme 17.6% (CI: 12.0- 24.9%) Severe : 2.1% (CI: 0.8-5.5%) Moderate : 15.4% (CI: 10.5-22.2%) Yr 3 indicator calculated for 6-23 N/A National Ethics Committee Progress Report 16 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities mos IR3 Acute Malnutrition / Wasting (tracking only) % children 0-23 months who are underweight for height (-2SD for the median height for age, according to WH0 reference population) Disaggregate wasting by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) (OR) OR Annually Kaduha 7.6% (CI: 4.9- 11.6%) Severe 3.9% (CI:2.3-6.8%) Moderate 3.7% (CI:2.2- 5.9%) Kaduha 8.7% (CI : 5.4-13.6%) Severe 2.3% (CI : 1.0- 5.2%) Moderate 6.3% (CI : 3.6-11.0%) Kaduha 6.5% (CI : 3.7- 11.0%) Severe : 1.1% (CI : 0.3-3.9%) Moderate : 5.4% (CI : 3.0-9.7%) Yr 3 indicator calculated for 6-23 mos N/A BCC through MCG, Churches, Community meetings, Home visit NW Counseling through GMP Kigeme 6.1% (CI:4.1 - 9.1%) Severe 2.2% (CI:1.1-4.6%) Moderate: 3.9% (CI:2.3- 6.4%) Kigeme 2.7% (CI : 1.2- 6.0%) Severe : 1.0% (CI: 0.2- 4.4%) Moderate : 1.7% (CI: 0.7- 3.9%) Kigeme 5.9 % (CI: 2.8 - 11.9) Severe : 0.5 % (CI: 0.1 - 3.9) Moderate : 5.3% (CI: 2.6-10.4%) Yr 3 indicator calculated for 6-23 mos N/A IR3 Acute Malnutrition (tracking only) Percent of children 6-23 months acutely malnourished as measured by MUAC Monthly Growth Monitoring Report Monthly Annually Kaduha 8.3% (CI: 5.3- 12.7%) Kaduha 9.6% (CI: 5.8- 15.3%) Kaduha 0.5% (CI: 0.1-3.0%) Severe : 0.0% (CI : 0.0-2.0%) N/A BCC through MCG, Churches, Community National Ethics Committee Progress Report 17 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities Disaggregate by ‘at risk’, moderate and severe acute malnutrition OR 1.5% severe 6.8% mod. 18.52% at￾risk Severe 2.4% (CI: 1.0-5.5%) Moderate 7.2% (CI: 4.1- 12.4%) Moderate : 0.5% (CI : 0.1-3.0%) Yr 3 indicator calculated for 6-23 mos meetings, Home visit NW Counseling through GMP Kigeme 5.2% (CI: 3.0- 8.9%) 0.4% severe 4.8% mod. 20.37% at￾risk Kigeme: 4.0% (CI: 2.0-7.6%) Severe 0.0% (CI: 0.0-0.0%) Moderate: 4.0% (CI: 2.0- 7.6%) Kigeme5.3% (CI: 2.8-9.8%) Severe : 0.0% (CI : 0.0-0.0%) Moderate : 5.3% (2.8-9.8%) Yr 3 indicator calculated for 6-23 mos N/A IR3 Stunting (tracking only) Percentage of children 0-23 months who are under height/length for age (-2SD for the median height for age, according to WHO reference population) OR Annually Kaduha 44.3% (CI:37.6- 51.2%) Severe 25.1% Moderate 19.2% Kaduha 33.3% (CI: 26.1-41.3%) Severe: 13.3% (CI: 9.3-18.8%) Moderate: 20.0% (CI: 14.8-26.4%) Kaduha 34.1% (CI: 27.6- 41.1%) Severe : 13.0% (CI : 8.9-18.6%) Moderate : 21.1% (CI : 15.8-27.5%) Yr 3 indicator calculated for 6-23 mos N/A BCC through MCG, Churches, Community meetings, Home visit NW Counseling through GMP National Ethics Committee Progress Report 18 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities Disaggregate stunting by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) Kigeme 33.4% (CI:27.1- 40.4%) Severe 12.5% Moderate 20.9% Kigeme 34.0% (CI: 26.9-41.9%) Severe: 11.7% (CI: 8.4-16.0%) Moderate: 22.3% (CI: 17.6-27.9%) Kigeme 33.0% (CI: 26.2- 40.5%) Severe : 13.3% (CI: 8.4-20.4%) Moderate : 19.7% (CI: 14.5-26.2%) Yr 3 indicator calculated for 6-23 mos N/A IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities Maternal & Newborn Care (35% LOE) IR1 Increase % of mothers who have 4+ ANC visits % mothers of children age 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child. MT KPC Final KPC Y3&4 Kaduha 45.5% (CI: 40.34- 50.66%) Not included in abridged survey Not included in abridged survey 75% Training ASM CHWs for MNC; BCC; household visit Kigeme 48.9% Not included in abridged Not included in abridged survey 75% National Ethics Committee Progress Report 19 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities (RC1) (CI: 43.74- 54.06%) survey IR1 Increase % of mothers who have ANC in their first trimester (tracking only) % mothers of children age 0-23 months who had antenatal visit in the first trimester when they were pregnant with the youngest child MT KPC Final KPC Kaduha 54.5% (CI: 49.34- 59.56%) Not included in abridged survey Not included in abridged survey N/A ASM training, BCC, household visit Kigeme 54.7% (CI: 49.56- 59.84%) Not included in abridged survey Not included in abridged survey N/A IR1 Increase % of mothers who get at least two TT %mothers with children age 0-23 months who received at least two Tetanus toxoid vaccinations before the birth of their youngest child. (RC2) MT KPC Final KPC ASM monthly report Y3&4 Monthly Kaduha 68.43% (CI: 63.58- 73.22%) Not included in abridged survey Not included in abridged survey 80% ASM training, BCC, household visit Kigeme 68.33% (CI: 63.49- 73.11%) Not included in abridged survey Not included in abridged survey 80% IR1 Increase skilled birth attendance % children age 0-23 months whose births MT KPC Y3&4 Kaduha 83.0% Not included in abridged Not included in abridged survey N/A ASM training, National Ethics Committee Progress Report 20 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities (tracking only) were attended by skilled personnel. (RC3) Final KPC ASM monthly report Monthly (CI: 79.11- 86.89%) survey BCC, household visit Kigeme 91.7% (CI: 88.85- 94.55%) Not included in abridged survey Not included in abridged survey N/A IR1 Increase % of newborns who get a post-natal check-up within 2 days of birth (RC 4) % of mothers of children 0-23 m. whose youngest child received a post-natal visit from an appropriate trained health worker within 2 days of birth. (RC4) MT KPC Final KPC ASM monthly report Y3&4 Monthly Kaduha 37.70% (CI: 32.68- 42.72%) Not included in abridged survey Not included in abridged survey 60% ASM training, BCC, household visit Kigeme 44.2% (CI: 39.07- 49.33%) Not included in abridged survey Not included in abridged survey 60% Current Contraceptive Use Among Mothers of Young Children (tracking only) % mothers of children 0-23 months who are using a modern contraceptive method. (RC5) MT KPC Final KPC ASM monthly report Y3&4 Monthly Kaduha 57.5% (CI: 52.38- 62.62%) Not included in abridged survey Not included in abridged survey N/A ASM training, BCC, community mobilization to use CBP Kigeme 62.5% Not included in abridged Not included in abridged survey N/A National Ethics Committee Progress Report 21 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities (CI: 57.5- 67.5%) survey IR1 Increase iron￾folic acid supplementation during pregnancy. Percentage of mothers who received tablets; average number of days consumed of those who received pills. (OR) MT KPC Final KPC OR Annually Kaduha 80.4% received (CI: 72.29- 84.51%) Average days: 35.37 Kaduha 69.4% received (CI: 64.1- 76.6%) Average days: 39.88 Kaduha 81.0% (CI: 74.2-87.8%) Average days: 41.53 90% 60 days ASM training, BCC, household visit, advocacy to improve quality of ANC Kigeme 81.4% received (CI: 77.38- 85.42%) Average days: 33.45 Kigeme 70.9% received (CI: 65.7- 76.0%) Average days: 33.45 Kigeme 83.7% (CI: 79.3-88.0%) Average days: 42.00 90% 60 days Control of Diarrheal Diseases (15% LOE) IR1 Prevention Increase % of households that treat water effectively POU Water Tx: Percentage of households of children age 0-23 months that treat water effectively. (RC15, OR) MT KPC Final KPC Y3&4 Kaduha 50.0% (CI: 44.83- 55.17%) Kaduha 98.3% (CI: 96.6- 99.9%) Kaduha 75.7% (CI: 68.3-83.0%) 65% Kigeme Kigeme Kigeme 65% National Ethics Committee Progress Report 22 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities 56.4% (CI: 51.28- 61.52%) 97.6% (CI: 95.2- 99.9%) 57.0% (CI: 48.6-65.4) IR2 Improve appropriate hand washing practices Percentage of mothers of children age 0-23 months who live in households with soap at the place for hand washing. (RC16, OR) MT KPC Final KPC Y3&4 Kaduha 38.6% (CI:33.57- 43.63) Kaduha 78.1% (CI:72.9- 83.2%) Kaduha 73.7% (CI: 63.5-83.9) 65% BCC, Home Visit, Hygiene Club rep in Care Group Kigeme 43.9% (CI: 38.77- 49.03) Kigeme 89.4% (CI: 85.4- 93.3%) Kigeme 73.0% (CI: 63.2-82.8%) 65% IR2 Hand Washing at Appropriate times (tracking only) Percentage of mothers of children age 0-23 months who wash hands with soap at all four key times MT KPC Final KPC Y3&4 Kaduha 2.8% (CI: 1.40- 5.20% Kaduha 21.0% (CI: 16.3- 25.6% Kaduha 29.7% (CI: 19.7-39.6%) N/A BCC, Home Visit, Hygiene Club rep in Care Group Kigeme 5.0% (CI: 3.10- 7.90%) Kigeme 9.7% (CI: 6.3- 13.0%) Kigeme 15.3% (CI: 9.5-21.2%) N/A IR2 Percentage of MT KPC Y3&4 Kaduha Kaduha Kaduha N/A BCC, Home National Ethics Committee Progress Report 23 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities Latrine/toilet in good condition (tracking only) households of children age 0-23 months that have a toilet facility in appropriate condition Final KPC 15.0% (CI: 11.31- 18.69%) 20.7% (CI: 16.1- 25.2%) 27.3% (CI : 19.3-35.4%) visit, CHW, use church channel to mobilize for hygiene Kigeme 26.9% (CI: 22.32- 31.48%) Kigeme 14.0% (CI: 10.0- 17.9%) Kigeme 23.3% (CI : 17.1-29.6%) N/A IR2 Safe feces disposal (tracking only) Percentage of mothers of children 0-23 months who disposed of the youngest child’s feces safely the last time a stool passed. (Key Indicator) MT KPC Final KPC Y3&4 Kaduha 71.4% (CI: 66.73- 76.07%) Kaduha 69.0% (CI: 63.7- 74.2%) Kaduha 80.7% (CI: 74.9-86.5%) N/A BCC, Home visit, CHW, use church channel to mobilize for hygiene Kigeme 82.8% (CI: 78.90- 86.70%) Kigeme 76.3% (CI: 71.4- 81.1%) Kigeme 81.0% (CI: 75.6-86.4%) N/A IR1 Prevalence Two week prevalence of diarrhea Percentage of children 0-23 months with diarrhea in the MT KPC Final KPC Y3&4 Kaduha 17.2% (CI: 13.30- 21.10%) Not included in abridged survey Not included in abridged survey N/A BCC, Home visit, CHW, use church channel to National Ethics Committee Progress Report 24 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities (tracking only) previous two weeks (Key Indicator) Kigeme 19.4% (CI: 15.32- 23.48%) Not included in abridged survey Not included in abridged survey N/A mobilize for hygiene IR1 Improve home management of diarrhea (ORT use, increased fluids and continued feeding) Percentage of children age 0-23 months with diarrhea in the last 2 weeks who received ORS and/ or recommended home fluids. (RC13) MT KPC Final KPC Y3&4 Kaduha 23.1% (CI: 12.85- 33-35%) Not included in abridged survey Not included in abridged survey 70% CHW refresher training on CCM, BCC, household visit Kigeme 22.9% (CI: 13.06- 32.74%) Not included in abridged survey Not included in abridged survey 70% IR2 Percentage of children 0-23 months with diarrhea in the last two weeks who were offered more fluids during the illness. (Key Indicator) MT KPC Final KPC Y3&4 Kaduha 36.9% (CI: 25.17- 48.63%) Not included in abridged survey Not included in abridged survey 70% CHW refresher training on CCM, BCC, household visit Kigeme 40.0% (CI: 28.52- 51.48%) Not included in abridged survey Not included in abridged survey 70% IR2 Percentage of children 0-23 months with diarrhea in the last two weeks who MT KPC Final KPC Y3&4 Kaduha 63.1% (CI: 51.37- Not included in abridged survey Not included in abridged survey 75% National Ethics Committee Progress Report 25 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities were offered the same amount or more food during the illness. (Key Indicator) 74.83%) Kigeme 64.3% (CI: 53.08- 75.52%) Not included in abridged survey Not included in abridged survey 75% IR1 Zinc Treatment Increase use of zinc to treat diarrhea Percentage of children 0-23 months with diarrhea in the last two weeks who were treated with zinc supplements. (Key Indicator) MT KPC Final KPC CHW monthly rport Y3&4 monthly Kaduha 24.6% (CI: 14.13- 35.07%) Not included in abridged survey Not included in abridged survey 70% Kigeme 10.0% (CI: 2.97- 17.03%) Not included in abridged survey Not included in abridged survey 70% IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) EOP Target Related Activities National Ethics Committee Progress Report 26 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities Pneumonia Case Management (LOE 10%) IR1 Prevalence Two week prevalence of suspected pneumonia (tracking only) Percent of children 0-23 months with cough and rapid and/or difficult breathing during two weeks prior to survey MT KPC Final KPC Y3&4 Kaduha 23.9% (CI: 19.49- 28.31%) Not included in abridged survey Not included in abridged survey N/A BCC, Home visit, CHW, use church channel to mobile for hygiene, promote improved stove Kigeme 31.4% (CI: 26.61- 36.19%) Not included in abridged survey Not included in abridged survey N/A IR1 Care Seeking Improve appropriate care seeking for pneumonia Percent of children age 0-23 months with chest-related cough and fast and/ or difficult breathing in the last 2 weeks who were taken to an appropriate health provider. (RC14) MT KPC Final KPC Y3&4 Kaduha 44.2% (CI: 33.70- 54.70%) Not included in abridged survey Not included in abridged survey 70% BCC, Home visit, CHW, use church channel to mobile for hygiene, promote improved stove Kigeme 45.1% (CI: 35.93- 54.27%) Not included in abridged survey Not included in abridged survey 70% National Ethics Committee Progress Report 27 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities Immunization – Not an intervention; Rapid CATCH Only Measles vaccination (tracking only) Percentage of children age 12-23 months who received a measles vaccination.(RC9) MT KPC Final KPC Y3&4 Kaduha 87.4% (CI: 81.2- 92.10%) Not included in abridged survey Not included in abridged survey N/A Community mobilization, support HC out reach Kigeme 83.4% (CI: 76.49- 89.10%) Not included in abridged survey Not included in abridged survey N/A Access to immunization services (tracking only) Percentage of children aged 12-23 months who received Pentavalent-1 (DTP1 +HepB + Hib) by vaccination card or mother’s recall by the time of the survey . (RC10) MT KPC Final KPC Y3&4 Kaduha 89.3% (CI: 83.40- 93.60%) Not included in abridged survey Not included in abridged survey N/A Kigeme 86.9% (CI: 80.30- 91.90%) Not included in abridged survey Not included in abridged survey N/A Health System Performance Percentage of children aged 12-23 months who MT KPC Final KPC Y3&4 Kaduha 84.3% Not included in abridged survey Not included in abridged survey N/A National Ethics Committee Progress Report 28 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities regarding Immunization services (tracking only) received Pentavalent-3 (DTP3 with HepB and Hib) according to the vaccination card or mother’s recall by the time of the survey. (RC) (CI: 77.0- 89.7%) Kigeme 84.1% (CI: 77.20- 89.70%) Not included in abridged survey Not included in abridged survey N/A Malaria – Not an official intervention; Rapid CATCH IR1 Prevention LLIN/ITN use Percentage of children age 0-23 months who slept under an insecticide-treated bed net (in malaria risk areas, where bed net use is effective) the previous night. (RC17) MT KPC Final KPC Y3&4 Kaduha 66.9% (CI: 61.80- 71.80%) Not included in abridged survey Not included in abridged survey N/A Support HC to distribute ITN , BCC, Kigeme 66.9% (CI: 61.80- 71.80%) Not included in abridged survey Not included in abridged survey N/A Prevalence Two week prevalence of fever Percent of children 0-23m with fever in the past two weeks. MT KPC Final KPC Kaduha: 20.8% (CI: 16.61- 24.99%) Not included in abridged survey Not included in abridged survey N/A National Ethics Committee Progress Report 29 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities (tracking only) Kigeme: 23.9% (CI: 19.49- 28.31%) Not included in abridged survey Not included in abridged survey N/A Treatment of fever Treatment of Fever in Malarious Zones (tracking only) NOTE: Because of Rapid Diagnostic Testing, only children with a positive test should receive a drug. This is not reflected in Rapid Catch Indicator. 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. (RC12) MT KPC Final KPC Y3&4 Kaduha 14.0% (CI: 7.60- 24.70%) Not included in abridged survey Not included in abridged survey N/A CHW refresher training on integrated CCM, BCC, Home visit Kigeme 1.2% (CI: 0.0- 6.3%) Not included in abridged survey Not included in abridged survey N/A IR1 Care-seeking Percentage of children age 0-23 months with a febrile Final KPC Y4 Kaduha 53.30% (CI: 42.01- Not included in abridged survey Not included in abridged survey N/A CHW refresher training on National Ethics Committee Progress Report 30 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities for fever (Measured because of RDT issues explained above.) episode during the last two weeks who sought treatment from appropriate provider. CCM monthly report Monthly 64.59%) integrated CCM, BCC, Home visit Kigeme 52.3% (CI41.74- 62.86%) Not included in abridged survey Not included in abridged survey N/A Process Indicators related to CHWs and Nutrition Weeks IR2 Contact with CHW for health education: Percent of households with children 0- 23 months that received health information from a CHW in the past month, according to location (home visit, community meeting, health facility, Growth Monitoring and Counseling, Nutrition Week, etc.) Final KPC Y4 IR2 CHW Home Visits Percent of households with children 0- 23 months that received a visit from a CHW in the past month, according to reported purpose MT KPC Final KPC Y3&4 Kaduha 26.7% (CI: 22.13- 31.27%) Kaduha 52.2% (CI: 46.3- 57.6%) Kaduha 61.7% (CI: 53.6-69.8%) 75% CHWs and Local leaders plan in MCG home visits, Care Group visit homes monthly Kigeme 21.9% (CI 17.63- Kigeme 27.7% (CI 22.6- Kigeme 36.7% 75% National Ethics Committee Progress Report 31 IR Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Source/ Measurement Method Frequency of data collection Location and Baseline Value (95% Confidence Int.) Location and Year 2 KPC Value (95% Confidence Int.) Location and Year 3 KPC Value (95% Confidence Int.) EOP Target Related Activities 26.17%) 32.7%) (CI: 28.2-45.1%) IR3 Participation in Nutrition Weeks: Percentage of mothers with children 0- 23 months who participated in “Nutrition Week” intervention at least once in the past 6 months for 4 or more days. MT KPC Final KPC Y3&4 Quarter-ly Kaduha Kaduha 53.0% (CI: 47.3- 58.6%) Kaduha 53.0% (CI : 44.3-61.7%) 80% Community mobilization, organize NW, Kigeme N/A Kigeme N/A Kigeme N/A NA National Ethics Committee Progress Report 32 E. Evaluative Plan for Operations Research, IR3 Objective/Sub-Objectives Key Indicators Data Source and frequency OR objective: Identify a feasible way to reduce and prevent undernutrition in infants and young children of ages 6 months to 23 months in Nyamagabe District, Rwanda (To assess the effectiveness of Nutrition Weeks in reducing and preventing undernutrition) Proportion of infants and young children age 6m-23m fed according to the Minimum Acceptable Diet (WHO 2008) (Primary Outcome) Increase in number of food groups consumed in 24 hours for breastfeeding and non-breastfeeding children 6-23 months. Meal frequency (per day). Proportion of infants and young children having timely introduction of complementary foods. Proportion of infants and young children who are actively fed (whether someone assists the child with feeding). KPC and monitoring surveys, annual SO 1: Identify key messages to develop the content, key messages and format of the Nutrition Week intervention. Desk Review Completed Annex to DIP – May 2012 Market Surveys Conducted Annex to DIP-May 2012 Positive Deviance Inquiries conducted Annex to DIP-May 2012 Input obtained from Primary Investigator and Co-PI and Co-Investigators, Nutrition Technical Working Group and District stakeholders Project records – July 2012 National Ethics Committee Progress Report 33 SO 2: Train MOH and CHWs/local leaders in how to run Nutrition Weeks Curriculum and lesson plans developed, including field testing Project Records Number of training sessions implemented Project Records Pre and Post-Tests for CHWs and Social Affairs Project Records SO3: Implement Nutrition Weeks 3 times per year Number of Nutrition Weeks implemented per year Project Records SO4: Revise Curriculum Meetings to solicit feedback on pilot training experience and suggested revisions Report from feedback meeting, following pilot implementation Exit interviews with mothers for feedback on their experience in nutrition weeks Exit interview report, After pilot test Input received from MOH Nutrition Technical Working Group Meeting notes Revised Curriculum Curriculum SO5: Scale up to all of Kaduha Zone Number of sectors with Nutrition Weeks implementation Project Records Ammendments to 2014 version of protocol Protocal 34 II. Amendments to May 21, 2014 version of Protocol A. Summary of Changes Please note the following amendments to the original protocol, as detailed below and reflected in the version of the protocol included for this annual review: 1. The study will add screening for edema to the survey to assess malnutrition, and will add a question regarding access to MicroNutrient Powder. 2. The KPC surveys will also add a question related to the location that CHWs are delivering health education messages. 3. Because Ms. Alphonsine Nyirahabineza, who was a co-investigator, resigned from the Nutrition Desk at the Ministry of Health, the new co-investigator is Mr. Alexis Mucumbitsi. Mr. Mucumbitsi’s CV is included. 4. In addition to the operations research, World Relief requests approval from the National Ethics Committee to conduct a Final Evaluation of the project, which includes qualitative and quantitative review for both Kigeme and Kaduha. The results from the quantitative KPC surveys and qualitative tools (focus groups, meetings, interviews) conducted for the Operations Research will inform the evaluation. Additional qualitative inquiry will take place in Kigeme, where Nutrition Weeks was not implemented. An external evaluator will join World Relief staff in making field visits and meeting with stakeholders for qualitative inquiry. The evaluator may not be able to attend all of the visits and meetings. The tools planned to be used for this evaluation are included in the protocol. The evaluator will review the quantitative data collected by the two KPC surveys (one in Kigeme and one in Kaduha). Please see a more detailed description of the Final Evaluation, below. Additional and Replacement Documentation Protocal 35 B. Additional and Replacement Documentation Description of Final Evaluation Timeline for Year 4 January - August 2015 Budget for Year 4 Additional CV for Co-Investigator Qualitative Tools for Kigeme, for Final Evaluation Updated KPC Survey Questionnaire Final Evaluation: Child Survival and Health Grants Program-- USAID In addition to the operations research, World Relief requests approval from the National Ethics Committee to conduct a Final Evaluation of the project. The Child Survival and Health Grants Program of USAID (the funder of this project) requires a final evaluation at the end of the project to show program achievements and contribute to the evidence base to improve future programming and policy actions. The FE provides an opportunity for all project stakeholders to take stock of accomplishments to date and to listen to the beneficiaries at all levels, including mothers and caregivers, other community members and opinion leaders, community- and facility-based health workers, health system administrators, local partners, other organizations, and donors. The evaluation will include qualitative and quantitative review for both Kigeme and Kaduha. The results from the quantitative KPC surveys and qualitative tools (focus groups, meetings, interviews) conducted for the Operations Research will inform the evaluation. Additional qualitative inquiry will take place in Kigeme, where Nutrition Weeks was not implemented. An external evaluator will join World Relief staff in making field visits and meeting with stakeholders for qualitative inquiry. The evaluator may not be able to attend all of the visits and meetings. The evaluator will assess how the project implementation process and contextual factors contributed to the success or failure of project results. The evaluator will also review the quantitative data collected by the two KPC surveys (one in Kigeme and one in Kaduha). The tools planned to be used for this evaluation are included in this protocol. The FE will draw upon existing data collected or compiled during the project cycle, as well as additional data collected during the evaluation for the following purposes: Additional and Replacement Documentation Protocal 36 • To provide an overview of project goals, objectives, and key intervention strategies implemented • To determine the extent to which the project accomplished the results outlined in the Detailed Implementation Plan and to present evidence of these accomplishments • To describe key factors that contributed to what worked or did not work regarding some or all aspects of the program • To demonstrate how the project contributed to learning and evidence that is directly relevant to improving MOH policies and practices, as well as global learning about community-oriented health programming • To provide a record of the results obtained by the project and the process by which they were achieved, so USAID can share these results with others outside of the CSHGP—including the U.S. Congress and in-country partners—and help others understand what should be done if they want to reproduce these results During the evaluation, the final evaluator should: • visit the study site(s) with the evaluation team to observe project activities to better understand the context and interview beneficiaries; • conduct data analyses; • collect additional data to fill gaps identified during document reviews through site visits, key informants interviews, and/or focus group discussions to understand the project implementation process and its outcomes; • hold an in-country presentation of preliminary findings and discussion (must include relevant ministries, U.S. Government stakeholders/USAID Mission); Along with assessing improvements in outcomes (e.g., minimum acceptable diet), the evaluator will analyze issues such as stakeholder and partner opinions on the importance of the project; the community’s perspective of the project; the process of project implementation; how the project addressed contextual factors that changed over the life of the project (e.g., deteriorating security situation, change in government); the effectiveness of the overall project strategy; and lessons learned for future activities. The final evaluator is required to make a presentation to in-country stakeholders (with remote USAID/Washington DC, participation as able). Additional and Replacement Documentation Protocal 37 ICSP Tangiraneza Year 4 Final KPC & OR Timeline, January - August, 2015 Activity Jan Feb Mar Apr May June July August September 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 Meeting with MOH Co￾Investigator to prepare OR Stakeholder’s meeting to provide updates on OR Develop study protocol including consent forms, draft questionnaires, Interview & FGD guides and sampling frame: Submit protocol to MOH for sign-off – Jan 30, 2015 Submit protocol to RNEC for ethical approval – Feb 16, 2015 Prepare electronic data collection software – Additional and Replacement Documentation Protocal 38 Activity Jan Feb Mar Apr May June July August September 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 March 2015 Prepare enumerator training: March 2015 Train ICSP M&E Officers :March, 2015 Train Supervisors March, 2015 Train data collection teams March, 2015 Conduct pilot exercise March, 2015 Revise questionnaire and software for electronic data collection – March, 2015 Field data collection for KPC March – April, 2015 Data cleaning April 2015 Data analysis April 2015 Additional and Replacement Documentation Protocal 39 Activity Jan Feb Mar Apr May June July August September 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 Train teams collecting Qualitative information April, 2015 Conduct Qualitative assessment April - May, 2015 (Kaduha) Qualitative Data Analysis and Reporting May 2015 Presentation of KPC preliminary results to MOH and partners June, 2015 Arrival of the Evaluator and meetings with MOH; Project staff and stakeholders Final Evaluation led by the consultant ICSP Final OR and Final Evaluation Report writing June –August 2015 Additional and Replacement Documentation Protocal 40 Activity Jan Feb Mar Apr May June July August September 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 Submit the Final Evaluation report to MoH & USAID Share the Final Evaluation results with Nutrition Technical Working Group Disseminate the FE findings to District Stakeholders Disseminate the Final Evaluation results to community leaders and Modified Care Groups Additional and Replacement Documentation Protocal 41 ICSP Year 4 Evaluation Budget - Actual Costs ACTIVITIES Units Quanti ty Days Rate TOTAL (RwFrs) I. Household Survey Training of supervisors on HH Survey Supervisors from District Person 1 1 5,000 5,000 Supervisors from I-CSP Person 3 Research Coordinator Person 1 Tea break for Participants 5 1 1,500 7,500 Lunch for Participants Lunch 5 1 3,000 15,000 Water bottle 5 1 400 2,000 29,500 Training of surveyors on HH Survey Enumerators from Health Facilities & Sectors Person 26 3 19,500 1,521,000 Enumerators from I- CSP Person 6 Supervisors from District Person 1 3 5,000 15,000 Supervisors from I-CSP Person 3 Research Coordinator Person 1 Tea break for Participants 37 3 1,500 166,500 Lunch for Participants Lunch 37 3 3,000 333,000 Transport cost for HC & Sector participants Person 26 2 10,000 520,000 Transport cost for participants: field gtest Car 2 1 60,000 120,000 Water bottle 37 3 400 44,400 2,719,900 Household Survey Enumerators from Health Facilities & Sectors Person 26 8 15,000 3,120,000 Transport cost for HC & Sector participants Motobikes 10 8 15,000 1,200,000 Supervisors from District Person 1 8 15,000 120,000 Lunch for Project surveyors Lunch 3 8 2,000 48,000 Overnights for Project surveyors -HH Survey Overnight 6 8 12,000 576,000 Research Coordinator 1 Water bottle 74 8 400 236,800 Community guides person 60 1 3000 180,000 5,480,800 II. Interviews & Focus Group Discussions Training of surveyors on Qualitative research Surveyors from Kaduha Health Facilities & Sectors Person 10 2 19,500 390,000 Surveyors from Kigeme Health Facilities & Sectors Person 10 2 5,000 100,000 Surveyors from ICSP Person 9 Research Coordinator Person 1 Tea break for Participants 30 2 1,500 90,000 Lunch for Participants Lunch 30 2 3,000 180,000 Transport cost for HC & Sector participants Person 20 2 10,000 400,000 Water bottle 30 2 400 24,000 1,184,000 Additional and Replacement Documentation Protocal 42 Data collection- Interviews & FGDs Surveyors from Kaduha Health Facilities & Sectors Person 10 4 5,000 200,000 Surveyors from Kigeme Health Facilities & Sectors Person 10 4 5,000 200,000 Lunch for Project surveyors Lunch 9 1 2,000 18,000 Research Coordinator Person 1 Water bottle 30 6 400 72,000 Refreshment for FGD participants person 120 1 3,000 360,000 850,000 Supplies & Logistics flipchart pc 3 1 6,000 18,000 markers pc 2 1 3,500 7,000 pens pc 50 1 100 5,000 folders and Note books pc 50 1 3,500 175,000 vehicle rental- HH survey veh 2 8 100,000 1,600,000 vehicle rental-QA veh 2 6 100,000 1,200,000 phone cards card 50 1 2,000 100,000 Renewal fees 1 1 425,000 425,000 3,530,000 Total 13,794,200 Additional and Replacement Documentation Protocal 43 CURRICULUM VITAE Identification Name: MUCUMBITSI HABIYAMBERE First name: Alexis Born: 1966 Bukavu/RDC Marital status: Married Phone: 07 88 58 53 33 Email: mucumbitsi2002@yahoo.fr Education: May 2012– 2014 Masters in Public Health /International Health Mount Kenya University, Kigali Rwanda 2007– 2009 Degree in Public Health /Human Nutrition School of Public Health, National University of Rwanda, Kigali, Rwanda 1993– 1995 Bachelor in Nutrition and Dietetics Institute of Medical Technology Bukavu/RDC Professional Experience: 2013 − Present Head of Nutrition Desk Ministry of Health, Kigali, Rwanda Additional and Replacement Documentation Protocal 44 2009 – 2013 Maternal and Child Health Supervisor Ministry of Health, Kigali, Rwanda 1996 – 2009 Hospital Supervisor In charge of all Minimum and Complementary activities package in Health Center and Hospital District Ministry of Health/ Kiziguro Hospital Language Skills  Kinyarwanda (native speaker), French (fluent), Swahili (fluent), English (Not fluent) Current Professional Affiliations: 1. Allied Health Professionals ‘Council- Ministry of Health (Member) 2. Maternal and Child Health Technical Working Group (Member) 3. Food and Nutrition Technical Working Group (Member) 4. Sectoral Committee on Health for the East African Community (Member) 5. National Steering committee of Harvest plus (Member) 6. National fortification alliance (Member) 7. Steering committee for One Cup of Milk per child program (Member) Training gained December 2011: Training of trainers on the management of severe malnutrition Rwamagana District/ Rwanda November 2011: Training of trainers on Mother Infant Young Children Nutrition (MIYCN) Musanze District/Rwanda Additional and Replacement Documentation Protocal 45 August 2011: Training of trainers on integrated management of childhood illness (IMCI clinical) in Huye District/ Rwanda August 2011: Training of trainers on the use of misoprostol for postpartum hemorrhage at the community level. Musanze District/ Rwanda April 2011: Training of trainers on new vaccine introduction against the cervical cancer (Gardasil) Musanze District/ Rwanda June 2010: Training of trainers on Rapid SMS and mUbuzima Huye District/ Rwanda Contributions to Nutrition Desk in Ministry of Health  Coordination of Nutrition activities and the Nutrition Technical working Group (NTWG;  Elaboration food and nutrition policy and nutrition strategy 2013-2018  The National Food and Nutrition Strategic Plan for the years 2013 – 2018  National Strategy to Eliminate Micronutrients Deficiencies 2013 – 2018  Conduct Public awareness on 1000 days Nutrition campaign  Organize 1st,2rd and 3rd National Nutrition Summit  Organize Maternal Child Health week  Conduct supervision of Nutrition activities;  Assist the districts in plan and implementation of DPEM ;  Implementation and Monitoring/ Evaluation of policies, strategies ,standards and guidelines in the field of Nutrition  Update management tools in the field of nutrition Additional and Replacement Documentation Protocal 46  Prepare timely plans and reports of Nutrition desk and submit to the Head of the unit;  Capacity building at all the level of the Health system (HD,HC and community)  Analyze data from Health facilities at all levels and give recommendations and feedback. Contributions to National and EAC Documents 1. National Community Health Policy of Rwanda, 2008 2. Protocol of Community Base Nutrition Program (CBNP) 3. National Nutrition Food and Policy 2013-2018 4. Elaboration Food and Nutrition Strategy 2013-2018 5. Elaboration of EAC Food and Nutrition Security Policy 6. National Strategy to Eliminate Micronutrients Deficiencies 2013 – 2018 7. National Strategy to Mother Infant Young Children Feeding 2014 8. National manual on "Nutritional care for prevention and treatment of NCDs 2014 9. National cook and recipes booklet 2014 10. Annual Nutrition Report Computer skills - Advanced knowledge of Office package (Word, Excel, Access, and PowerPoint). - Advanced knowledge of SPSS, Epi-info, ENA Other skills I have a Rwandese-driving license, A&B category I certify that information contained in these curriculum vitae is true and complete. Additional and Replacement Documentation Protocal 47 NUMBITSI HABIYAMBERE Alexis Signature: Date: Draft Qualitative Tools (Interview and Focus Group Discussion Guides) to be used in Kigeme for Final Evaluation (results from the OR qualitative tools for Kaduha will also be considered in the final evaluation) 1. Draft FGD Guide with Mothers in Kigeme/ Ibibazo bibazwa ababyeyi muri zone ya Kigeme a. Did you participate in the Growth Monitoring and Promotion (GMP) sessions held in your village? / Mwaba mwaritabiriye gahunda yo gupima no gukurikirana imikurire y’umwana ibera mu mudugudu? b. What did you learn about Nutrition from the GMP sessions?/Ni iki mwize ku mirire muri gahunda yo gupima no gukurikirana imikurire y’abana ? c. What did you like about the GMP sessions? Benefits?/Ni iki cyabashimishije muri gahunda yo gupima no gukurikirana imikurire y’abana ? Ni iki mwahungukiye ? d. What did you not like about the GMP sessions?/ Ni iki kitabashimishije muri gahunda yo gupima no gukurikirana imikurire y’abana ? e. What other nutrition activities have taken place in your village? Ni ibihe bikorwa bindi birebana n’imirire byabereye mu mudugudu wanyu? f. What did you change in your family based on training received in GMP or other nutrition activities?/ Ni iki mwahinduye mu miryango yanyu mushingiye ku nyigisho mwahawe muri gahunda yo gupima no gukurikirana imikurire y’abana ? g. What are the challenges you are facing to implement new nutrition teachings in your family? Probe to know if any barriers related to food availability, affordability and acceptance. Ni izihe mbogamizi muhura nazo mugushyira mubikorwa ibyo mwigishijwe Additional and Replacement Documentation Protocal 48 muri gahunda yo gupima no gukurikirana imikurire y’abana? Komeza ubabaze kugira ngo umenye niba hari imbogamizi bahura nazo (zirebana n’ ibiribwa bitaboneka, badashobora kugura cyangwa batemerewe kurya) . How did you respond to the challenges? /Ibyo bibazo mwabikemuye mute? h. Who in your family support you in the application of the new behavior? How? Ni bande bo mu muryango wanyu babafasha gushyira mu bikorwa inyigisho nshya ? Babafasha bate? i. What else could be done to improve nutrition in your village? Ni ibihe bikorwa bindi byakorwa kugira ngo biteze imbere imirire mu mudugudu wanyu? j. Is there anything you would like to tell me about how to improve GMP sessions or other nutrition activities? We are very interested in your opinions to change to make it better./ Ese hari ikintu mwumva mwatubwira cyateza imbere gahunda yo gupima no gukurikirana imirire y’abana ? Ibitekerezo byanyu ni ingenzi mu gutuma habaho impinduka. 2. Draft FGD Guide with Fathers in Kigeme/ IBIBAZO BIGENEWE ITSINDA RY’ABAGABO BITABIRIYE GAHUNDA YO GUPIMA NO GUKURIKIRANA IMIKURIRE Y’ABANA MU MUDUGUDU a. Did you participate in the GMP sessions or any other nutrition activities held in your village? Which activities? / Mwaba mwaritabiriye gahunda yo gupima no gukurikirana imikurire y’abana mu mudugudu wanyu? b. What did you learn about Nutrition from the nutrition activities?/Ni iki mwize ku mirire mu gihe cya gahunda yo gupima no gukurikirana imikurire y’abana mu mudugudu? c. What did you like about the GMP sessions or other nutrition activities? Benefits?/ Ni iki cyabashimishije muri gahunda yo gupima no gukurikirana imikurire y’abana ? Ni iki mwahungukiye ? d. What did you not like about the GMP sessions/other nutrition activities?/ Ni iki kitabashimishije muri gahunda yo gupima no gukurikirana imikurire y’abana ? Additional and Replacement Documentation Protocal 49 e. What did you change in your family based on training received in GMP sessions or other nutrition activities?/ Ni iki mwahinduye mu miryango yanyu mushingiye ku nyigisho mwahawe muri gahunda yo gupima no gukurikirana imikurire y’abana cyangwa ibindi bikorwa by’imirire? f. How men in this village are involved in child feeding? Probe to know more./Mu mudugudu wanyu, nigute abagabo bagira uruhare mu kugaburira abana? Komeza ubabaze kugirango umenye byinshi. g. What are the challenges you are facing to feed properly your children?/Ni izihe ngorane muhura nazo mu kugaburira abana banyu neza? h. What can be done to improve men participation in children’s nutrition?/ Ni iki cyakorwa kugira ngo abagabo barusheho kugira uruhare mu mirire y’abana ? i. What can be done to improve participation in GMP? / Ni iki cyakorwa kugira ngo abagabo barusheho kwitabira ibikorwa byo gupima no gukurikirana imikurire y’abana babo ? j. What can be done to improve nutrition in your community? Ni iki cyakorwa kugira ngo imirire irusheho gutera imbere mu midugudu yanyu? 3. Draft FGD Guide with Modified Care Groups in Kigeme/ Ibibazo bibazwa abagize amatsinda y’ubuzima (CG) avuguruye. a. What are your main responsibilities in Community health?/Ni izihe nshingano z’ingenzi mufite kubijyanye n’ubuzima bw’abaturage? b. How do you collaborate (Binome CHW & ASM & Religious & Local Leaders) to mobilize community for behavior change? Probe to get details and more examples on their collaboration. /Mukorana mute (n’abajyanama b’ubuzima n’abahagarariye amadini ndetse n’abayobozi b’inzego z’ibanze) kugirango mushishikarize abantu guhindura imyifatire? Komeza ubabaze kugira ngo baguhe ubusobanuro n’ingero zifatika zijyanye n’uko bakorana. c. How do you appreciate the CG member’s attendance? Probe to estimate the attendance?/ Mubona mute ubwitabire bw’abagize itsinda ? Komeza ubabaze kugirango umenye ikigereranyo cy’ubwitabire. Additional and Replacement Documentation Protocal 50 d. What are the main barriers that prevent volunteers to attend CG trainings? What can be done to improve CG attendance? / Ni izihe mbogamizi zituma abagize amatsinda batitabira cyane? Hakorwa iki kugira ngo ubwitabire bwiyongere? e. To what extend people or families apply in their lives the health messages they received from CHWs? What is the most challenging health behavior? How do you face to that challenge? / Ni gute mubona imiryango ishyira mu bikorwa inyigisho z’ubuzima bigishijwe n’Umujyanama w’ubuzima? Ni uwuhe mwifato mubona uruhije guhindura kuruta iyindi? Mubyifatamo gute? f. In what ways has the CG training impacted you and your family’s health? Probe to learn more changes occurred? / Ni gute inyigisho muhabwa mu matsinda zagize impinduka kuri mwe no ku miryango yanyu? Komeza ubabaze kugirango bavuge n’izindi mpinduka zabaye. g. Based on the report provided by the CHWs, the # of households visited monthly is still low. What are the main challenge CG members are facing that prevent them to accomplish more home visits? Probe to learn more about how the CG members share the HHs, and if no many HHs per each./ Duhereye kuri raporo zitangwa n’abajyanama b’ubuzima, umubare w’ingo zisurwa mu kwezi uracyari hasi. Ni ibihe bibazo bibangamira abagize amatsinda bikababuza gusura ingo nyinshi ? Komeza ubabaze neza kugirango umenye uburyo abagize amatsinda bagabana ingo no kumenya niba badafite ingo nyinshi. 4. Draft Program Implementation Review Meeting Guide with Health Center and Hospital staff in Kigeme a. Have you observed any health changes in the community since last year? What? Probe to learn more. /Uhereye umwaka ushize kugeza ubu, haba hari ibyo mwabonye byahindutse mungo? Ni ibihe? Komeza ubabaze kugirango bakubwire ibyahindutse byose. b. Have you visited GMP sessions? How many visit this year? / Mwigeze musura aho gahunda yo gupima no gukurikirana imikurire y’abana mu mudugudu ibera? Mwahasuye incuro zingahe muri uyu mwaka? c. Since GMP sessions began in your community what changes have you notice? (Only for Kaduha participants)/ Kuva aho gahunda yo gupima no gukurikirana imikurire y’abana yatangira mu midugudu yanyu, Hari impinduka mumaze kubona? Additional and Replacement Documentation Protocal 51 d. Have you visited CGs? How many visit in last three months?/ Mwaba mwarasuye amatsinda y’ubuzima (C.G) ? Mwayasuye inshuro zingahe mu mezi atatu ashize? e. What are the main barriers that prevent you to supervise CHWs effectively? What can be done in order to improve supervisions to CHWs?/ Ni izihe nzitizi zituma rimwe na rimwe mudasura uko bikwiye ibikorwa by’ abajyanama b’ubuzima? Ni iki cyakorwa murwego rwo kuzamura ikurikirana bikorwa ry’abajyanamab’ubuzima? f. What community health concerns do you believe need to be better addressed?/ Ni ibihe bibazo by’ubuzima bw’abaturage mubona bikwiye kwitabwaho by’umwihariko? g. What can be done to better involve communities in health promotion? Hakorwa iki kugira ngo abaturage barusheho kugira uruhare mu bukangurambaga bw’ubuzima mu mudugudu? h. What can be done to better train communities in Health promotion?/ Ni iki cyakorwa kugirango abantu bigishwe kurutaho ku bijyana n’ubuzima i. What can be done to sustain community health programs?/ Ni iki cyakorwa ngo ibikorwa by’ubuzima mu mudugudu birusheho kuramba? Additional and Replacement Documentation Protocal 52 5. Draft Guide for Program Implementation Review Meeting with Sector and Cell Leaders in Kigeme/ Ibibazo bizifashishwa mu nama n’abayobozi b’akagali n’umurenge a. Now, what are your responsibilities in community health?/ Ubu ni izihe nshingano mufite kubirebana n’ubuzima bw’abaturage? b. Since BCC and GMP sessions began in your sector, what changes have you observed? Probe to learn more. / Guhera aho ubukangurambaga na gahunda z’icyumweru cy’imirire zatangiriye mu murenge wanyu, ni izihe mpinduka mwabonye. Komeza ubabaze kugira ngo ubashe kumenya byinshi. c. Have you visited CGs ? GMP sessions? How many visits in last three months? / Mwigeze musura amatsinda y’ubuzima (CG)? Ibikorwa byo gupima no gukurikirana imikurire y’abana mu mudugudu? Mwasuye inshuro zingahe mu mezi atatu ashize? d. What are the main barriers that prevent you to supervise CG effectively? What can be done in order to improve supervisions to CHWs?/ Ni izihe nzitizi muhura nazo mu gusura amatsinda y’ubuzima (CG) cyangwa gusura ibikorwa byo gupima no gukurikirana imikurire y’abana uko bikwiye? Ni iki cyakorwa kugirango ibikorwa by’isura birusheho kugenda neza? e. What is an area of need for health promotion in your sector/cell?/ Ni iki mwifuza ko cyatezwa imbere byumwihariko kubirebana n’ubukangurambaga bw’ubuzima muri uyu murenge/akagali? f. What could be done differently to meet your sector need?/ Ni ibihe bikorwa bitandukanye byakorwa kugira ngo haboneke ibisubizo by’ibibazo umurenge wanyu ufite? g. What are if any barriers faced when addressing your sector about health promotion? / Ni izihe nzitizi mwahuye nazo mu guteza imbere ubuzima mu murenge wanyu? h. What can be done to sustain community health programs?/ Ni iki cyakorwa kugira ngo hashimangirwe gahunda y’ubuzima bw’abaturage mu buryo burambye? Additional and Replacement Documentation Protocal 53 6. Draft Guide for Program Implementation Review Meeting with Religious Leaders in Kigeme/Ibibazo bizifashishwa mu nama n’abahagarariye amatorero a. As the church leaders, how are you involved in health promotion activities? Nk’abantu bahagarariye amatorero/amadini, mwibona cyangwa mwisanga gute mu bikorwa byo guteza imbere ubuzima bw’abaturage? b. In your community health role, with who do you collaborate more? And How? Ku birebana n’inshingano zanyu mu by’ubuzima bw’abaturage, ni bande mukorana kenshi? Kandi mukorana mute? c. Since BCC and GMP began in your community r, what changes have you observed? Probe to learn more./ Kuva aho ubukangurambaga na gahunda yo gupima no gukurikirana imikurire y’abana zatangiriye mu midugudu, ni izihe mpinduka mwabonye? Komeza ubabaze kugira ngo urusheho kumenya byinshi. d. What are the main challenges you are facing to promote health? What did you do or can be done to respond to the challenges?/ Ni izihe ngorane zikomeye muhura nazo mu guteza imbere ubuzima? Ni iki mwakoze cyangwa mubona cyakorwa kugira ngo izo ngorane zikemuke? e. What can be done to sustain community health programs?/ Ni iki cyakorwa kugira ngo hashimangirwe gahunda y’ubuzima bw’abaturage mu buryo burambwe? Additional and Replacement Documentation Protocal 54 7. Draft Focus Group Discussion Guide with CHWs in Kigeme/ Ibibazo bigenewe abajyanama b’ubuzima muri zone ya Kigeme a. What did you like about the CBNP (GMP sessions, etc.)? Benefits? What did you not like about it? / Ni iki cyabashimishije ku bijyanye na Gahunda y’Imirire Ishingiye ku Mudugudu (gupima no gukurikirana imikurire y’abana, igikoni cy’umudugudu,…)? Ni iki kitabashimishije muri izo gahunda? b. What did you change in your family based on training received for CBNP/GMP? / Nyuma yo guhabwa amahugurwa kubijyanye na Gahunda y’Imirire Ishingiye ku Mudugudu /gahunda yo gupima no gukurikirana imikurire y’abana, ni iki mwahinduye mu muryango? c. What are the challenges you are facing to implement nutrition activities in your community? Probe to know all challenges. How do you respond to each challenge? / Ni izihe ngorane muhura nazo mu gushyira mu bikorwa inyigisho zirebana na Gahunda y’Imirire Ishingiye ku Mudugudu? Komeza ubababaze kugirango bavuge ingorane zose. Ni iki mukora kuri buri kibazo? d. What need of training you feel in order to improve your skills for leading nutrition activities?/ Ni ayahe mahugurwa mwumva mwahabwa mu rwego rwo kongera ubumenyi bwanyu mu kuyobora ibikorwa by’imirire? e. Who support you more during the implementation of CBNP/GMP? or from whom you ask advice for implementing them? How often does he/she visit you? / Ninde ubaha ubufasha cyane mu gushyira mu bikorwa Gahunda y’Imirire Ishingiye ku Mudugudu/ Gahunda yo gupima no gukurikirana imikurire y’umwana mu mudugudu? Cyangwa ninde musaba inama zibafasha gushyira mu bikorwa Gahunda y’Imirire Ishingiye ku Mudugudu/ Gahunda yo gupima no gukurikirana imikurire y’umwana mu mudugudu? Yabasuye kangahe muri gahunda iherutse? f. After GMP, have you visited the families that attended GMP or other nutrition activities? What are the behaviors taught they applied more and what behaviors they did not apply?/ Mwigeze musura ababyeyi bitabiriye gahunda yo gupima no gukurikirana imikurire y’abana mu ngo zabo? Ni ibiki mwasanze bashyira mu bikorwa cyane mu nyigisho bahawe? Ni ibiki mwasanze badashyira mu bikorwa g. What more could be done to improve nutrition in your village? Ni ikihe gikorwa kindi cyakorwa kugira ngo imirire irusheho gutera imbere mu mudugudu wanyu? Additional and Replacement Documentation Protocal 55 h. Is there anything you would like to tell me about how to improve nutrition activities? We are very interested in your opinions to change to make it better./ Ni ikihe gitekerezo mwatanga mu rwego rwo kurushaho guteza imbere ibikorwa by’imirire? Twifuza cyane kumenya ibitekerezo byanyu byatuma gahunda yo gupima no gukurikirana imirire y’abana irushaho kugenda neza. Year 4 KPC Survey Questionnaire with Translation World Relief Rwanda Tangiraneza Innovation Child Survival Project, 2014 i. RESPONDENT IDENTIFICATION/ UMWIRONDORO W’USUBIZA 0) Hospital catchment area / Aho ibitaro bikorera Kigeme…………….. 1 Kaduha……………. 2 i1) Cluster No. / Nimero y’itsinda |___|___| i2) Household No. / Nimero y’urugo |___|___|___|___| i4) Interviewer Name/ Amazina y’ubaza ______________________________ i5) Sector/ Umurenge i6) Cell/ Akagali i7) Village/ Umudugudu i8) Health center/ Ikigo Nderabuzima i9) Date of Interview/ Itariki y’ibazwa 2015 - ___ ___ - ___ ___ MM - DD i10) Was consent received? Yes/ Yego……………………………….1  i12 Additional and Replacement Documentation Protocal 56 Ubazwa yabyemeye? No/ Oya…………………………………..2 i11) If no, why not? Niba ari Oya, kubera iki? Unavailable/ Ntaboneka………………..1 End/ Iherezo Unwilling/ Ntameze neza……………….2 End/ Iherezo Child not Home/ Umwana ntahari……3 End/ Iherezo Other/ Ibindi…………………….…………4 End/ Iherezo ________________________________ (Specify/ Sobanura) i12) What are the name, sex, and date of birth of your youngest child that is still alive? Umwana wawe muto ufite yitwa nde? Yavutse ryari? Igitsina cye ni ikihe? i12a) NAME OF THE CHILD LESS THAN 24 MONTHS AMAZINA Y’UMWANA URI MUNSI Y’AMEZI 24 ____________________________________________ i12b) SEX OF CHILD (1=MALE, 2=FEMALE/ IGITSINA CY’UMWANA( 1=GABO, 2=GORE)……1……..2 i12c) DATE OF BIRTH IGIHE YAVUKIYE ___ ___ ___ ___/___ ___/ ___ ___ Y Y Y Y / M M / D D i12d) AGE OF THE CHILD (IN MONTHS) |___|___| Additional and Replacement Documentation Protocal 57 IMYAKA Y’UMWANA (MU MEZI) i13) Ask the mother: What is your name? / Baza umubyeyi w’umwana: Witwa nde? ____________________________________________ i14) Ask the mother: What is your age in years? / Baza umubyeyi w’umwana: Ufite imyaka ingahe? |___|___| i15) Are you the biological mother of the child? / Ni wowe wabyaye uyu mwana? YES/ YEGO………………………..1 NO/ OYA…...………………….…...0 i16) Time interview began / Isaha ibazwa ryatangiriye AM/ Mbere ya saasita ___ ___:___ ___ PM/ Nyuma ya saasita ___ ___:___ ___ SECTION I: SOCIO-DEMOGRAPHICS / IGICE CYA 1: IMIBEREHO RUSANGE INSTRUCTIONS: Ask the questions exactly as they are written. Do not read responses unless directed to do so. Words in Italics are instructions for the interviewer and should not be read aloud. Follow skip patterns as directed. Write answers in the box unless otherwise directed. AMABWIRIZA: Baza ibibazo nkuko byanditse. Irinde kumu somera ibisubizo. Amagambo yanditse mu buryo buberamye ni amabwiriza y’ubaza ntabwo ugomba kuyasomera ubazwa. Aho ugomba gu simbuka hasimbuke. Andika igisubizo mu kazu kabugenewe. Additional and Replacement Documentation Protocal 58 # Questions Ibibazo Responses Ibisubizo bishoboka Skip Simbu ka Ans wer/I gisu bizo atan ze 1. Have you ever attended school? Mwaba mwarageze mu ishuri? Yes/ Yego……….....……….1 No/ Oya…………….......…....2 Don’t know/ Simbizi………88 S 3 3 2. If yes, then ask: What is the highest grade or level of school you have completed? Niba ari yego, mubaze uti: Warangije ayahe mashuri? None/ Did not complete primary Ntayo/Ntiyarangije amashuri abanza.................................................0 Primary/ Amashuri abanza ……….....1 Secondary/ Amashuri yisumbuye.….2 Past Secondary/ Amashuri makuru…3 Other/ Ibindi………………………….………..…4 ________________________________ (Specify/ Sobanura) 3. How many people live in your household? Muri uru rugo mubamo muri bangahe? Number/ Umubare………………….…|___|___| Don’t know/ Simbizi…………………….....88 4 What is your ubudehe category according to the participatory poverty assessment as defined by MINALOC? Read options if needed. 1. Umutindi nyakujya (those in abject poverty)…………1 2. Umutindi (the very poor)…..........2 Additional and Replacement Documentation Protocal 59 Mwashyizwe mu kihe cyiciro cy’ubudehe nyuma y’ubushakashatsi bwakozwe na MINALOC kubijanye n’ubukire cyangwa ubukene? Musomere ibyiciro niba atabizi If the category is unknown, the interviewer should check the list at the health center so that data is entered for every household. If there is debate, use the category assigned by MINALOC. Niba ubazwa atazi icyiciro arimo, ubaza ajye kureba kuri lisiti yo ku Kigo Nderabuzima iriho ibyiciro by’ingo zose, Niba ubazwa ajya impaka ku cyiciro yashyizwemo, koresha icyiciro kiri ku ilisiti ya MINALOC Are you using health insurance? Ese waba uri mu bwisungane mu kwivuza? If yes: Can I see your member card? Niba ari yego, nshobora kureba ikarita yawe y’ubwisungane mu kwivuza? 3. Umukene (the poor) …….………..3 4. Umukene wifashije (the resourceful poor..………...…4 5. Umukungu (the food rich)…….....5 6. Umukire (the money rich).……….6 8. Simbizi (don’t know).………..…88 (Source: Government of Rwanda Poverty Reduction￾Strategy Paper,June 2002 – p.15.) Yes/ Yego………………………………1 No/ Oya……………………….………...0 Card available/ Ikarita irahari….…….1 No card/ Ikarita ntayo afite…….……..0 5 Additional and Replacement Documentation Protocal 60 4 SECTION II: MATERNAL AND NEWBORN CARE/ IGICE CYA KABIRI KWITA K’UMUBYEYI NURUHINJA # Questions Ibibazo Responses/ Ibisubizo bishoboka Skip Simb uka Answ er/Igi subiz o atanz e 5 How long should you wait after the birth of your child before you try to become LESS THAN 2 YEARS MUNSI Y’IMYAKABIRI..……...1 Additional and Replacement Documentation Protocal 61 pregnant again? Uzategereza igihe kingana iki kugirango wongere gusama indi nda? 2 TO 5 YEARS HAGATI Y’IBIRI N’ITANU….…..2 MORE THAN 5 YEARS HEJURU Y’IMYAKA ITANU…...3 DON’T KNOW SIMBIZI……………….………. 88 6 What are the risks of getting pregnant too soon after the birth of a child? Ni izihe ngorane zishobora kuboneka mugihe umubyeyi akurikije hakiri kare? DO NOT READ RESPONSES. RECORD ALL THAT ARE MENTIONED. IRINDE KUMUSOMERA IBISUBIZO. ANDIKA IBYO AGUSUBIJE BYOSE. BABY BORN TOO SMALL….……A UMWANA AVUKANA IBIRO BIDASHYITSE BABY BORN TOO EARLY………..B UMWANA AVUKA ATAGEJEJE KU GIHE MOTHER CAN DIE……………..…..C UMUBYEYI ASHOBORA GUPFA MOTHER CAN HAVE MISCARRIAGE…………………….D UMUBYEYI ASHOBORA GUKURAMO INDA MOTHER CAN SUFFER ANEMIA……………….……….…...E UMUBYEYI ASHOBORA KUBURA AMARASO OTHER / IBINDI...............................X ______________________________ (SPECIFY/ SOBANURA) 7 Are you currently doing something or using any method to delay or avoid getting pregnant? Hari uburyo ukoresha ngo wirinde YES/ YEGO…….…………...……………………1 Additional and Replacement Documentation Protocal 62 gusama? NO/ OYA…………...………………..…………….0 Which method are you (or your husband/ partner) using? Ni ubuhe buryo ukoresha (cyangwa umugabo wawe)? DO NOT READ RESPONSES. CODE ONLY ONE RESPONSE. IRINDE KUMUSOMERA IBISUBIZO. SHYIRA AKAMENYETSO KUCYO AKUBWIYE. IF MORE THAN ONE METHOD IS MENTIONED, ASK, / NIBA AKUBWIYE UBURYO BURENZE BUMWE, MUBAZE UTI What is your MAIN method that you (or your husband/ partner) use to delay or avoid getting pregnant?” Ni ubuhe buryo, wowe cyangwa umugabo wawe mukoresha kurusha ubundi kugirango wirinde gusama? IF REPONDENT MENTIONS BOTH CONDOMS AND STANDARD DAYS METHOD, CODE “12” FOR STANDARD DAYS METHOD. AGAKINGIRIZO N’UBURYO BWA KAMERE SHYIRA AKAMENYETSO KURI “12” IF RESPONDENT MENTIONS FEMALE STERILIZATION KWIFUNGISHA BURUNDU KU MUGORE …..….1 MALE STERILIZATION KWIFUNGISHA BURUNDU KU MUGABO………………………….……………..………..2 PILL/ IBININI….………………………………………….3 IUD/ AGAPIRA MU MUMURA……….……………..4 INJECTABLES URUSHINGE.….………………………………………..…5 IMPLANTS/ AGAPIRA MU KABOKO.............……6 CONDOM AGAKINGIRIZO K’ABAGABO ………………………..7 FEMALE CONDOM AGAKINGIRIZO K’ABAGORE………………..….…….8 DIAPHRAGM AGAPIRA KO KU NKONDO Y’UMURA…..…….…..9 Additional and Replacement Documentation Protocal 63 BREASTFEEDING, CODE “15” FOR OTHER AND RECORD BREASTFEEDING./NIBA AVUZE UBURYO BWO KONSA SHYIRA AKAMENYETSO KURI “15 “KANDI UBYANDIKE NO MUMAGAMBO IF RESPONDENT MENTIONS ABSTINENCE OR ISOLATION, CODE “15” FOR OTHER AND RECORD RESPONSE IN SPACE PROVIDED. NIBA AVUZE UBURYO BWO KWIFATA SHYIRA AKAMENYETSO KURI “15” KANDI UBYANDIKE NO MUMAGAMBO. FOAM/JELLYAMAVUTA…….…………………..…10 LACTATIONAL AMEN. METHOD KONSA GUSA………………………………………….…11 STANDARD DAYS METHOD/ CYCLEBEADS KUBARA IMINSI Y’UBURUMBUKE…………….…...12 RHYTHM METHOD (OTHER THAN STANDARD DAYS) UBUNDI BURYO BWO KUBARA…………………..……13 WITHDRAWAL/KWIYAKANA………….……………14 OTHER/ IBINDI………………………..……….……….15 _______________________________________ (SPECIFY/ BISOBANURE) 9 During your pregnancy with (Name), did you see anyone for antenatal care? Mugihe wari utwite Kanaka (Izina ry’ umwana muto) waba warigeze wipimisha inda ? YES/ YEGO………….....……………………1 NO/ OYA……………………..…………...….0 9 IF YES: Whom did you see? Anyone else? NIBA AVUZE YEGO MUBAZE UTI : Ninde DOCTOR/MEDICAL ASSISTANT Additional and Replacement Documentation Protocal 64 wagusuzumye ? Ntawundi? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN. MUSOBANUZE NEZA WUMVE NIBA YARASUZUMWE N’UMUNTU UBUFITIYE UBUSHOBOZI MUGANGA/ UMUFASHA WE………………A NURSE/UMUFOROMO……..……………....B MIDWIFE/ UMUBYAZA…………………….C TRADITIONAL BIRTH ATTENDANT UMUBYAZA WA GIHANGA……………….D OTHER / ABANDI____________________........X (SPECIFY/ BAVUGE) NO ONE NTA NUMWE…………………………………Y 16 1 During your pregnancy with (Name), where did you receive antenatal care? Mugihe wari utwite Kanaka ( Izina ry’umwana muto ) ni hehe wipimishirije inda? CIRCLE ALL MENTIONED. SHYIRA AKAZIGA KUGISUBIZO AGUHAYE IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. HOME/ MURUGO YOUR HOME/ IWAWE …………………....A MIDWIFE/TBA HOME/ MURUGO RW’UMUBYAZA……....……....B OTHER HOME/ MURUNDI RUGO............C Additional and Replacement Documentation Protocal 65 NIBA ARI KUBITARO, KUKIGO NDERABUZIMA CYANGWA KU IVURIRO RYIGENGA ,ANDIKA UKO HITWA. MUSOBANUZE NEZA KUGIRA NGO WANDIKE IGISUBIZO CY’UKURI _________________________________ (NAME OF PLACE/ IZINA RYAHO YABYARIYE) PUBLIC SECTOR/ IVURIRO RYA LETA HOSPITAL/ IBITARO …………………...…D HEALTH CENTER IKIGO NDERABUZIMA…………………....E HEALTH POST IVURIRO RYUNGIRIJE …………………....F OUTREACH/ KU MUDUGUDU/ STRATEGIE AVANCEE…………………………………...G OTHER PUBLIC ANDI MAVURIRO YA LETA…..................H (SPECIFY/SOBANURA______________) PRIVATE SECTOR/ AMAVURIRO YIGENGA PRIVATE HOSPITAL IBITARO BYIGENGA ……………………….I Additional and Replacement Documentation Protocal 66 PRIVATE CLINIC KIRINIKE YIGENGA …………………..….J OTHER PRIVATE IRINDI VURIRO RYIGENGA……………………………….....K (SPECIFY/ RIVUGE________________) OTHER/ AHANDI......................................................X (SPECIFY/ HAVUGE_____________) 1 During your pregnancy with (Name), how many months pregnant were you when you first received antenatal care? Mugihe wari utwite kanaka (Izina ry’umwana) wagiye kwipimisha bwa mbere inda ifite amezi angahe? MONTHS/ AMEZI………….… DON’T KNOW/ SIMBIZI…………….88 1 During your pregnancy with (Name), how many times did you receive antenatal care?/Mugihe wari utwite kanaka (Izina ry’umwana) wipimishije inda inshuro zingahe ? TIMES/ INSHURO…………..…. DON’T KNOW/ SIMBIZI……………88 1 As part of your antenatal care during this pregnancy, were any of the following done at least once? YES/YEGO NO/OYA Additional and Replacement Documentation Protocal 67 Hari ibintu by’ingenzi bakorera umugore utwite iyo agiye kwipimisha,inda,muri ibi bikurikira ni iki baba baragukoreye nibura inshuro imwe ? A. Was your height taken?/ Bagupimye uburerebure? B. Was your blood pressure measured? Bagufatiye umuvuduko w’amaraso? C. Did you give a urine sample?/ Wigeze utanga ikizami cy’inkali? D. Did you give a blood sample?/Hari ikizami cy’amaraso wigeze utanga? A. HEIGHT/ UBUREBURE……….1 …….0 B. BP/ UMUVUDUKO W’AMARASO …………………..….1 ……..0 C. URINE/ INKARI………………….1 …….0 D. BLOOD/ AMARASO……………1 ..…….0 1 During (any of) your antenatal care visits, were you told about the signs of pregnancy complications? Mugihe wajyaga kwipimisha inda bigeze bakubwira ibimenyetso mpuruza kumugore utwite ? YES/ YEGO…………………………..…1 NO/ OYA……………………………..….0 DON’T KNOW/ SIMBIZI……………....88 16 16 1 Were you told where to go if you had any of these complications? Bigeze bakubwira aho wajya mugihe ubonye kimwe muri ibyo bimenyetso? YES/ YEGO………………………….…1 NO/ OYA…………………………….….0 DON’T KNOW/ SIMBIZI…………….88 1 During pregnancy, woman may encounter severe problems or illnesses and should go or be taken immediately to a health facility. VAGINAL BLEEDING KUVIRA KU NDA………………...…….A Additional and Replacement Documentation Protocal 68 Iyo umugore atwite ashobora guhura n’ibibazo cyangwa se uburwayi bishobora gutuma yihutira kujya kwa muganga. What types of symptoms would cause you to seek immediate care at a health facility (right away)? Ni ibihe bimenyetso by’uburwayi bishobora kugutera kwihutira kujya kwa muganga mu gihe utwite? ASK: Anything else? BAZA UTI: Nta bindi? DO NOT READ RESPONSES. RECORD ALL THAT ARE MENTIONED. IRINDE KUMUSOMERA IBISUBIZO, SHYIRA AKAMENYETSO KU BISUBIZO AGUHAYE BYOSE. FAST/DIFFICULT BREATHING/ GUHUMEKA BIMUGOYE………….....B FEVER/ UMURIRO…….…………..….C SEVERE ABDOMINAL PAIN/ KUBABARA MU NDA CYANE……….D HEADACHE/BLURRED VISION KURIBWA UMUTWE/ KUTABONA NEZA…………………………………….E CONVULSIONS/ KUGAGARA…..………….…………...F FOUL SMELLING DISCHARGE/FLUID FROM VAGINA KUZANA IBINTU BY’URUZI BINUKA………………………………....G BABY STOPS MOVING INDA NTIYONKA…………………...….H LEAKING BROWNISH/GREENISH FLUID FROM THE VAGINA KUZANA IBINTU BY’URUZI BISA N’IKIGINA CYANGWA ICYATSI Additional and Replacement Documentation Protocal 69 KIBISI……………………………………..I OTHER / IBINDI …………………….......X ______________________________ (SPECIFY/ BISOBANURE) 1 During your pregnancy with (Name of the child) did you receive an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth? Mugihe wari utwite kanaka (Izina ry’umwana) wigeze ubona urukingo ku kaboko rukingira umwana tetanus(agakwega) kugagara? YES/ YEGO……………………….……1 NO/ OYA ..………………….………….0 DON’T KNOW/ SIMBIZI………………88 19 19 1 While pregnant with (name of the child), how many times did you receive such an injection? Igihe wari utwite kanaka (Izina ry’umwana muto) urwo rukingo warutewe inshuro zingahe? ONE/ RIMWE………………………...….1 TWO/ KABIRI………….……..…………2 THREE OR MORE INCURO 3 CYANGWA ZIRENGA……3 DON’T KNOW/ SIMBIZI…………..…..88 1 Did you receive any tetanus toxoid injection at any time before that pregnancy, including during a previous pregnancy or between pregnancies? Mbere yo gutwita (Izina ry’umwana muto) YES/ YEGO……………..………….……1 NO/OYA………………………………...0 21 Additional and Replacement Documentation Protocal 70 wigeze uhabwa urukingo rwa tetanus ushyizemo mu gihe wari utwite iyabanjirije iy’uyu mwana cyangwa se mu gihe cyo hagati y’izo nda? DON’T KNOW/ SIMBIZI……..……….88 21 2 Before the pregnancy with (Name of the child), how many times did you receive a tetanus injection? Mbere yo gutwita kanaka (izina ry’umwana muto) urwo rukingo warutewe inshuro zingahe? ONE/ RIMWE………………………...….1 TWO/ KABIRI……………………………2 THREE OR MORE INCURO 3 CYANGWA ZIRENGA……3 DON’T KNOW/ SIMBIZI………………..8 21 If biological mother (i15) ask: During your pregnancy with (Name), were you given or did you buy any iron tablets/syrup? Mubaze iki kibazo niba ariwe wabyaye uyu mwana (i15): Mu gihe wari utwite (izinary’umwana muto) wigeze uhabwa cyangwa ugura ibinini/umushongi bya feri byongera amaraso? SHOW TABLETS/ BIMWEREKE YES/ YEGO……………...………….1 NO/ OYA…………………………….0 DON’T KNOW/ SIMBIZI...……….88 29 29 29 22 During the whole pregnancy, for how many days did you take the tablets/syrup? DAYS/ IMINSI……………..…|___|___| Additional and Replacement Documentation Protocal 71 If the answer is not numeric, probe for the approximate number of days. Igihe wari utwite, ibyo binini bya feri wabifashe mu minsi ingahe? Niba igisubizo aguhaye Atari umubare, komeza umubaze agereranye mu mibare. DON’T KNOW/ SIMBIZI……….….888 23. Who assisted with the delivery of (Name)? Ni nde wakubyaje kanaka(izina ry’umwana muto) ? Anyone else?/Ntawundi PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED. KOMEZA UMUBAZE KUGIRA NGO UMENYE NIBA YARABYAJWE N’UMUNTU WABIHUGURIWE IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY. NIBA AVUZE KO NTAWE, KOMEZA UMUBAZE UMENYE NIBA HARI UMUNTU MUKURU WARI UHARI MU GIHE YABYARAGA. DOCTOR/ DOGITERI…………...……..A NURSE/ UMUFOROMO ……..….........B MIDWIFE/ UMUBYAZA…..…..……….C AUXILIARY MIDWIFE/ UMUFASHA W’UMUBYAZA…….............................D OTHER HEALTH STAFF W/ MIDWIFERY SKILLS UNDI MUFOROMO UZI KUBYAZA …E TRAINED TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA WAHUGUWE.........................F TRAINED COMMUNITY HEALTH WORKER/UMUJYANAMA W’ Additional and Replacement Documentation Protocal 72 UBUZIMA WAHUGUWE……………....G TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA UTARAHUGUWE………………...…….H COMMUNITY HEALTH WORKER UMUJYANAMA W’UBUZIMA UTARAHUGUWE……………………....I RELATIVE/FRIEND/ UWO MUGIRA ICYO MUPFANA/INSHUTI/ UMUTURANYI ………………………….J NO ONE/ NTA N’UMWE.……………...Y 24. Was (NAME) dried (wiped) immediately after birth before the placenta was delivered? Nyuma y’uko kanaka(Izina ry’umwana) avuka,yaba yarahanaguwe, agafubikwa ako kanya nyuma yo kuvuka mbere yuko iyanyuma isohoka? YES/YEGO………………………………1 NO/ OYA………………………………...0 DON’T KNOW/ SIMBIZI………….….88 25. Was (NAME) wrapped in a warm cloth or blanket immediately after birth before the placenta was delivered? Kanaka (Izina) yaba yarafubitswe mubintu bishyushye(Imyenda cg ikiringiti ) akimara kuvuka? YES/YEGO……...………………………1 NO/ OYA………………………………...0 DON’T KNOW/ SIMBIZI……………. 88 26. After (Name) was born, did any health care provider or traditional birth attendant check on YES/YEGO………………………………1 29 Additional and Replacement Documentation Protocal 73 (Name’s) health? Nyuma yo kuvuka kwa, Kanaka hari ibindi uwagufashije/uwafashije nyina amubyara yaba yarakoreye uwo mwana mu rwego rwo kwita ku buzima bwe? NO/ OYA………………….……………...0 27. How many hours, days or weeks after the birth of (Name) did the first check take place? Kanaka (amazina) yaba yarasuzumwe nyuma y’igihe kingana iki amaze kuvuka? IF LESS THAN ONE DAY, CIRCLE 0 AND RECORD HOURS; IF ONE TO SIX DAYS CIRCLE 1 AND RECORD DAYS; IF MORE THAN 6 DAYS CIRCLE 2 AND RECORD WEEKS. NIBA ARI MUNSI Y’UMUNSI UMWE SHYIRA AKAMENYETSO KURI “0” KANDI WANDIKE “Amasaha”, NIBA ARI HAGATI Y’IMINSI UMWE KUGERA KURI ITANDATU SHYIRA AKAMENYETSO KURI RIMWE WANDIKE “Iminsi”, NIBA ARI HEJURU Y’IMINSI ITANDATU SHYIRA AKAMENYETSO KURI 2 KANDI WANDIKE IBYUMWERU. HOURS / AMASAHA 0 DAYS/ IMINSI 1 WEEKS/ IBYUMWERU 2 DON’T KNOW/ SIMBIZI…………..…88 28. Who checked on (Name’s) health at that time? Muri icyo gihe ninde wasuzumye uko ubuzima bwe bumeze? Anyone else?/Ntawundi? PROBE FOR THE MOST QUALIFIED DOCTOR/ DOGITERI…………...……..A NURSE/ UMUFOROMO……...............B MIDWIFE/ UMUBYAZA…….......…….C AUXILIARY MIDWIFE/ UMUFASHA W’UMUBYAZA……....…D Additional and Replacement Documentation Protocal 74 PERSON AND RECORD ALL MENTIONED.KOMEZA UMUBAZE WUMVE KO ARI UMUNTU UBIFITIYE UBUMENYI WAMUSUZUMYE KANDI ABO AKUBWIRA BOSE UBANDIKE. OTHER HEALTH STAFF WITH MIDWIFERY SKILLS. / UNDI MUFOROFO UZI KUBYAZA …………E TRAINED TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA WAHUGUWE………………............….F TRAINED COMMUNITY HEALTH WORKER/ UMUJYANAMA W’UBUZIMA WAHUGUWE .....................................G TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA UTARAHUGUWE………...........……..H COMMUNITY HEALTH WORKER/ UMUJYANAMA W’UBUZIMA UTARAHUGUWE……………………...I RELATIVE/FRIEND/ UWO MUGIRA ICYO MUPFANA/ INSHUTI/ UMUTURANYI………………………...J NO ONE/ NTA N’UMWE …………….Y Additional and Replacement Documentation Protocal 75 SECTION III: BREASTFEEDING AND CHILD NUTRITION / KONSA NO KUGABURIRAUMWANA 29 Did you ever breastfeed (NAME)? Wigeze wonsa (izinary’umwana muto)? YES/ YEGO................................. 1 NO/ OYA ................................... 0 36 30 How long after birth did you first put (NAME) to the breast? IF LESS THAN 1 HOUR, CIRCLE ‘000’ HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. Ukimara kubyara kanaka (izinary’umwana muto) wamwonkeje bwa mbere amaze igihe kingana iki avutse? NIBA ARI MUNSI Y’ISAHA IMWE SHYIRA AKAZIGA KURI 000,NIBA ARI MUNSI Y’AMASAHA 24, ANDIKA UMUBARE W’AMASAHA, NIBA ARI HEJURU Y’AMASAHA 24, ANDIKA IMINSI. Less than 1 hour / lgihe kitageze ku isaha ………….0 0 0 or / cyangwa Hours / Amasaha……………... |___|___| or / cyangwa Days / Iminsi …………………...|___|___| 31 During the first three days after delivery, did you give (NAME) the liquid that came from your breasts? Mu minsi itatu ya mbere umaze kubyara, waba waronkeje ( IZINA RY’UMWANA MUTO)? YES/ YEGO................................. 1 NO / OYA ................................... 0 DON’T KNOW/ SIMBIZI.............. 88 Additional and Replacement Documentation Protocal 76 32 During the first three days after delivery, was (NAME) given anything to drink other than breast milk? Mu minsi itatu ya mbere umaze kubyara, hari ikinyobwa wahaye kanaka kitari amashereka? YES/ YEGO................................. 1 NO / OYA ................................... 0 DON’T KNOW/ SIMBIZI ............. 88  34  34 33 What else was (NAME) given to drink during the first three days? Ni ibihe binyobwa bindi wahaye (IZINA RY’UMWANA MUTO) mu minsi itatu ya mbere? Anything else? Nta kindi? DO NOT READ THE LIST NTUMUSOMERE IBISUBIZO. RECORD ALL MENTIONED BY CIRCLING LETTER FOR EACH ONE MENTIONED SHYIRA AKAZIGA KUCYO AKUBWIYE MILK (OTHER THAN BREAST MILK) AMATA (ATARI AMASHEREKA……A PLAIN WATER / AMAZI……...…......B SUGAR OR GLUCOSE WATER / AMAZI ARIMO ISUKARI………..…….C HOME REMEDY/ IMITI YATEGURIWE MU RUGO ITARI IYO KWA MUGANGA………………………………D SUGAR-SALT-WATER SOLUTION / AMAZI ARIMO UMUNYU N’ISUKARI…………………………….…E FRUIT JUICE/ UMUTOBE W’IMBUTO …………….....F INFANT FORMULA / AMATA Y’ABANA YO Additional and Replacement Documentation Protocal 77 MU BIKOMBE…………………..….G TEA / ICYAYI………………………….....H HONEY/ UBUKI …………………………I OTHER/ IBINDI…………………….……X ________________________________ (SPECIFY/ SOBANURA) 34 Was (NAME) breastfed yesterday during the day or at night? (Izinary’umwana muto) waramwonkeje ejo kumanywa cyangwa nijoro? YES/ YEGO ................................ 1 NO / OYA.................................... 0 DON’T KNOW / SIMBIZI ............ 88 36 35 Sometimes babies are fed breast milk in different ways, for example by spoon, cup or bottle. This can happen when the mother cannot always be with her baby. Sometimes babies are breastfed by another woman, or given breast milk from another woman by spoon, cup or bottle or some other way. This can happen if a mother cannot breastfeed her own baby. Did (NAME) consume breast milk in any of these ways yesterday during the day or at night? YES/ YEGO ................................ 1 NO / OYA.................................... 0 DON’T KNOW / SIMBIZI............. 88 Additional and Replacement Documentation Protocal 78 Rimwe n arimwe abana bahabwa amashereka mu buryo butandukanye, urugero: kukayiko, mu gikombe cg mu icupa. Ibyo bishobora kuba iyo umubyeyi adashoboye kuba ari kumwe n’umwana we. Bishobora no kuba iyo umubyeyi adashobora konsa umwana we. Mbese (KANAKA) yaba yarahawe amashereka ejo kumanywa cg nijoro hakoreshejwe bumwe muri ubwo buryo maze kukubwira? 36 Now I would like to ask you about some medicines and vitamins that are sometimes given to infants. Was (NAME) given any vitamin drops or other medicines as drops yesterday during the day or night? Ubu ndashaka kukubaza ibyerekeranye n’imiti cyangwa amavitamini ajya ahabwa abana. Ese (KANAKA) yaba yarahawe ibitonyanga bya vitamin cyangwa indi miti ejo ku manywa cg nijoro? YES/ YEGO ................................ 1 NO / OYA.................................... 0 DON’T KNOW / SIMBIZI............. 88 37 Was (NAME) given ORS yesterday during the day or at night? Haba hari uruvange rw’imyunyu n’isukari(SRO) waba warahaye (izinary’umwanamuto) ejo kumanywa cg nijoro? YES/ YEGO ................................ 1 NO / OYA.................................... 0 DON’T KNOW / SIMBIZI............. 88 38 Did (NAME) drink anything from a bottle with a nipple yesterday or last night? (Izinary’umwana muto) yaba yaranywesheje YES/ YEGO ................................ 1 Additional and Replacement Documentation Protocal 79 bibero ejo kumanywa cyangwa iri joro? NO / OYA.................................... 0 DON’T KNOW / SIMBIZI............. 88 Read out Q.39 below. Read the list of liquids one by one and mark ‘yes’ or ‘no’, accordingly. After you have completed the list, follow by asking Q. 40. [See far right hand column for those items (40B, 40C, and/or 40F) where the respondent replied ‘YES’.] Soma ibibazo biri hasi, Birebana n’ikibazo cya 39. Soma urutonde rw’ibinyobwa kimwe kimwe ushyireho yego cyangwa oya, nyuma yo kurangiza urutonde, komeza ubaze ikibazo cya 40 [reba ibyanditse iburyo ( 40B, na 40C/cyangwa 40F) aho igisubizo ari ‘YEGO’]. No. QUESTIONS AND FILTERS/ IBIBAZO CODING CATEGORIES/ IBISUBIZO BITEGEREJWE QUESTIONS AND CODING CATEGORIES/ IBIBAZO N’IBISUBIZO BITEGEREJWE 39 Next I would like to ask you about some liquids that (Name) may have had yesterday during the day or at night. Did (Name) have any (ITEM FROM LIST)? READ THE LIST OF LIQUIDS STARTING WITH ‘PLAIN WATER.’ Noneho ndifuza kukubaza ibinyobwa waba wahaye umwana wawe ejo kumanywa cg nijoro. Hari ibyo waba wamuhaye? YES YEGO NO OYA DK SINZI 40 READ QUESTION 40 FOR ITEMS B, C AND F, IF CHILD CONSUMED THE ITEM. RECORD 88 for DON’T KNOW. How many times yesterday during the day or at night did (Name) consume any (ITEM FROM LIST)? SOMA IKIBAZO CYA 40 KU BISUBIZO B, C NA F, NIBA UMWANA YARABINYOYE. WANDIKE 88 AHO Additional and Replacement Documentation Protocal 80 (IBIRI KU ILISTI) SOMA URUTONDE RW’IBINYOBWA UHEREYE KU “AMAZI GUSA”. YASHUBIJE SIMBIZI. Ibi binyobwa kanaka (izinary’umwanamuto) yabifashe inshuro zingahe ku munsi haba ku manywa cyangwa nijoro? A Plain water? Amazi ? 1 0 88 B Infant formula such as Kigozi, Rinda and others? Amata y’abana yo mu bikombe nka Kigozi, Rinda n’andi? 1 0 88 B. TIMES/ Inshuro I__I__I C Milk such as tinned, powdered or fresh animal milk? Amata yo mu dukarito, ay’ifu cyangwa inshyushyu( y’inka, ihene)? 1 0 88 C. TIMES/ Inshuro I__I__I D Juice or juice drinks? Umutobe w’ibitoke cyangwa ubundi bwoko bw’imitobe? 1 0 88 E Clear broth? Isupu imeze nk’amazi? 1 0 88 F Yogurt? Yawurute? 1 0 88 F. TIMES/ InshuroI__I__I G Thin porridge? Igikoma kidafashe? 1 0 88 H Any other water-based liquids such as 1 0 88 Additional and Replacement Documentation Protocal 81 (insert local) sorghum juice? Ibindi binyobwa nk’ umusururu ? I Any other liquids? Ibindi binyobwa? 1 0 88 41 Please describe everything that (NAME) ate yesterday during the day or night, whether at home or outside the home. a) Think about when (Name) first woke up yesterday. Did (NAME) eat anything at that time? IF YES: Please tell me everything (NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. IF NO, CONTINUE TO QUESTION b). b) What did (NAME) do after that? Did (NAME) eat anything at that time? IF YES: please tell me everything (NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. REPEAT QUESTION b) ABOVE UNTIL RESPONDENT SAYS THE CHILD WENT TO SLEEEP UNTIL THE NEXT DAY. c) IF RESPONDENT MENTIONS MIXED DISHES LIKE A PORRIDGE, SAUCE OR STEW, PROBE: What ingredients were in that (MIXED DISH)? PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. AS THE RESPONDENT RECALLS FOODS, UNDERLINE THE CORRESPONDING FOOD AND CIRCLE ‘1’ IN THE COLUMN NEXT TO THE FOOD GROUP. IF THE FOOD IS NOT LISTED IN ANY OF THE FOOD GROUPS BELOW WRITE THE FOOD IN THE BOX LABELLED ‘OTHER FOODS.’ IF FOODS ARE USED IN SMALL AMOUNTS FOR SEASONING OR AS A CONDIMENT, INCLUDE THEM UNDER THE CONDIMENTS FOOD GROUP. ONCE THE RESPONDENT FINISHES RECALLING FOODS EATEN, READ EACH FOOD GROUP WHERE ‘1’ WAS NOT CIRCLED, ASK THE FOLLOWING QUESTION AND CIRCLE ‘1’ IF RESPONDENT SAYS YES, ‘0’ IF NO AND ‘8’ IF DON’T KNOW: Additional and Replacement Documentation Protocal 82 Yesterday during the day or night, did (NAME) drink/eat any (FOOD GROUP ITEMS)? Mwatubwira ibiribwa (IZINA RY’UMWANA MUTO) yagaburiwe ejo hashize kumanywa na nijoro murugo cyangwa ahandi a) Tekereza mugihe (kanaka) yamaragakubyuka ,hari icyo kurya yaba yarahawe? NIBA ARI YEGO watubwira buri kimwe cyose yaba yarariye muri icyo gihe? KOMEZA UMUBAZE UTI: Nta kindi? KUGEZA UBWO ASUBIZA KO NTA KINDI. NIBA NTACYO, KOMEZA KUKIBAZO CYA b). b) Nyuma yibyo (kanaka) yakoze iki? Hari ikintu (Kanaka) yariye muri icyo gihe? NIBA ARI YEGO: watubwira buri kimwe cyose yaba yarariye? KOMEZA UMUBAZE UTI: Nta kindi? KUGEZA UBWO ASUBIZA KO NTA KINDI. SUBIRAMO IKIBAZO CYA b) CYO HARUGURU KUGEZA UBWO UBAZWA AKUBWIRA KO UMWANA YAGIYE KURYAMA AGAKANGUKA K’UWUNDI MUNSI. c) NIBA AGUSHUBIJE IBYO KURYA BIVANGAVANZE NK’IGIKOMA, ISOSI CYANGWA IBINDI BIRYO BITETSE, KOMEZA UMUBAZE UTI: Ni ibihe biribwa byari muri iyo MVANGE y’ibiryo? KOMEZA UMUBAZE UTI: Nta cyindi yariye? KUGEZA UBWO ASUBIZA KO NTA KINDI. UKO USUBIZA AGENDA YIBUKA IBIRYO UMWANA YARIYE, UGENDE USHYIRAHO IKIMENYETSO KUCYO BIHUJE KANDI UZENGURUTSE AKAZIGA KURI”1” MU KUMBA KEGEREYE ITSINDA RY”IBIRIBWA. NIBA IBIRYO AVUZE BITARI KU ILISITI IRI HASI HANO, IBIRYO AVUZE UBYANDIKE AHAGENEWE “IBINDI BIRYO” NIBA HARI IBIRIBWA BYAKORESHEJWE MU KURYOSHYA IBIRYO NK’IBIRUNGO, UBISHYIRE AHAGENEWE ITSINDA RY’IBIRUNGO. MU GIHE USUBIZA ARANGIJE KUVUGA IBIRYO BYOSE UMWANA YARIYE< SOMA BURI KICIRI CY’IBIRYO AHO UTIGEZE USHYIRA AKAZIGA KURI “1” , UBAZE IKIBAZO GIKURIKIRA HANYUMA USHYIRE AKAZIGA KURI “1” NIBA ASHUBIJE YEGO, KURI “0” NIBA ASHUBIJE OYA, KURI “88” NIBA ASHUBIJE SIMBIZI: Ejo kumanywa cyangwa nijoro, ese (Kanaka) yaba yarariye cyangwa yaranyoye ibiryo biri muri ibi biryo ngiye kukubaza (IBIRYO MU BYICIRO)? OTHER FOODS: PLEASE WRITE DOWN OTHER FOODS IN THIS BOX THAT RESPONDENT MENTIONED BUT ARE NOT IN THE LIST BELOW Additional and Replacement Documentation Protocal 83 IBINDI BIRIBWA: ANDIKA IBINDI BIRIBWA YAVUZE BITAGARAGARA KURUTONDE RWO HASI. NO. QUESTIONS AND FILTERS/ IBIBAZO CODING CATEGORIES/ IBISUBIZO BITEGEREJWE YES/ YEGO NO/ OYA DK/ SIMBIZI A Thicker porridge, bread, rice, noodles, or other foods made from grains Igikoma gifashe, umugati, umuceri, amakaroni, cyangwa ibindi biribwa bikomoka kubinyampeke 1 0 88 B Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside Ibihaza, karoti, ibijumba by’ umuhondo cyangwa bya orange 1 0 88 C White potatoes, white yams, cassava, or any other foods made from roots Ibirayi, ibikoro, imyumbati, cyangwa ibindi biribwa bikomoka kubinyabijumba. 1 0 88 D Any dark or green leafy vegetables Imboga z’icyatsi kibisi cyane, Imboga rwatsi 1 0 88 E Ripe mangoes, ripe papayas or ripe guava Imyembe ihishije,ipapayi ihishije, cyangwe amapera ahishije 1 0 88 F Any other fruits or vegetables (such as avocado) Hari izindi mbuto cyangwa imboga uha umwana zitavuzwe haruguru (nka avoka) 1 0 88 G Liver, kidney, heart or other organ meats Umwijima, impyiko, umutima, cyangwa izindi nyama zo munda 1 0 88 H Any meat, such as beef, pork, lamb, goat, chicken or duck 1 0 88 Additional and Replacement Documentation Protocal 84 Izindinyama / Iz’inka, ingururube, intama, ihene, inkoko cyangwa imbata I Eggs / Amagi 1 0 88 J Fresh or dried fish, shellfish or seafood Amafi mabisi cyangwa yumye,isambaza ,injanga/indagara 1 0 88 K Any foods made from beans, peas, lentils, nuts or seeds Ibindi biribwank’ibishyimbo, amashaza, lantiye, ubunyobwa 1 0 88 L Cheese, yogurt, or other milk products foromage,yawurute,cyangwa ibindi bikomoka ku mata 1 0 88 M Any oil, fats or butter, or foods made with any of these Andi mavuta,ibinure cyangwa mayonese, cyangwa ibiribwa bikomoka kubyo tuvuze. 1 0 88 N Any sugary foods such as chocolates, sweets, candies, pastries cakes or biscuits Ibindi biribwa birimo isukari nka shokora, bombo, shikareti, gato cyangwa biswi 1 0 88 O Condiments for flavor, such as chilies, spices, herbs or fish powder ibiribwaby’ibirungo nk’urusenda, utundi twatsi, ifu y’indagara 1 0 88 P Grubs, snails or insects inswa ,isenani cyangwa utundi dusimba duto tuguruka 1 0 88 Q Foods made with red palm oil, red palm nut or red palm nut pulp sauce Ibiribwa byatekeshejwe amamesa 1 0 88 R Other foods not recorded on the list Ibindi biryo bitavuzwe haruguru 1 0 88 Check categories A-Q / GENZURA IBYICIRO A-Q IF ALL “NO” or “DK”  GO TO 42 Additional and Replacement Documentation Protocal 85 IF AT LEAST ONE “YES”  GO TO 43 NIBA BYOSE ARI “OYA” CYANGWA “SIMBIZI” JYA KURI 42 NIBA BYIBUZE KIMWE MURI BYO ARI “YEGO” JYA KURI 43 42 Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night? IF ‘YES’ PROBE: What kind of solid, semi-solid, or soft foods did (NAME) eat? Ese (KANAKA) yigeze arya ibiryo bikomeye , bidakomeye cyane cyangwa byoroshye ejocyangwa ijoro ryakeye? NIBA ARI YEGO KOMEZA UBAZE UTI: Ni ubuhe bwoko bw’ ibiryo bikomeye , bidakomeye cyane cyangwa byoroshye yafashe? YES/ YEGO ……………………...1 NO / OYA ……………………......0 DON’T KNOW/ SIMBIZI……….88 GO BACK TO Q41 AND RECORD FOODS EATEN THEN CONTINUE. Subira kukibazo cya 41 umusubiriremo byabibazo nyuma ukomeze 44 44 43 How many times did (NAME) eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night? No. OF TIMES/ INSHURO………………...|___|___| Additional and Replacement Documentation Protocal 86 Such as pureed cassava, potatoes, avocado or other pureed foods? WE WANT TO FIND OUT HOW MANY TIMES THE CHILD ATE ENOUGH TO BE FULL. SMALL SNACKS AND SMALL FEEDS SUCH AS ONE OR TWO BITES OF MOTHER’S OR SISTER’S FOOD SHOULD NOT BE COUNTED. LIQUIDS DO NOT COUNT FOR THIS QUESTION. DO NOT INCLUDE THIN SOUPS OR BROTH, WATERY GRUELS, OR ANY OTHER LIQUID. USE PROBING QUESTIONS TO HELP THE RESPONDENT REMEMBER ALL THE TIMES THE CHILD ATE YESTERDAY Ibiryo bikomeye ,bidakomeye cyane cyangwa ibindi biryo byoroshye ariko bitarink’amazi yabifashe inshuro zingahe ejo kumanywa cyangwa nijoro? Urugero: Ese mwamuhaye inombe y’imyumbati, y’ibijumba? Y’avoka? Cyangwa inombe y’ibindi biryo? TURIFUZA KUMENYA UMUBARE W’INSHURO UMWANA AGABURIRWA KUGEZA AHAZE. NTUBARIREMO UTWO GUHUGENZA UMWANA N’UTUNDI TUNTU DUTO ASHOBORA GUHABWA NA NYINA CYANGWA BAKURU BE. IBINYOBWA NTIBIBARWA MURI IKI KIBAZO. NTUBARIREMO AMASUPU AMEZE NK’AMAZI N’IBINDI BIRYO BIMEZE NK’AMAZI CYANGWA BINYOBWA. DON’T KNOW/ SIMBIZI ……….88 Additional and Replacement Documentation Protocal 87 KOMEZA UMUBAZE KUGIRA NGO UMUFASHE KWIBUKA INSHURO ZOSE UMWANA YAGABURIWE UMUNSI W’EJO. 44 (If yes to 41 or 42) At what age did (NAME) begin eating solid, semi-solid, or soft foods? (NIBA ARI YEGO)( kanaka) yanganaga iki mutangira kumuha ibiryo bikomeye cyangwa bidakomeye cyane cyangwa byoroshye? Age (months)/ Imyaka mumezi………….|___|___| DON'T KNOW/ SIMBIZI………………….…….88 44a (If yes to 41 or 42) Does (NAME) eat from his/her own separate bowl/cup? (Niba ari yego) Ese (Izina ry”umwana) yaba arira cyangwa agaburirwa ku gasahane/ mu gakombe ke? YES/ YEGO……….…………..…..1 NO/ OYA…………….…………..…0 45 Are you or someone in your family helping (NAME) eat? (ie. physically feeding them) Ujya ufasha (IZINA RY’UMWANA MUTO) kurya cyangwa hari undi wo mu muryango umufasha? YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 46b 46a IF NO: At what age did (NAME) start eating by himself/herself? NIBA ARI OYA: ni ku yahe mezi izina ry’umwanamuto ) yatangiye kwigaburira ubwe? Age (months)/ Imyaka mumezi………....|___|___| DON'T KNOW/ SIMBIZI……………………….….88 46b Do you encourage (NAME) to eat/feed (including when you breastfeed)? Mbese ujya ushishikariza (IZINA RY’UMWANA) kurya (no mu gihe umwonsa)? YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 47. Has (NAME) ever received a vitamin A dose (like this/any of these)? Kanaka (IZINA RY’UMWANA MUTO) yigeze ahabwa YES/ YEGO................................1 Additional and Replacement Documentation Protocal 88 ikinini cya Vitamini A? SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS MWEREKE IKININI CYA VITAMINI A GISANZWE GIKORESHWA NO/ OYA ..................................0 DON’T KNOW/ SIMBIZI ............88 49 49 48. If Yes, did (NAME) receive a vitamin A dose within the last 6 months? Niba ari Yego kanaka( izina ry’umwana muto) hari ubwo yahawe akanini ka Vitamini A mu mezi atandatu ashize YES/ YEGO ...............................1 NO/ OYA .................................... 0 DON’T KNOW/ SIMBIZI .............88 49. Has (NAME) taken any drug for intestinal worms in the past 6 months? Kanaka (izinary’umwana Muto) yaba hari utunini tw’inzoka zomunda yahawe mu mezi atandatu ashize? Show example of drug for worms Mwereke urugero rw’ibinini by’inzoka YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 DON’T KNOW / SIMBIZI……….88 49.a Has (NAME) ever received any MNP packets, like these? Kanaka (izinary’umwana Muto) yaba hari udupaki twa Ongera intungamubiri nk’utu yahawe? YES/ YEGO……..……………..…..1 NO/ OYA……………….………..…0 DON’T KNOW / SIMBIZI……….88 50 50 49b. If yes, did (NAME) receive it in the last 3 months? YES/ YEGO……..……………..…..1 Additional and Replacement Documentation Protocal 89 Niba ari Yego kanaka( izina ry’umwana muto) hari ubwo yahawe Ongera intungamubiri mu mezi atatu ashize? NO/ OYA……………….………..…0 DON’T KNOW / SIMBIZI……….88 SECTION IV: INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS/ UBUVUZIBUKOMATANIJEBW’INDWARAZ’ABANA A.DANGER SIGNS/IBIMENYETSO MPURUZA 50. Sometimes children get sick and need to receive care or treatment for illnesses. What are the signs of illness that would indicate your child needs treatment? Rimwe na rimwe abana bajya barwara bagakenera ubufasha cyangwa kuvurwa, ni ibihe bimenyetso byakwereka ko umwana wawe urwaye akeneye kuvuzwa? RECORD ALL MENTIONED. ANDIKA IBYO AKUBWIYE BYOSE. Don’t Know/ Simbizi …………...….A Looks Unwell Or Not Playing Normally/Kwigunga cg kudakina n’abandi............................................B Not Eating Or Drinking/Ntabasha kurya/kunywa……………………....C Lethargic Or Difficult To Wake Gucika intege bikabije…......................D High Fever/ Umuriro mwinshi….….E Fast Or Difficult Breathing/ Guhumeka insigane cg Additional and Replacement Documentation Protocal 90 bimugoye......................................F Vomits Everything/ Kuruka ibintu byose…………………………….G Convulsions/ Kugagara…..……….H Gets worse despite home care Kurushaho kuremba .…………... I Looks dehydrated (dry mouth or no tears)/Amazi yamushizemo (iminywa yumye, cg nta turira)…………………....J Other/ Ibindi ____________________K (Specify/ Sobanura) B.CONTROL OF MALARIA/GUKURIKIRANA MALARIYA 51. Has (Name) been ill with fever at any time in the last 2 weeks? Kanaka ( izina ry’umwana muto ) yigeze agira umuriro mubyumweru bibiri bishize? YES/ YEGO ................................ 1 NO/ OYA ................................... 0 DON’T KNOW/ SIMBIZI ................88 57 57 52. Did you seek advice or treatment for (NAME’S) YES/ YEGO................................. 1 Additional and Replacement Documentation Protocal 91 fever? Waba waragiriwe inama cyangwa waravuje kanaka (izina ry’umwana muto) igihe yari afite umuriro? NO/ OYA.................................... 0 57 53 Where did you first go for advice or treatment for fever? Nihe wabanje kujya kugisha inama cyangwa kumuvuza? Hospital/ Ku bitaro bikuru ……......01 Health Center Ku kigo nderabuzima………..……..02 Health Post/ Poste de Sante ….......03 Community Health Worker Umujyamana w’ubuzima binome...04 Traditional Practitioner Umuvuzi wa gihanga………………05 Shop/ Mu Isoko………………….….06 Pharmacy/ Farumasi………..……...07 Friend/Relative Inshuti/Abavandimwe ………………08 Other/ Ahandi_________________09 (Specify/ Sobanura) 54. How long after you noticed (NAME’S) fever did you seek treatment? Wamuvuje amaze igihe kingana iki afashwe Same Day/ Uwo munsi……………...0 Additional and Replacement Documentation Protocal 92 n’umuriro? Next Day/ Umunsi ukurikiyeho……1 Two Days/ Nyuma y’iminsi 2………2 Three Or More Days/ Nyuma y’iminsi 3/irenga ……..……3 Don’t Know/ Simbizi ……………...88 55. At any time during the illness, did (Name) take any drugs for the fever? Hari imiti y’umuriro Kanaka (Izina ry’umwana) yahawe mu gihe yari arwaye? YES/ YEGO ................................ …….1 NO/ OYA.................................... …….0 DON’T KNOW/ SIMBIZI……..……..88 57 57 56. Which medicines were given to (NAME) for his/her fever? Ni iyihe miti yahawe kubera impanvu z’umuriro? CIRCLE ALL MEDICINES THAT WERE GIVEN. SHYIRA AKAZIGA KU MUTI WOSE AKUBWIYE KO YAHAWE IF MOTHER IS UNABLE TO RECALL DRUG NAME(S), ASK HER TO SHOW THE DRUG(S) TO YOU. IF SHE IS UNABLE TO SHOW YOU THEM, SHOW HER TYPICAL ANTI-MALARIALS AND HAVE HER IDENTIFY WHICH WERE GIVEN. NIBA UMUBYEYI ADASHOBOYE KUKUBWIRA IYO MITI, MUSABE AYIKWEREKE, NIBA ADASHOBOYE KUYIKWERERA MWEREKE IMITI YA MALARIYA ITANDUKANYE AKWEREKE IYO YAKORESHEJE. ANTI-MALARIAL DRUGS/IMITI IRWANYA MALARIYA A. Coartem/ Primo……0 1 2 3 8 B. Quinine/kinini………..0 1 2 3 8 Other Drugs/ Indi miti C. Paracetamol Parasitamolu………....0 1 2 3 8 D. Unknown Drug/ Ntuzwi…0 1 2 3 8 Additional and Replacement Documentation Protocal 93 FOR EACH ANTI-MALARIAL MEDICINE ASK: KURI BURI MUTI WA MALARIYA, MUBAZE UTI: How long after the fever started did (NAME) start taking the medicine? Yatangiye kuwufata amaze igihe kingana iki afashwe n’umuriro? CIRCLE THE APPROPRIATE CODE/ SHYIRA AKAZIGA KU GISUBIZO AKUBWIYE . CODES/ KODE: SAME DAY/UWO MUNSI= 0 NEXT DAY AFTER THE FEVER UMUNSI UKURIKIYEHO = 1 TWO DAYS AFTER THE FEVER NYUMA Y’IMINSI 2 = 2 THREE OR MORE DAYS AFTER THE FEVER NYUMA Y’IMINSI 3 CYANGWA IRENGA = 3 DON’T KNOW/ SIMBIZI =88 E. Other/ Undi_________0 1 2 3 8 _______________________________ (Specify/ Sobanura) 57. Does your household have any mosquito nets that can be used while sleeping? Mu rugo rwawe mufite inzitiramibu mukoresha? YES/ YEGO................................. 1 NO/ OYA ................................... 0 62 Additional and Replacement Documentation Protocal 94 58. Who slept under a bed net last night? Ni bande baraye mu nzitiramibu iri joro ryakeye? RECORD ALL MENTIONED SHYIRA IKIMENYETSO KU BO AKUBWIYE IF ANYONE OTHER THAN THE CHILD OF INTEREST IS MENTIONED, CIRCLE “OTHER.” NIBA HARI ABANDI BAYIRAYEMO BATARI UWO MWANA, SHYIRA IKIMENYETSO KURI “ABANDI” No One/ Nta numwe…………..…… 0 Child (Name)/ Umwana…..………...1 Nyina w’umwana……………………..2 Other/ Undi………………………..…..3 62 59 59. Which brand of bed net did (Name) sleep under last night? Ni ubuhe bwoko bw’inzitiramibu kanaka (amazina y’umwana) yarayemo iri joro ryakeye? READ THE PIECE OF PAPER ON THE BEDNET WHICH SHOWS THE BRAND OF THIS BEDNET SOMA KU GAPAPURO KARI KU NZITIRAMIBU GASOBANURA UBWOKO BWAYO BRAND OPTIONS NEED TO MATCH WHAT IS LOCALLY AVAILABLE IN EACH CATEGORY. THE PURPOSE OF THIS QUESTION IS TO IDENTIFY WHAT TYPE OF NET IS BEING USED BURI BWOKO BWOKO KURI IYI LISTI BUGOMBA GUHUZWA N’UBWOKO BW’ INZITIRAMIBU BUBONEKA MURI AKO GACE. IMPAMVU Y’IKI KIBAZO NI UKUGIRA NGO TUMENYE NEZA UBWOKO BW’INZITIRAMIBU BUKORESHWA LONG LASTING NET/ INZITIRA MIBU IKORANYWE UMUTI Permanet…………………..….1 Olyset…..……………………..2 Netprotect………………….…3 DON’T KNOW/ SIMBIZI …..88 PRETREATED NETS/ INZITIRAMIBU IKARISHYWA No tag/Nta gapapuro………...4 DON’T KNOW/ SIMBIZI …….88 OTHER NET (UNTREATED)/ IZINDI NZITIRAMIBU ZIDAKARISHIJE OTHER NET/ IZINDI………...…5 Specify/ Sobanura ……………6 62 62 62 Additional and Replacement Documentation Protocal 95 DON’T KNOW/ SIMBIZI …....88 60. Was the bed net that (Name) slept under last night ever soaked or dipped in a liquid treated to repel mosquitoes or bugs? Inzitiramibu kanaka (amazina y’umwana) yarayemo iri joro yigeze ikarishywa? YES/ YEGO ................................ 1 NO/ OYA ................................... 0 DON’T KNOW/ SIMBIZI …….88 62 62 61. How long ago was the net last soaked or dipped in a liquid treated to repel mosquitoes or bugs? Iyo nzitiramibu imaze igihe kingana iki ikarihijwe? IF LESS THAN ONE MONTH AGO, RECORD 00 MONTHS. NIBA IMAZE IGIHE KIRI MUNSI Y’UKWEZI KUMWE, ANDIKA AMEZI 00 IF LESS THAN 2 YEARS AGO, RECORD MONTHS AGO. PROBE FOR EXACT NUMBER OF MONTHS. NIBA ICYO GIHE KIRI MUNSI Y’IMYAKA IBIRI, ANDIKA UMUBARE W’AMEZI ASHIZE. KOMEZA UMUBAZE UMENYE NEZA UMUBARE W’AMEZI ASHIZE. MONTHS/ AMEZI I___I___I MORE THAN 2 YEARS AGO/ HEJURU Y’IMYAKA IBIRI …………2 DON’T KNOW/ SIMBIZI………….…88 C. PNEUMONIA/GUKURIKIRANA UMUSONGA 62. Has (Name) had an illness with a cough that comes from the chest at any time in the last two weeks? Kanaka (Amazina y’umwana) yaba yarigeze arwara inkorora no kubabara mu gatuza igihe icyo aricyo cyose mu byumweru bibiri YES/ YEGO…………………….....1 NO/ OYA..............................….0 Additional and Replacement Documentation Protocal 96 bishize? DON’T KNOW/ SIMBIZI …...88 66 66 63. When (Name) had an illness with a cough, did s/he have trouble breathing or breath faster than usual with short, fast breath? Mu gihe kanaka (izina ry’umwana muto) yari arwaye inkorora, yahumekaga insigane cyangwa yahumekaga bimugoye? YES/ YEGO .................................1 NO/ OYA .................................... 0 DON’T KNOW/ SIMBIZI ………………..88 66 64. Did you seek advice or treatment for the cough/fast breathing? Wigeze usaba inama cyangwa ushaka umuti w’ inkorora, guhumeka insigane cyangwa guhumeka bimugoye? YES/ YEGO .................................1 NO/ OYA ................................... 0 66 65. Who gave you advice or treatment? Anyone else? Record all mentioned. Ninde waba yarakugiriye inama cyangwa akaguha umuti? Ntawundi? ANDIKA ABO AKUBWIYE BOSE. Doctor/ Dogiteri………………………….A Nurse/ Umuforomo……………………….B Community Health Worker Umujyanama w’ubuzima binome…....C Other/Undi_______________________D Sobanura D.CONTROL OF DIARRHEAL DISEASES/GUKURIKIRANA INDWARA Z’IMPISWI Additional and Replacement Documentation Protocal 97 66. Has (NAME) had diarrhea in the last 2 weeks? Kanaka ( izina ry’umwana muto ) yigeze arwara impiswi mu byumweru bibiri bishize Bavugako umwana arwaye impiswi iyo agiye ku musarane inshuro zirenze 3 ku munsi kandi yituma umusarani w’amazi. YES/ YEGO ................................ 1 NO/ OYA .................................... 0 DON’T KNOW/ SIMBIZI …………………...88 76 76 67. What was given to treat the diarrhea? Ni iki wamuhaye kugira ngo impiswi ihagarare ? Anything else?/Ntakindi ? If answer pill or syrup, show local packaging for zinc and ask if the child received this medicine. Niba ari ibinini cg imiti y’amazi, mwereke ibinini bya zinc noneho umubaze niba umwana yarahawe iyo miti. RECORD ALL MENTIONED. ANDIKA IBO AVUZE BYOSE. NOTHING/ NTACYO……………………………….A FLUID FROM ORS PACKET/ URUVANGE RW’IMYUNYU……………………………………....B HOME-MADE FLUID/ IBYO KUNYWA BITEGURIWE IMUHIRA ………………………..…C PILL OR SYRUP,ZINC/ IKININI,UMUTI W’ AMAZI, ZINC ……………………………………...D PILL OR SYRUP, NOT ZINC/ IBININI,UMUTI W’AMAZI NTA ZINC…………………………….….E INJECTION/ URUSHINGE…………………………F Additional and Replacement Documentation Protocal 98 (IV) INTRAVENOUS/ SERUMU…………….…….G HOME REMEDIES/ HERBAL MEDICINES/ IMITI Y’IBYATSI……………………………………….…...H OTHER/ IBINDI_________________________ X (SPECIFY/ BISOBANURE) 68. If the child is exclusively breastfed (only taking breastmilk), ask only this question and then skip to Q 71 Niba umwana yonka gusa baza gusa iki kibazo noneho uhite ujya ku kibazo cya 71 When (name of child) was sick, was s/he offered more breastmilk than usual, about the same amount, or less than usual? Mu gihe Kanaka (izina ry’umwana muto) yari arwaye, yonkejwe inshuro nyinshi kuruta ubusanzwe, zingana cyangwa nkeya kubusanzwe? Less than usual/Nkeya k’ubusanzwe...A Same amount/ Zingana …………………B More than usual/ Ziruta ubusanzwe ….C 69. When (NAME) had diarrhea, was he/she offered less than usual to drink, about the same amount, or more than usual to drink? Mu gihe Kanaka (izina ry’umwana muto) yari arwaye impiswi, yahawe ibinyobwa bike, bingana cyangwa biruta ibyo yarasanzwe anywa? Less than usual/Nkeya k’ubusanzwe...A Same amount/ Zingana …………………B More than usual/ Ziruta ubusanzwe …..C 70. When (name of child) was sick, was s/he offered more than usual to eat, about the same amount, or less than usual to eat? Mu gihe Kanaka (izina ry’umwana Less than usual/Nkeya k’ubusanzwe...A Same amount/ Zingana …………………B Additional and Replacement Documentation Protocal 99 muto) yari arwaye impiswi, yahawe ibyo kurya bike, bingana cyangwa biruta ibyo yarasanzwe arya? More than usual/ Ziruta ubusanzwe ….C 71. Was s/he given any of the following to drink at any time s/he started having diarrhea? Mugihe Kanaka yari atangiye kugira impiswi hari ibyo wamuhaye muri ibi binyobwa bikurikira: Read the choices to the mother and circle all mentioned: Bimusomere maze ushyire akaziga kubyo akubwiye byose A fluid made from a special packet called (local name for ORS packet) Uruvange rw’imyunyu (SRO)……………..…...A Cereal based ORT (rice water, maize water) Amazi avura impiswi (Amazi y’umuceri)........B Other home available fluids/ Ibindi binyobwa byateguriwe imuhira ………..C Bisobanure 72. Did you seek advice or treatment from someone outside of the home for (NAME’S) diarrhea? Igihe Kanaka yari arwaye impiswi,wigezeushaka inama cyangwa umuti hanze y’urugo? YES/ YEGO ........................... 1 NO/ OYA ............................... 2 75 73. Where did you first go for advice or treatment? 3 Washakiye inama cyangwa wamuvurije he bwa mbere? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE HEALTH FACILITY/ AMAVURIRO HOSPITAL/ IBITARO BIKURU ……………….01 HEALTH CENTER/ IKIGO NDERABUZIMA ………………………..02 HEALTH POST/ IVURIRO RYUNGIRIJE ……………….……….03 Additional and Replacement Documentation Protocal 100 NAME OF THE PLACE. NIBA AHO YAKUYE IMITI ARI KUBITARO,KU KIGO NDERABUZIMA CG MU IVURIRO RYIGENGA , ANDIKA IZINA RYAHO. _________________________________ _____________________________ (NAME OF PLACE/ IZINA RY’AHO HANTU) CHW / UMUJYANAMA W’UBUZIMA ……….06 OTHER HEALTH FACILITY/ IRINDI VURIRO _____________________________________07 (SPECIFY/RISOBANURE) OTHER SOURCE/ AHANDI YAKUYE IMITI TRADITIONAL PRACTITIONER UMUVUZI WA GIHANGA…………………....08 SHOP/ MU IDUKA.…………………….…..…09 PHARMACY/ FARUMASI………………..…10 FRIEND/RELATIVE INSHUTI CG UMUVANDIMWE ……..…….12 OTHER/ ABANDI____________________88 (SPECIFY/ BAVUGE) 74. Who decided that you should go there for (NAME’S) diarrhea? Ninde wafashe icyo cyemezo cyo kumujyanayo (kumuvuza)? RESPONDENT/ USUBIZA……………………. A HUSBAND/PARTNER/ UMUGABO………… ..B RESPONDENT’S MOTHER/ NYINA W’USUBIZA………………………………………. C Additional and Replacement Documentation Protocal 101 RECORD ALL MENTIONED. ANDIKA IBYO AKUBWIYE BYOSE. MOTHER-IN-LAW NYIRABUKWE W’USUBIZA … ………………..D FRIENDS/NEIGHBORS INSHUTI/ABATURANYI ……………………….E OTHER/ABANDI______________________ X (SPECIFY/ BASOBANURE) 75. Since (NAME) has been recovering from diarrhea, did you give him/her less than usual to eat, about the same to eat, or more than usual to eat? Mugihe umwana yari akimara gukiruka impiswi, mbese mwamuhaye ibyo kurya bike, bingana cyangwa byinshi kuruta ibyo yari asanzwe ahabwa? LESS/ BIKE……………………………………1 SAME/ BINGANA……………………………..2 MORE/ BIRUTA…………………………..……3 STILL HAS DIARRHEA/ ARACYAHITWA ... 4 DON’T KNOW/ SIMBIZI………………………88 SECTION V: WATER & SANITATION / AMAZI N’ISUKURA 76. Do you treat your water in any way to make it safer for drinking? Hari uburyo mukoresha mu gutu nganya amazi yokunywa? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………...…0  78 77. IF YES: What do you usually do to Let It Stand And Settle/ Additional and Replacement Documentation Protocal 102 the water to make it safer to drink? Niba ariYego: ubikora ute ngo wize reko amazi ari meza yokunyobwa? (ONLY CHECK MORE THAN ONE RESPONSE, IF SEVERAL METHODS ARE USUALLY USED TOGETHER, FOR EXAMPLE, CLOTH FILTRATION AND CHLORINE) SHYIRA IKIMENYETSO KU GISUBIZO KIRENZE KIMWE NIBA AKORESHA UBWO BURYO BWOSE ICYARIMWE, URUGERO: KUYAYUNGURURA UKORESHEJE CHLORINE CYANGWA AGATAMBARO. Sedimentation kuyatereka akiyungurura……….A Strain It Through Cloth Kuyayunguruza agatambaro……………………...B Boil/ kuyateka………………………………………..C Add Bleach/Chlorine Kuyashyiramo sur’eau/kolorine………………….D Water Filter (Ceramic, Sand, Composite) Kuyayunguruza filitire(iyakizungu, amakara, umucanga…………………..….……………………..E Solar Disinfection/ Kwica udukoko ukoresheje izuba………………...F Don’t Know/ simbizi…………………………….….G Other/ Ikindi______________________________H (Specify/ Sobanura) 78. When do you wash your hands? Ni ryari ukaraba intoki? Never / nta narimwe …………..……………………….A Before Food Preparation / Mbere yogutegura 81 Additional and Replacement Documentation Protocal 103 DO NOT PROMPT. CIRCLE ALL MENTIONED. NTUMUHAGARIKE, KOMEZA WUMVE IBYO AKUBWIRA USHYIRE AKAMENYETSO KU BYO AKUBWIRA BYOSE. amafunguro.………………………………………….….B Before Feeding Child / Mbere yo konsa/ mbereyo kugaburira umwana………………………………..…C After Defecation/Visiting The Toilet / Nyuma yo ku kuva ku musarane …………………………………...D After attending to a child who has defecated/soiled / Nyuma yo gutunganya/guhanagura umwana umaze kwituma…………………………….……………………E Other/ Ikindi ihe.____________________________F (Specify/ Sobanura) 79 Can you show me where you usually wash your hands and what you use to wash hands? Mushobora kunyereka aho mukarabira intoki n’icyo mukoresha mukaraba intoki? ASK TO SEE AND OBSERVE MUSABE ABIKWEREKE NAWE WITEGEREZE. Inside/Near Toilet Facility/ Mu musarane imbere cyangwa hafi yawo…….….1 Inside/Near Kitchen/Cooking Place/ mu gikoni, Iruhande rwacyo/ aho batekera……………….…. 2 Elsewhere In Yard Ahantu aho ari ho hose mu rugo………………....3 Outside Yard/ inyumay’urugo………….…....…….4 No Specific Place Nta mwanya wihariye uhari…………………….…..5 Additional and Replacement Documentation Protocal 104 No Permission To See Ntakwemereye kuhareba …………………….……8 80a. OBSERVATION ONLY: Is there soap or detergent or locally used cleansing agent? This item should be either in place or brought by the interviewee within one minute. If the item is not present within one minute check none, even if brought out later. (ONLY CHECK MORE THAN ONE IF SEVERAL CLEANING AGENTS ARE USED) ITEGEREZE GUSA: Hari isabune cyangwa ibindi bikoreshwa mu gukaraba intoki? Icyo gikoresho gishobora kuba gihari cyangwa kikazanwa n’umubyeyi Soap/ Isabune isanzwe………………….…………A Detergent/ Isabune y’ifu nka omo………………..B Ash/ Ivu…………………………………………….…C Mud/Sand/ Icyondo/ Akabuye………………….…D None/ Ntanakimwe………………………………....E Other/ Ikindi______________________________F (Specify/ Sobanura) Additional and Replacement Documentation Protocal 105 mu gihe cy’umunota umwe gusa. Niba kitabonetse mu munota umwe, kibarwa nk’ikidahari. (SHYIRA IKIMENYETSO KU GIKORESHO CYOSE YIFASHISHA AKARABA INTOKI ) 80b OBSERVATION ONLY: Specify what kind of hand washing facility is used, if any? (ONLY CHECK MORE THAN ONE IF SEVERAL FACILITIES ARE USED) ITEGEREZE GUSA: Bakoresha ibihe bikoresho bakaraba? (SHYIRA IKIMENYETSO KU Tippy tap / Kandagira ukarabe ……………………A Basin/ Ibase…………………………………….…… B Jerry can / jug: injerekani / ijage…………………C Pan / pot / : Isafuliya/ Inkono ……………………D Sink / Lavabo ……………………………………...E None/ Nta nakimwe ……………………………..…F Other/ Ikindi_____________________________G (Specify/ Sobanura) Additional and Replacement Documentation Protocal 106 GIKORESHO CYOSE YIFASHISHA AKARABA INTOKI ) 80c. (If pan, pot, bowl, or basin) What else, if anything, are you using this receptacle for other than hand washing? (ONLY CHECK MORE THAN ONE IF SEVERAL ARE PRACTICED) (Niba ari isafuliya,inkono cyangwa ibase ) mubaze undi murimo akoresha ibi bikoresho utari gukaraba intoki? (SHYIRA IKIMENYETSO KU BYO AKUBWIYE BYOSE) Nothing else/ Ntakindi……………………………A Food preparation/ Gutegura Amafunguro……B Laundry/ Kumesa………………….……………..C Other/ Ibindi____________________________D (Specify/ Sobanura) 81. What kind of toilet facility do you have? Can I see it? Umusarane mukoresha umeze ute? No toilet facility/ Nta musarane ………………….1 Open latrine/ Umusarane udapfundikiye ………2 Additional and Replacement Documentation Protocal 107 Nshobora kuwureba ? Closed latrine/ umusarane upfundikiye……..….3 Flush toilet/ umusarane wa kizungu…………..…4 No permission to see/ ntiyakwemereye kureba….5 82. The last time (NAME) passed stools, where were the feces disposed of? Igihe cyashize (izina ry’umwana) amaze kwituma umwanda we wawushyize he? Probe to find the location. Komeza umubaze wumve aho yaba ashyira umwanda w’umwana. Disposed into a latrine or toilet facility Yawushyize mu musarane ………………………....1 Disposed into a garbage/ trash bin yawushyize mu kintu kijyamo imyanda cyangwa ahagenewe imyanda…………………....….2 Dug and buried – near the house or in the yard?/ Yawushyize iruhande rwinzu cyangwa kure yayo ……………………………………………………...3 Dug and buried – far from the house or yard?/ Yawushyize cyangwa yawutabye kure yinzu cyangwa ahandi..........................................................4 Did not bury – near the house or yard / Ntiyawutabye hafi yinzu cyangwa ahandi……………………………………….………..…...5 Did not bury – far from the house or yard / Ntiyawutabye kure yinzu cyangwa ahandi …….....6 Don’t know/ Simbizi……………………..……............7 Additional and Replacement Documentation Protocal 108 Other/ Ahandi______________________________8 (Specify/ Sobanura) SECTION VI: IMMUNIZATION/ IKINGIRA 83. Did you receive a card or child health booklet where (name of child’s) vaccinations and Vitamin A doses can be written down? If so, can I see the card? Ese ufite igipande kanaka(izina ry’umwana) yakingiriweho, yanahereweho vitamine A? Niba gihari wakinyereka? Yes, interviewer sees the card Yego, ubaza abonye igipande ……………….A Yes, but card is missing or lost Yego, ariko igipande ntagihari ……………….B No, never had a card Oya, nta gipande afite.…………………………..C Don’t know / Simbizi …………….…………....…D 86 86 86 84. Date of Immunization/ Itariki y’ikingira DAY/ UMU NSI MONT H/UK WEZI YEAR/UM WAKA BCG/ IGITUNTU POLIO 0 / IMBASA 0 (POLIO GIVEN AT BIRTH OR BEFORE 6 WEEKS URUKINGO RW’IMBASA RUTANZWE UMWANA AKIVUKA CYANGWA MBERE Y’IBYUMWERU BIBIRI) Additional and Replacement Documentation Protocal 109 POLIO 1 POLIO 2 POLIO 3 PENTA-1 PENTA-2 PENTA-3 HEPATITE B 1 HEPATITE B 2 HEPATITE B 3 Measles/ Iseru Vitamin A (most recent dose Akanini aherutse kubona) Vitamin A (previous dose Akanini kabanjirije agaheruka) 85. Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations given during immunization campaigns? Kanaka hari urundi rukingo yaba yarahawe rutari kugipande, ushyizemo n’izo yaherewe mu ikingira rusange? Yes/ Yego...................................1 No/ Oya ...................................... 0 93 93 Additional and Replacement Documentation Protocal 110 Don’t Know/ Simbizi ...............88 86. Please tell me if (NAME) received any of the following vaccinations: Ndabasaba kumbwira niba (KANAKA ) yarahawe izi nkingo zikurikira: BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar? Urukingo rw’igituntu, rumwe bakingira umwana kukaboko cg ku rutugu rukamusigiraho inkovu? Yes/ Yego.................................. 1 No/ Oya ..................................... 0 Don’t Know/ Simbizi................ 88 87. Polio vaccine, that is, drops like these, in the mouth? Urukingo rw’imbasa Igitonyanga baha umwana mukanwa? SHOW THE EXAMPLE OF POLIO DROPS MWEREKE URUGERO RW’ IGITONYANGA. Yes/ Yego.................................. 1 No/ Oya ..................................... 0 Don’t Know/ Simbizi................ 88 90 90 88. When was the first polio vaccine received? [In the first two weeks after birth or later? Niryari umwana yahawe urukingo rwa mbere rw’imbasa?(Mu byumweru bibiri bya mbere amaze kuvuka cg nyuma yabyo) First Two Weeks After Birth Mubyumweru bibiri bya mbere avutse ……1 Later/ Nyuma yaho……………………………..2 Don’t Know/ Simbizi……………………………88 89. How many times was the polio vaccine received? Urukingo rw’imbasa yarubonye Number Of Times/ Incuro ...... Don’t Know/ Simbizi…………………………88 Additional and Replacement Documentation Protocal 111 inshuro zingahe? 90. DTP vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops? Urukingo batera ku kibero akenshi batangira rimwe n’urw’imbasa yararuhawe? Yes/ Yego.................................. 1 No/ Oya ..................................... 0 Don’t Know/ Simbizi................ 88 92 92 91. How many times? Yaruhawe inshuro zingahe? Number Of Times/ Incuro....... Don’t Know/ Simbizi…………………………88 92a. Did (name of child) ever receive an injection in the arm to prevent Measles? Ese Kanaka (Izina ry’umwana muto) yaba yarakingiwe urukingo rw’iseru? Yes/ Yego.................................. 1 No/ Oya ..................................... 0 Don’t Know/ Simbizi………………..88 92b. Did (name of child) ever receive a dose of vitamin A? Ese Kanaka (Izina ry’umwana muto) yaba yarahawe ikanini cya Vitamini A? Yes/ Yego.................................. 1 No/ Oya ..................................... 0 Don’t Know/ Simbizi………………88 93 93 92c. When was the last dose of vitamin A? Ikinini cya vitamin A aherutse kugihabwa ryari? Less than 6 months/ Amezi 6 ntarashira……1 More than 6 months/ Amezi 6 ararenga……2 Don’t Know/ Simbizi…………………..………88 SECTION VII: ANTHROMPOMETRICS/ IBIPIMO 93 May I weigh (name of child)? Nshobora gupima (izinary’umwana muto) ibiro? Yes/ Yego ……………….1st __________ Additional and Replacement Documentation Protocal 112 Measure twice. If difference in weight is more than 0.5 KG, measure a third time. Pima umwana inshuro ebyiri ,niba ikinyuranyo cy’ibiro by’umwana ari inusu( 500 gs) ongera umupime bwa gatatu Kilograms/ Ibiro 2nd __________ Kilograms/ Ibiro 3rd __________ Kilograms/ Ibiro No/ Oya…………….0 94 May I use MUAC Tape with (name of child)? Nshobora gupima umuzenguruko w’ikizigira (izinary’umwanamuto)? Measure twice. If difference in length is more than 0.5 CM, measure a third time. Pima umwana inshuro ebyiri ,niba ikinyuranyo cy’umuzenguruko w’ikizigira by’umwana ari 0.5 cm ongera umupime bwa gatatu Yes / Yego……………1st ____________ cm/ santimetero 2nd ____________ cm/ santimetero 3rd ____________ cm/ santimetero No/ Oya…………….0 Additional and Replacement Documentation Protocal 113 95. May I measure length for (name of child)? Nshobora gupima uburebure bw’umwana? Measure twice. If difference in length is more than 0.5 CM, measure a third time. Pima umwana inshuro ebyiri ,niba ikinyuranyo cy’uburebure bw’umwana ari 0.5 cm ongera umupime bwa gatatu Yes / Yego……………1st ____________ cm/ santimetero 2nd ____________ cm/ santimetero 3rd ____________ cm/ santimetero No/ Oya…………….0 95a. Check if (name of child) has oedema in both feet / Suzuma urebe niba (Izina ry’umwana muto) yaba afite edeme ku maguru yombi. Yes/ Yego……………………………………………..1 No/ Oya………………………………………………..0 96 May I use MUAC Tape with you? Nshobora gupima umuzenguruko w’ikizigira cy’akaboko kawe? Measure twice. If difference in length is more than 0.5 CM, measure a third time. Pima umubyeyi inshuro ebyiri ,niba ikinyuranyo cy’umuzenguruko w’ikizigira cy’umubyeyi ari 0.5 cm ongera umupime bwa gatatu Yes / Yego…………..1st ____________ cm/ santimetero 2nd ____________ cm/ santimetero 3rd ____________ Additional and Replacement Documentation Protocal 114 cm/ santimetero No/ Oya…………….0 SECTION VIII: BEHAVIOR CHANGE COMMUNICATION/IKIGANIRO KIGAMIJE GUHINDURA IMYITWARIRE 97. In the past 6 months, have you participated in a week-long training on child feeding and food preparation? Mu mezi 6 ashije , waba warigeze witabira inyigisho zimara icyumweru zijyanye no kugaburira umwana no gutegura amafunguro mu mudugudu? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0 DON’T KNOW / SIMBIZI……..........88  101  101 98. IF YES: How many times? NIBA ARI YEGO: wazigiyemo inshuro zingahe ? Once/ Rimwe………………………………1 Twice/ Kabiri…………………………....…2 Three or more/ Gatatu cyangwa karenga…………………………………….3 99. When was the most recent time you participated in such a week-long training? Ni ryari uherutse gukurikirana izo nyigisho zimara icyumweru? Month/Ukwezi ______________________ Year/ Umwaka ______________________ 100. The most recent time, how many of the days did you participate? Izo uherutse wazitabiriye iminsi ingahe? Number / Umubare………………|___|___| Don’t know/ Simbizi………………..…88 No response/ Nta gisubizo………….99 Additional and Replacement Documentation Protocal 115 101. Did you receive a visit related to health in the past month? Hari uwaba yaragusuye mu byerekeranye n’ubuzima mu kwezi gushize? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0 DON’T KNOW / SIMBIZI……..........88 101a. If yes, who visited you? Niba ari yego ni nde? Do not prompt; Circle all that apply. Wimuca mu ijambo andika ibyo akubwiye aho bigomba kujya. Care group member/ Uri mu itsinda ry’ubuzima (care group)……………….A Health facilities staff/ Umukozi w’ivuriro………………………..B Local government staff/ Umuyobozi mu nzego z’ibanze………..C Others?/ Abandi?__________________D (Specify/ Sobanura) 102 If yes, can you tell me what the purpose of the visit was? Niba ari yego, wambwira icyamugenzaga? Do not prompt; Circle all that apply. Wimuca mu ijambo andika ibyo akubwiye aho bigomba kujya. A. FOLLOW UP ON SICK CHILD GUKURIKIRANA UMWANA URWAYE B. PROVIDE HEALTH EDUCATION ON MALARIA PREVENTION GUTANGA INYIGISHO ZO KWIRINDA MALARIYA C. PROVIDE HEALTH EDUCATION ON DIARRHEA PREVENTION GUTANGA INYIGISHO ZO KWIRINDA IMPISWI D. PROVIDE HEALTH EDUCATION ON PNEUMONIA GUTANGA INYIGISHO KUNDWARA Y’UMUSONGA Additional and Replacement Documentation Protocal 116 E. PROVIDE HEALTH EDUCATION ON NUTRITION GUTANGA INYIGISHO KU MIRIRE F. PROVIDE HEALTH EDUCATION ON IMMUNIZATION GUTANGA INYIGISHO KU IKINGIRA G. OTHER/ IKINDI: ____________________ (Specify/ Sobanura) 103. Did you receive any health information from a CHW in the last month? If yes, where did you receive that health information? Hari inyigisho wigeze uhabwa n’umujyanama w’ubuzima muri uku kwezi gushize? Niba ari yego, izo nyigisho waziboneyehe? A. Home visit Mu isura ry’ingo…………………..A B. Community Meeting/Mu nama y’umudugudu cg iy’Akagali………B C. Health Facility Ku Kigo Nderabuzima………………C D. Growth Monitoring and Counseling Mu gihe cyo gukurikirana imikurire y’abana mu Akagali…………………..D E. Nutrition Week/ Mu cyumweru cy’Imirire……………………………….E F. Other/Ahandi.....................................F ________________________________ (Specify/Sobanura) G. Did not receive any health information Additional and Replacement Documentation Protocal 117 from a CHW last month. Ntabwo yigeze ahabwa inyigisho z’ubuzima n’Umujyanama w’ubuzima mu kwezi gushize………………….…………….G Time interview ended/ Igihe ibazwa ryarangiriye AM Mbere ya saasita ___ ___:___ ___ PM Nyuma ya saasita ___ ___:___ ___ Thank you. Murakoze. Previously approved ammendments to protocol Protocal 118 III.Previously Approved Amendments to May 13, 2013 & May 21, 2014 versions of Protocol A. Summary of Changes Made in 2013 Please note the following amendments to the original protocol, as detailed below and reflected in the version of the protocol: Cover page • Addition of UBC logo • Repositioning of logos • Notation of revision Acronyms and Abbreviations(Protocol, p. 5) • Removal of ICG – “Integrated Care Group” in favor of “modified Care Groups” so as not to confuse with alternate use of the term “integrated care group” being used in Burundi by another organization. Contact Persons • Updated World Relief Home Office contacts in Baltimore, MD, USA (Protocol, p.7) o Removed Monisha Jayakumar and Olga Wollinka, who are not currently employed by World Relief Synopsis(Protocol, p.8) • Frequency of Nutrition Weeks increased from twice to thrice per year, per recommendation of Nutrition Working Group (Protocol p.8 and elsewhere) • Reference to 33-cluster surveys corrected to 30-cluster (Protocol p. 8 and elsewhere) Overall Project Strategy (Protocol, p.13) • Changed term from “Integrated Care Groups” to “modified Care Groups” (Protocol, p.13) Formative Research • Table 4: Market Survey Findings (Protocol, p. 21): Combined headings for fat and carbohydrate into one column labeled “energy”. • Exit interviews with mother participants in Nutrition Weeks (Protocol. 25); timing of follow up interview changed from four weeks post-intervention to “at least” four weeks post intervention. • Please see below for additional qualitative methods that will be used to assess implementation and continue to shape design of the Nutrition Weeks and other interventions. Evaluation Methods – KPC Sampling (Protocol p. 29-30) Previously approved ammendments to protocol Protocal 119 • For monitoring surveys in years two and three, the sample was adjusted to two, 30x10 cluster samples in each arm (from 30 x 12 used at baseline), without parallel sampling. This was deemed sufficient for monitoring purposes and a better use of limited resources. Logistics (Protocol, p.33) • Table 7. Roles and Responsibilities(Protocol, p.33): updated to reflect changing individuals and responsibilities. Changes highlighted in yellow. • Table 4: FY 2,3 and 4 Timeline as of Year 1.(Protocol, p. 36) o Please see addendum below for a more detailed, updated table for May-December 2013 • Budget (Protocol, p. 37) o Please see addendum below for the Year 2 Budget. Annex A: CVs for Principal Investigators and Co-Investigators (Protocol, p. 38) o CVs for Principal Investigators Dr. Judy McLean and Dr. Fidele Ngabo, and for Co￾Investigator Ms. Melene Kabadege were already included in Annex A. o Please see addendum below for the CV for Co-Investigator Ms. Alphonsine Nyirahabineza Annex B. Project Indicators Table • Table 5: Proposed Project and OR Indicators to be measured by KPC Surveys (p.45) Please see below for a revised indicator table that re-orders the indicators, adds an additional process indicator related to home visits, and shifts timing of measurement of some indicators from Y2 to Y3. Annex E. KPC Survey Draft Questionnaire • The KPC Survey Draft Questionnaire included in the original protocol (p.60) was for the baseline survey. For monitoring purposes in Year 2, an abridged version of the survey will be used that focuses on the operations research indicators (nutrition and control of diarrheal disease). • The Year 2 KPC Monitoring Survey is included with the additions below; it will use the same consent form that was already approved for the baseline KPC in Year 1 (p.59) Annex I. Standard KPC Survey Methodology(Protocol, p. 117) • The KPC Monitoring Survey will largely follow the “standard” KPC 30 clusters x 10 households methodology as described in the original Annex I. Minor changes include the following: o In households with more than one child 0-23 months-old, instead of systematically selecting the younger child (to favor data collection on exclusive breastfeeding), the child to be included will be randomly selected by flipping a coin or drawing straws (in the rare event of three children 0-23 months). o The number of interviewers (Protocol, p. 118) will be 32 o The anticipated time for completing the questionnaire (Protocol, p. 119) will be 40 minutes. Previously approved ammendments to protocol Protocal 120 B. Additional Tools for Year 2 Data Collection, Quantitative and Qualitative A number of additional data collection instruments will be used in Year 2, included below and summarized in the following table. Summary of Year 2 data collection Sample size Comments Kaduha Kigeme Total HH KPC survey interviews with mothers, abridged from baseline to focus on OR indicators 300 300 600 NW Exit Interviews with Mothers: Part two of exit interviews to follow up with a sample of mothers who participated in exit interviews one week after Nutrition Week intervention. 4 4 All mothers participating to NW were interviewed but not all Sites. We will select randomly one NW per HC Focus group discussions with mother participants to NW who did not participate in exit interviews one week post NW 4 4 1 FGD/HC Focus group discussion with Village Nutrition Committees to understand implementation issues with NW 4 4 1 FGD after each NW cycle Focus Groups Discussions with modified Care Groups for BCC, nutrition & data reporting 4 4 8 Feedback meeting with health Staff: Director of Hospital; Head of HC; Hospital & HC In charge of Community Health activities 1 1 2 Kaduha: 18 Participants Kigeme: 20 Participants Feedback meeting with Sector & Cell Leaders 1 1 2 Kaduha: 8 particpants from sectors + only 22 from cell= 30 participants Kigeme: 9 particpants from sectors + only 21from cell= 30 participants Feedback meeting with religious leaders 1 1 2 Kaduha: 18 Participants Kigeme: 35 Participants Focus Group Discussion with Tangiraneza I-CSP staff All Interview with Tangiraneza I-CSP Manager 1 Previously approved ammendments to protocol Protocal 121 Year 2 KPC Monitoring Survey Questionnaire with Translation World Relief Rwanda Tangiraneza Innovation Child Survival Project RESPONDENT IDENTIFICATION/UMWIRONDORO W’USUBIZA Cluster Number/ Nimero y’itsinda Household Number/ Nimero y’urugo Record Number/ Nimero y’ubazwa Interviewer Name/ Amazina y’ubaza Sector/ Umurenge Cell/ Akagali Village/ Umudugudu Health center/ Ikigo nderabuzima NAME OF THE MOTHER / AMAZINA Y’UMUBYEYI _________________________________ _____________________ AGE OF THE MOTHER IN YEARS IMYAKA Y’UMUBYEYI What is the name, sex, date of birth of your youngest child that you gave birth to and that is still alive? Umwana wawe muto wabyaye kandi ukiriho yitwa nde? Igitsina cye? Yavutse ryari? NAME OF THE CHILD LESS THAN 24 MONTHS AMAZINA Y’UMWANA URI MUNSI Y’AMEZI 24 __________________________________________ __ Previously approved ammendments to protocol Protocal 122 IS THE RESPONDENT THE BIOLOGICAL MOTHER OF THE CHILD? UBAZWA NI WE NYINA W’UMWANA WAMUBYAYE? YES/YEGO………………………..1 NO/OYA…...………………….…..0 SEX OF CHILD (1=MALE, 2=FEMALE)……1……..2 IGITSINA CY’UMWANA( 1=GABO, 2=GORE) DATE OF BIRTH ___ ___/___ ___/ ___ ___ ___ _ IGIHE YAVUKIYE AGE OF THE CHILD (IN MONTHS) IMYAKA Y’UMWANA (MU MEZI) Date of Interview/ Itariki y’ibazwa …………../…………../…………… Did the mother give consent? Ubazwa yemeye ubwumvikane? Yes/ Yego……………………………….1 No/ Oya…………………………………..2 If no, why? Niba ari Oya, kubera iki? Unavailable/ Ntaboneka………………..1 End/Iherezo Unwilling/ Ntameze neza……………….2 End/Iherezo Child not Home/ Umwana ntahari……3 End/Iherezo Other/ Ibindi………………………………..4 End/Iherezo Time interview began/ Isaha ibazwa ryatangiriye AM Mbere ya saa sita ……………….. PM Nyuma ya saa sita ………………... Time interview ended/ Igihe ibazwa ryarangiriye AM Mbere ya saa sita ……………….. PM Nyuma ya saa sita ……………….. # Questions Ibibazo Responses Ibisubizo bishoboka Skip Simbu ka Answer/ Igisubiz o Previously approved ammendments to protocol Protocal 123 atanze SECTION I: SOCIO-DEMOGRAPHICS / IGICE CYA 1: IMIBEREHO RUSANGE INSTRUCTIONS: ASK THE QUESTIONS EXACTLY AS THEY ARE WRITTEN. DO NOT READ RESPONSES UNLESS DIRECTED TO DO SO. WORDS IN ITALICS ARE INSTRUCTIONS FOR THE INTERVIEWER AND SHOULD NOT BE READ ALOUD. FOLLOW SKIP PATTERNS AS DIRECTED. WRITE ANSWERS IN THE ANSWER BOX UNLESS OTHERWISE DIRECTED. AMABWIRIZA: BAZA IBIBAZO NKUKO BYANDITSE. IRINDE KUMUSOMERA IBISUBIZO. AMAGAMBO YANDITSE MUBURYO BUBERAMYE NI AMABWIRIZA Y’UBAZA NTABWO UGOMBA KUYASOMERA UBAZWA. AHO UGOMBA GUSIMBUKA HASIMBUKE. ANDIKA IGISUBIZO MU KAZU KABUGENEWE. 1 Have you ever attended school? Mwaba mwarageze mu ishuri? Yes/ Yego…………………......……….1 No/ Oya……………………….......…....2 Don’t know/ Simbizi………………...88 3 3 2 If yes, then ask: What is the highest grade or level of school you have completed? Niba ari yego, mubaze uti: Warangije ayahe mashuri? None/ Did not complete primary Ntayo/Ntiyarangije amashuri abanza…....0 Primary/ Amashuri abanza ….……….....1 Secondary/ Amashuri yisumbuye….….2 Past Secondary/ Amashuri makuru…...3 Other/ Ayandi………………………...…...4 3 How many people live in your household? Muri uru rugo mubamo muri bangahe? Number/ Umubare………………………. Don’t know/ Simbizi………………….....88 4 4.a What is your ubudehe category according to the participatory poverty assessment as defined by 7. Umutindi nyakujya (those in abject poverty)……….……1 8. Umutindi(the very poor)…………..........2 9. Umukene(the poor) ……………….……..3 Previously approved ammendments to protocol Protocal 124 4.b 4.c MINALOC? Mwashyizwe mu kihe cyiciri cy’ubudehe nyuma y’ubushakashatsi bwakozwe na MINALOC ku bijanye n’ubukire cyangwa ubukene? 1. Umutindi nyakujya (those in abject poverty) 2. Umutindi (the very poor) 3. Umukene (the poor) 4. Umukene wifashije (the resourceful poor) 5. Umukungu (the food rich) 6. Umukire (the money rich) (Source: Government of Rwanda Poverty Reduction- Strategy Paper,June 2002 – p.15.) Are you using health insurance? Ese waba uri mu bwisungane mu kwivuza? If yes, can I see your member card? Niba ari yego, nshobora kureba ikarita yawe y’ubwisungane mu kwivuza? 10. Umukene wifashije (the resourceful poor)………..…………4 11. Umukungu(the food rich)……….…..5 12. Umukire(the money rich)……………..6 13. Don’t know/ imbizi……...……………88 If the category is unknown, the interviewer should check the list at the health center so that data is entered for every household. If there is debate, use the category assigned by MINALOC. Niba ubazwa atazi icyiciri arimo, ubaza ajye kureba kuri lisiti yo ku Kigo Nderabuzima iriho ibyiciri by’ingo zose, Niba ubazwa ajya impaka ku cyiciri yashyizwemo, koresha icyiciri kiri kuri listi ya MINALOC Yes/Yego……………………………………1 No/Oya……………………………………...0 Card available/Ikarita irahari…………….1 No card/Ikarita ntayo afite………………..0 21 Previously approved ammendments to protocol Protocal 125 SECTION II: MATERNAL AND NEWBORN CARE/ IGICE CYA KABIRI KWITA K’UMUBYEYI NURUHINJA 5- 20 Q5-20 removed for Y2 All21 21 During your pregnancy with (Name), were you given or did you buy any iron tablets/syrup? Mu gihe wari utwite Kanaka (izina ry’umwana muto) wigeze uhabwa cyangwa ugura ibinini/umushongi bya feri byongera amaraso? SHOW TABLETS/ BIMWEREKE YES/YEGO…………………...……………1 NO/ OYA…………………………………...0 DON’T KNOW/ SIMBIZI...……………….88 29 29 22 During the whole pregnancy, for how many days did you take the tablets/syrup? Igihe wari utwite, ibyo binini bya feri wabifashe mu minsi ingahe? IF THE ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS. NIBA IGISUBIZO AGUHAYE ATARI UMUBARE, KOMEZA UMUBAZE AGERERANYE MU MIBARE. DAYS/IMINSI……………………. DON’T KNOW/ SIMBIZI…………………….88 23- 28 Q23-28 removed for Y2 All 29 Previously approved ammendments to protocol Protocal 126 III: BREASTFEEDING AND CHILD NUTRITION/ KONSA NO KUGABURIRAUMWANA 29 Did you ever breastfeed (NAME)? Wigeze wonsa kanaka (izina ry’umwana muto)? YES/ YEGO............................. 1 NO/ OYA .............................. 0 36 30 How long after birth did you first put (NAME) to the breast?Ukimara kubyara kanaka (izina ry’umwana muto) wamwonkeje bwa mbere amaze igihe kingana iki avutse? IF LESS THAN 1 HOUR, RECORD ‘00’ HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. NIBA ARI MUNSI Y’ISAHA IMWE SHYIRA AKAMENYETSO KURI 00, NIBA ARI MUNSI Y’AMASAHA 24, ANDIKA UMUBARE W’AMASAHA, NIBA ARI HEJURU Y’AMASAHA 24, ANDIKA IMINSI. HOURS/ IGIHE KITAGEZE KU ISAHA 00 |___|___| HOURS/ AMASAHA 1 |___|___| DAYS/ IMINSI 2 |___|___| 31 During the first three days after delivery, did you give (NAME) the liquid that came from your YES/ YEGO ................................ 1 Previously approved ammendments to protocol Protocal 127 breasts? Mu minsi itatu ya mbere umaze kubyara, waba waronkeje Kanaka ( IZINA RY’UMWANA MUTO)? NO / OYA ..................................0 DON’T KNOW/ SIMBIZI .............88 32 In the first three days after delivery, was (NAME) given anything to drink other than breast milk? Mu minsi itatu ya mbere umaze kubyara, hari ikindi kinyobwa wahaye KANAKA (Izina ry’umwana muto) kitari amashereka? YES/ YEGO............................ 1 NO / OYA .............................. 0 DON’T KNOW/ SIMBIZI ....... 88  34  34 33 What was (NAME) given to drink? Ni bihe binyobwa wahaye Kanaka (IZINA RY’UMWANA MUTO)? Anything else? Ntakindi? DO NOT READ THE LIST NTUMUSOMERE IBISUBIZO. RECORD ALL MENTIONED BY CIRCLING LETTER FOR MILK (OTHER THAN BREASTMILK) AMATA (ATARI AMASHEREKA)……………A PLAIN WATER / AMAZI……...…..…………..B SUGAR OR GLUCOSE WATER AMAZI ARIMO ISUKARI…….………………C GRIPE WATER/ AMAZIYOMUNGANDA ……………………………………………………D SUGAR-SALT-WATER SOLUTION / AMAZI ARIMO UMUNYU N’ISUKARI……….E FRUIT JUICE/ UMUTOBE W’IMBUTO ……………………………………………...........F Previously approved ammendments to protocol Protocal 128 EACH ONE MENTIONED SHYIRA AKAZIGA KUCYO AKUBWIYE INFANT FORMULAAMATA Y’ABANA YO MU BIKOMBE………………….……………….G TEA / INFUSIONS / ICYAYI………………….H HONEY/ UBUKI ………………………………..I OTHER/IBINDI………………………………….X ________________________________ (SPECIFY/ SOBANURA) 34 Was (NAME) breastfed yesterday during the day or at night?Kanaka (Izina ry’umwana muto) waramwonkeje ejo ku manywa cyangwa nijoro? YES/ YEGO ............................ 1 NO / OYA............................... 0 DON’T KNOW/ SIMBIZI ....... 88 36 36 35 Sometimes babies are fed breast milk in different ways, for example by spoon, cup or bottle. This can happen when the mother cannot always be with her baby. Sometimes babies are breastfed by another woman, or given breast milk from another woman by spoon, cup or bottle or some other way. This can happen if a mother cannot breastfeed her own baby. Rimwe na rimwe abana bahabwa amashereka mu buryo butandukanye, urugero bagahabwa amashereka ku kayiko, YES/ YEGO ................................. 1 NO / OYA .................................. 0 DON’T KNOW/ SIMBIZI .............88 Previously approved ammendments to protocol Protocal 129 mu gikombe cg mu icupa. Ibyo bishobora kuba iyo umubyeyi adashoboye kuba ari kumwe n’umwana we. Bishobora no kuba iyo umubyeyi adashobora konsa umwana we. Did (NAME) consume breast milk in any of these ways yesterday during the day or at night? Mbese (KANAKA) yaba yarahawe amashereka)ejo kumanywa cg nijoro hakoreshejwe bumwe muri ubwo buryo maze kukubwira? 36 Now I would like to ask you about some medicines and vitamins that are sometimes given to infants. Was (Name) given any vitamin drops or other medicines as drops yesterday during the day or night? Ubunda shaka kukubaza ibyerekera nye n’imiti cyangwa amavitamini ajya ahabwa abana. Ese (KANAKA) yaba yarahawe ibitonyanga bya vitamin cyangwa indi miti ejo ku manywa cg nijoro? YES/ YEGO .................................1 NO / OYA .................................. 0 DON’T KNOW/ SIMBIZI .............…..88 Previously approved ammendments to protocol Protocal 130 37 Was (Name) given ORS yesterday during the day or at night? Haba hari uruvange rw’imyunyu n’isukari(SRO) waba warahaye kanaka (izinary’umwana muto) ejo kumanywa cg nijoro? YES/ YEGO ............................ 1 NO/ OYA ................................ 0 DON’T KNOW/ SIMBIZI ......... 88 38 Did (NAME) drink anything from a bottle with a nipple yesterday or last night? Kanaka (izina ry’umwana muto) yaba yaranywesheje BIBERO ejo kumanywa cyangwa iri joro? YES/ YEGO ............................ 1 NO/ OYA................................ 0 DON’T KNOW / SIMBIZI ....... 88 READ THE QUESTIONS BELOW PERTAINING TO Q. 39. READ THE LIST OF LIQUIDS ONE BY ONE AND MARK YES OR NO, ACCORDINGLY. AFTER YOU HAVE COMPLETED THE LIST, CONTINUE BY ASKING QUESTION 40 [SEE FAR RIGHT HAND COLUMN) FOR THOSE ITEMS (40B, 40C, AND/OR 40F) WHERE THE RESPONDENT REPLIED ‘YES’]. SOMA IKIBAZO KIRI HASI. SOMA URUTONDE RW’IBINYOBWA KIMWE KIMWE USHYIREHO YEGO CYANGWA OYA,NYUMA YO KUMVA URUTONDE, KOMEZA UBAZE IKIBAZO CYA 40 [KURI IBI BIBAZO (40B, 40C, NA 40D/CYANGWA 40F) AHO IGISUBIZO ARI ‘YEGO’]. No. QUESTIONS AND FILTERS/IBIBAZO CODING CATEGORIES/IBISUB IZO BITEGEREJWE QUESTIONS AND CODING CATEGORIES/IBIBAZO N’IBISUBIZO BITEGEREJWE 39 40 Previously approved ammendments to protocol Protocal 131 Next I would like to ask you about some liquids that (Name) may have had yesterday during the day or at night. Did (Name) have any (ITEM FROM LIST)? Noneho ndiifuza kukubaza ibinyobwa waba warahaye umwana wawe ejo ku manywa cg nijoro. Hari ibyo waba waramuhaye?(IBIRI KURI LISTI) READ THE LIST OF LIQUIDS STARTING WITH ‘PLAIN WATER.’ SOMA URUTONDE RW’IBINYOBWA UHEREYE KU “AMAZI GUSA”. YES YEGO NO OYA DK SINZI How many times yesterday during the day or at night did (Name) consume any (ITEM FROM LIST)? Ibi binyobwa kanaka (izina ry’umwana muto) yabifashe inshuro zingahe ku munsi haba ku manywa cyangwa nijoro?: READ QUESTION 40 FOR ITEMS B, C AND F, IF CHILD CONSUMED THE ITEM. RECORD 88 for DON’T KNOW. SOMA IKIBAZO CYA 40 KU BISUBIZO B, C NA F, NIBA UMWANA YARABINYOYE. WANDIKE 88 AHO YASHUBIJE SIMBIZI. A Plain water? Amazi gusa? 1 0 88 B Infant formula such as [INSERT LOCAL EXAMPLES]? Amata y’abana yo mu bikombe nka Kigozi, Rinda n’andi? 1 0 88 B. TIMES/ Inshuro I__I__I C Milk such as tinned, powdered or fresh animal milk? Amata yo mu dukarito, ay’ifu cyangwa inshyushyu (y’inka, ihene)? 1 0 88 C. TIMES/ Inshuro I__I__I D Juice or juice drinks? Umutobe w’ibitoke cyangwa 1 0 88 Previously approved ammendments to protocol Protocal 132 ubundi bwoko bw’imitobe? E Clear broth? Isupu imeze nk’amazi? 1 0 88 F Yogurt? Yawurute? 1 0 88 F. TIMES/InshuroI__I__I G Thin porridge? Igikoma kidafashe? 1 0 88 H Any other liquids such as [LIST other water-based liquids available in the local setting]? Ibindi binyobwa nk’umutobe, umusururu n’ibindi? 1 0 88 I Any other liquids? Ibindi binyobwa? 1 0 88 41 Please describe everything that (NAME) ate yesterday during the day or night, whether at home or outside the home. Mwatubwira ibiribwa (IZINA RY’UMWANA MUTO) yagaburiwe ejo hashize kumanywa na nijoro murugo cyangwa ahandi. d) Think about when (Name) first woke up yesterday. Did (NAME) eat anything at that time? IF YES: Please tell me everything (NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. IF NO, CONTINUE TO QUESTION Tekereza mu gihe (kanaka) yamaraga kubyuka ,hari icyo kurya yaba yarahawe? NIBA ARI YEGO watubwira buri kimwe cyose yaba yarariye muri icyo gihe? KOMEZA UMUBAZE UTI: Nta kindi? KUGEZA UBWO ASUBIZA KO NTA KINDI. NIBA ARI NTACYO, KOMEZA KUKIBAZO CYA b). e) What did (NAME) do after that? Did (NAME) eat anything at that time? IF YES: please tell me everything (NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. Nyuma y’ibyo (kanaka) yakoze iki? Hari ikintu (Kanaka) yariye muri icyo gihe? NIBA Previously approved ammendments to protocol Protocal 133 ARI YEGO: watubwira buri kimwe cyose yaba yarariye? KOMEZA UMUBAZE UTI: Ntakindi? KUGEZA UBWO ASUBIZA KO NTA KINDI. REPEAT QUESTION b) ABOVE UNTIL RESPONDENT SAYS THE CHILD WENT TO SLEEEP UNTIL THE NEXT DAY. IF RESPONDENT MENTIONS MIXED DISHES LIKE A PORRIDGE, SAUCE OR STEW, PROBE: SUBIRAMO IKIBAZO CYA b) CYO HARUGURU KUGEZA UBWO UBAZWA AKUBWIRA KO UMWANA YAGIYE KURYAMA AGAKANGUKA KU WUNDI MUNSI. NIBA AGUSHUBIJE IBYO KURYA BIVANGAVANZE NK’IGIKOMA, ISOSI CYANGWA IBINDI BIRYO BITETSE, KOMEZA UMUBAZE UTI: f) What ingredients were in that (MIXED DISH)? PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. Ni ibihe biribwa byari muri iyo MVANGE y’ibiryo? KOMEZA UMUBAZE UTI: Nta kindi yariye? KUGEZA UBWO ASUBIZA KO NTA KINDI. AS THE RESPONDENT RECALLS FOODS, UNDERLINE THE CORRESPONDING FOOD AND CIRCLE ‘1’ IN THE COLUMN NEXT TO THE FOOD GROUP. IF THE FOOD IS NOT LISTED IN ANY OF THE FOOD GROUPS BELOWWRITE THE FOOD IN THE BOX LABELLED ‘OTHER FOODS.’ IF FOODS ARE USED IN SMALL AMOUNTS FOR SEASONING OR AS A CONDIMENT, INCLUDE THEM UNDER THE CONDIMENTS FOOD GROUP. UKO USUBIZA AGENDA YIBUKA IBIRYO UMWANA YARIYE, UGENDE USHYIRAHO IKIMENYETSO KUCYO BIHUJE KANDI UZENGURUTSE AKAZIGA KURI”1” MU KUMBA KEGEREYE ITSINDA RY”IBIRIBWA. NIBA IBIRYO AVUZE BITARI KU ILISITI IRI HASI HANO, IBIRYO AVUZE UBYANDIKE AHAGENEWE “IBINDI BIRYO” NIBA HARI IBIRIBWA BYAKORESHEJWE MU KURYOSHYA IBIRYO NK’IBIRUNGO, UBISHYIRE AHAGENEWE ITSINDA RY’IBIRUNGO. ONCE THE RESPONDENT FINISHES RECALLING FOODS EATEN, READ EACH FOOD GROUP WHERE ‘1’ WAS NOT CIRCLED, ASK THE FOLLOWING QUESTION AND CIRCLE ‘1’ IF RESPONDENT SAYS YES, ‘0’ IF NO AND ‘8’ IF DON’T KNOW: Yesterday during the day or night, did (NAME) drink/eat any (FOOD GROUP ITEMS)? MU GIHE USUBIZA ARANGIJE KUVUGA IBIRYO BYOSE UMWANA YARIYE< SOMA BURI KICIRI CY’IBIRYO AHO UTIGEZE USHYIRA AKAZIGA KURI “1” , UBAZE IKIBAZO GIKURIKIRA HANYUMA USHYIRE AKAZIGA KURI “1” NIBA ASHUBIJE YEGO, KURI “0” Previously approved ammendments to protocol Protocal 134 NIBA ASHUBIJE OYA, KURI “88” NIBA ASHUBIJE SIMBIZI: Ejo ku manywa cyangwa nijoro, ese (Kanaka) yaba yarariye cyangwa yaranyoye ibiryo biri muri ibi biryo ngiye kukubaza (IBIRYO MU BYICIRO)? OTHER FOODS: PLEASE WRITE DOWN OTHER FOODS IN THIS BOX THAT RESPONDENT MENTIONED BUT ARE NOT IN THE LIST BELOW IBINDI BIRIBWA: ANDIKA IBINDI BIRIBWA YAVUZE BITAGARAGARA KURUTONDE RWO HASI. NO. QUESTIONS AND FILTERS/IBIBAZO CODING CATEGORIES/IBISUBIZO BITEGEREJWE YES/ YEGO NO/OYA DK/ SIMBIZI A Porridge, bread, rice, noodles, or other foods made from grains Igikoma, umugati, umuceri, amakaroni, cyangwa ibindi biribwa bikomoka ku binyampeke. 1 0 88 B Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside Ibihaza, karoti, ibijumba by’ umuhondo cyangwa bya orange 1 0 88 C White potatoes, white yams, cassava, or any other foods made from roots Ibirayi, ibikoro, imyumbati, cyangwa ibindi biribwa bikomoka ku binyabijumba. 1 0 88 D Any dark or green leafy vegetables/ Imboga z’icyatsi kibisi cyane, Imboga rwatsi 1 0 88 E Ripe mangoes, ripe papayas or (INSERT OTHER LOCAL VITAMIN A_RICH FRUITS) Imyembe ihishije, ipapayi ihishije, cyangwa 1 0 88 Previously approved ammendments to protocol Protocal 135 (ONGERAMO IZINDI MBUTO ZIKUNGAHAYE KURI VITAMINE A) F Any other fruits or vegetables Izindi mbuto cyangwa imboga 1 0 88 G Liver, kidney, heart or other organ meats Umwijima, impyiko, umutima, cyangwa izindi nyama zo munda 1 0 88 H Any meat, such as beef, pork, lamb, goat, chicken or duck Izindi nyama: iz’inka, ingururube, intama, ihene, inkoko cyangwa imbata 1 0 88 I Eggs/Amagi 1 0 88 J Fresh or dried fish, shellfish or seafood Amafi mabisi cyangwa yumye,isambaza ,injanga /indagara 1 0 88 K Any foods made from beans, peas, lentils, nuts or seeds Ibindi biribwa nk’ibishyimbo, amashaza, lantiye, ubunyobwa 1 0 88 L Cheese, yogurt, or other milk products foromage,yawurute,cyangwa andi mata 1 0 88 M Any oil, fats or butter, or foods made with any of these Andi mavuta,ibinure cyangwa mayonese, cyangwa ibiribwa bikomoka kw’ibyo tuvuze. 1 0 88 N Any sugary foods such as chocolates, sweets, candies, pastries cakes or biscuits Ibindi biribwa birimo isukari nka shokora, bombo, shikareti, gato cyangwa biswi 1 0 88 Previously approved ammendments to protocol Protocal 136 O Condiments for flavor, such as chilies, spices, herbs or fish powder Ibiribwa by’ibirungo nk’urusenda, utundi twatsi, ifu y’indagara 1 0 88 P Grubs, snails or insects Inswa ,isenani cyangwa utundi dusimba duto tuguruka 1 0 88 Q Foods made with red palm oil, red palm nut or red palm nut pulp sauce Ibiribwa byatekeshejwe amamesa 1 0 88 R Other foods not recorded on the list Ibindi biryo bitavuzwe haruguru 1 0 88 Check categories A-Q/GENZURA IBYICIRO A-Q IF ALL ‘No’  GO TO 41/ NIBA BYOSEARI OYA JYA KURI 41 IF AT LEAST ONE “YES” or ALL “DK”:  GO TO 42/ NIBA KIMWE MURI BYO ARI YEGO CYANGWA BYOSE ARI “SIMBIZI”: JYA KURI 42 42 Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night? Ese (Izina ry’umwana) yigeze arya ibiryo bikomeye cyangwa bidakomeye cyane cyangwa byoroshye ejo cyangwa ijoro ryakeye? IF ‘YES’ PROBE: What kind of solid, semi￾solid, or soft foods did (NAME) eat? NIBA ARI YEGO KOMEZA UBAZE UTI: Ni YES/ YEGO . . . . . . . . . .……..1 NO / OYA . . . . . . . . . . . …. . ….0 DON”T KNOW/ SIMBIZI……..88 GO BACK TO Q41 AND RECORD FOODS EATEN THEN CONTINUE. Subira ku kibazo cya 41 umusubiriremo bya bibazo 45 45 Previously approved ammendments to protocol Protocal 137 ubuhe bwoko bw’ ibiryo bikomeye cyangwa bidakomeye cyane cyangwa byoroshye yafashe? nyuma ukomeze 43 How many times did (NAME) eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night? Ibiryo bikomeye cyangwa bidakomeye cyane cyangwa ibindi biryo byoroshye ariko bitari nk’amazi yabifashe inshuro zingahe ejo kumanywa cyangwa nijoro? ADAPT THIS QUESTION TO USE LOCAL WORDS FOR THE SEMI-SOLID FOODS THAT ARE GIVEN. INCLUDE MASHED OR PUREED FOOD, ALONG WITH PORRIDGES, PAPS, THICK GRUELS, STEWS, ETC. SOLID FOODS – E. G., FAMILY FOODS, BANANAS, MANGOES, POTATOES, BREAD – SHOULD ALSO BE INCLUDED GERAGEZA GUKORESHA AMAGAMBO ASANZWE AKORESHWA MURI AKO GACE KU MAZINA Y’IBIRYO BIDAKOMEYE CYANE BIHABWA UMWANA. UBARIREMO INOMBE, IBISEYE, IGIKOMA, IBIRYO BYOKEJWE, IBITETSE, N’IBINDI; URUGERO RW’IBIRYO BIKOMEYE: IBIRYO BY’UMURYANGO WOSE. IMINEKE, IMYEMBE, IBIJUMBA, UMUGATI BISHOBORA KUBARIRWAMO. WE WANT TO FIND OUT HOW MANY TIMES THE CHILD ATE ENOUGH TO BE FULL. SMALL SNACKS AND SMALL FEEDS SUCH AS ONE OR TWO BITES NUMBER OF TIMES/ INSHURO………………..|___|___| DON’T KNOW/ SIMBIZI ………………………..88 GO BACK TO Q.41 TO RECORD FOOD EATEN YESTERDAY SUBIRA INYUMA KU KIBAZO CYA 41 KUGIRA NGO USHYIRE AKAZIGA KU BIRIBWA UMWANA YARIYE Previously approved ammendments to protocol Protocal 138 OF MOTHER’S OR SISTER’S FOOD SHOULD NOT BE COUNTED. TURIFUZA KUMENYA UMUBARE W’INSHURO UMWANA AGABURIRWA KUGEZA AHAZE. NTUBARIREMO UTWO GUHUGENZA UMWANA N’UTUNDI TUNTU DUTO ASHOBORA GUHABWA NA NYINA CYANGWA BAKURU BE. LIQUIDS DO NOT COUNT FOR THIS QUESTION. DO NOT INCLUDE THIN SOUPS OR BROTH, WATERY GRUELS, OR ANY OTHER LIQUID. IBINYOBWA NTIBIBARWA MURI IKI KIBAZO. NTUBARIREMO AMASUPU AMEZE NK’AMAZI N’IBINDI BIRYO BIMEZE NK’AMAZI CYANGWA BINYOBWA. USE PROBING QUESTIONS TO HELP THE RESPONDENT REMEMBER ALL THE TIMES THE CHILD ATE YESTERDAY KOMEZA UMUBAZE KUGIRA NGO UMUFASHE KWIBUKA INSHURO ZOSE UMWANA YAGABURIWE UMUNSI W’EJO. Previously approved ammendments to protocol Protocal 139 IF ‘YES’ PROBE: What kind of solid, semi-solid or soft foods did (NAME) eat? NIBA ARI “YEGO” MUBAZE UTI: Ni ibihe biribwa bikomeye, bidakomeye cyane cyangwa byoroshye kanaka (amazinay’umwana) yagaburiwe? GO BACK TO Q.41 TO RECORD FOOD EATEN YESTERDAY SUBIRA INYUMA KU KIBAZO CYA 41 KUGIRA NGO USHYIRE AKAZIGA KU BYO UMWANA YARIYE UMUNSI W’EJO. 44 (IF YES) At what age did (Name) begin solid, semi-solid, or soft foods? (NIBA ARI YEGO) ( kanaka) yanganaga iki mutangira kumuha ibiryo bikomeye cyangwa bidakomeye cyane cyangwa byoroshye? Age in months/ Imyakamumezi DON'T KNOW/ SIMBIZI. . . . . . . . . .88 45 Are you or someone in your family helping (NAME) eat? Ujya ufasha Kanaka (IZINA RY’UMWANA MUTO) kurya cyangwa hari undi wo mu muryango umufasha? YES/ YEGO……..………………1 NO/ OYA……………….…………049 46 IF NO:At what age did (Name) start eating by himself/herself? NIBA ARI OYA: ni ku yahe mezi Kanaka (izina ry’umwana muto ) yatangiye kwirisha ubwe? Age in months/ Amezi DON'T KNOW/ SIMBIZI . . . . . . . . . . . .88 47- 48 Q47- 48 removed for Y2 49 Has (NAME) taken any drug for intestinal worms in the past 6 months? Kanaka (izina ry’umwana muto) yaba hari utunini tw’inzoka zo mu nda yahawe mu mezi atandatu ashize? YES/ YEGO.............................1 NO/ OYA ................................ 0 DON’T KNOW/ SIMBIZI ….88 SECTION IV: INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS/ UBUVUZI BUKOMATANIJE BW’INDWARA Z’ABANA A. DANGER SIGNS/ IBIMENYETSO MPURUZA 50-75 Q51-75 removed for Y2 All 76 Previously approved ammendments to protocol Protocal 140 SECTION V: WATER AND SANITATION/AMAZI N’ISUKURA 76 Do you treat your water in any way to make it safer for drinking? Hari uburyo mukoresha mu gutunganya amazi yo kunywa? Yes/ Yego.....................................1 No/ Oya ........................................ 0 78 77 IF YES, what do you usually do to the water to make it safer to drink? Niba ari Yego, ubikora ute ngo wizere ko amazi ari meza yo kunyobwa? (ONLY CHECK MORE THAN ONE RESPONSE, IF SEVERAL METHODS ARE USUALLY USED TOGETHER, FOR EXAMPLE, CLOTH FILTRATION AND CHLORINE) SHYIRA IKIMENYETSO KU GISUBIZO KIRENZE KIMWE NIBA AKORESHA UBWO BURYO BWOSE ICYARIMWE, URUGERO: KUYAYUNGURURA UKORESHEJE CHLORINE CYANGWA AGATAMBARO. Let It Stand And Settle/Sedimentation Kuyatereka akiyungurura………...…..A Strain It Through Cloth Kuyayunguruza agatambaro………...B Boil/ kuyateka………………...………...C Add Bleach/Chlorine/ Kuyashyiramo sur’eau/kolorine………..………………D Water Filter (Ceramic, Sand, Composite) Kuyayunguruza filitire (iyakizungu, amakara, mucanga….…………….……E Solar Disinfection/ Kwica udukoko ukoresheje izuba…………………………...………....F Don’t Know/ simbizi…………………...G Other/ Ikindi____________________ H Previously approved ammendments to protocol Protocal 141 (Specify/ Sobanura) 78 When do you wash your hands? Ni ryari ukaraba intoki? DO NOT PROMPT. CIRCLE ALL MENTIONED. NTUMUHAGARIKE, KOMEZA WUMVE IBYO AKUBWIRA USHYIRE AKAMENYETSO KU BYO AKUBWIRA BYOSE. Never/ nta na rimwe ………………..…A Before Food Preparation/Mbere yo gutegura amafunguro.........................B Before Feeding Child Mbere yo konsa/ mbere yo kugaburira umwana………….……………………....C After Defecation/Visiting The Toilet Nyuma yo kuva ku musarane ... …….D After Attending To A Child Who Has Defecated/Soiled Nyuma yo gutunganya/guhanagura umwana umaze kwituma……………...E Other/ Ikindi gihe.________________ F (Specify/ Sobanura) 81 79 Can you show me where you usually wash your hands and what you use to wash hands? Mushobora kunyereka aho mukarabira intoki n’icyo mukoresha mukaraba intoki? ASK TO SEE AND OBSERVE MUSABE ABIKWEREKE NAWE WITEGEREZE. Inside/Near Toilet Facility/ Mu musarane imbere cyangwa hafi yawo………………………………………1 Inside/Near Kitchen/Cooking Place/ Mu gikoni/ Iruhande rwacyo/ aho batekera……………………………...…. 2 Elsewhere In Yard/ Ahantu aho ari ho hose mu rugo……………..……............................3 Previously approved ammendments to protocol Protocal 142 Outside Yard/ Inyumay’urugo……………………....….4 No Specific Place Nta mwanya wihariye uhari…………...5 No Permission To See/Ntakwemereye kuhareba …………………………….......8 80 OBSERVATION ONLY: Is there soap or detergent or locally used cleansing agent? ITEGEREZE GUSA: Hari isabune cyangwa ibindi bikoreshwa mu gukaraba intoki? This item should be either in place or brought by the interviewee within one minute. If the item is not present within one minute check none, even if brought out later. Icyo gikoresho gishobora kuba gihari cyangwa kikazanwa n’umubyeyi mu gihe cy’umunota umwe gusa. Niba kitabonetse mu munota umwe, kibarwa nk’ikidahari. Soap/ Isabune isanzwe………….……1 Detergent/ Isabune y’ifu nka omo.…..2 Ash/ Ivu…………………………………3 Mud/Sand/ Icyondo/ Akabuye………4 None/ Nta na kimwe…..……………….5 Other/ Ikindi____________________ 6 (Specify/ Sobanura) 81 What kind of toilet facility do you have? Can I see it? Umusarane mukoresha umeze ute? Nshobora kuwureba ? No toilet facility/ Ntamusarane ……..A Open latrine/ Umusarane udapfundikiye…………. B Closed latrine/ Umusarane upfundikiye…………..….C Flush toilet/ Umusarane wa kizungu………………D No permission to see/ Previously approved ammendments to protocol Protocal 143 Ntiyakwemere yekureba…..............….E 82-92 Q82 - 92 removed for Y2 All 93 SECTION VII: ANTHROPOMETRICS/ IBIPIMO 93 May I weigh (name of child)? Nshobora gupima kanaka (izina ry’umwana muto) ibiro? Yes/ Yego …………..1 __________ Kilograms/ Ibiro No/ Oya…………….0 94 May I use MUAC Tape with (name of child)? Nshobora gupima umuzenguruko w’ikizigira wa (izina ry’umwana muto)? Yes/ Yego…………..1 ___________ mm/ mirimetero No/ Oya…………….0 95 May I measure length for (name of child)? Nshobora gupima uburebure bw’umwana? Yes / Yego…………..1 ____________ cm/ santimetero No/ Oya…………….0 96 May I use MUAC Tape with you? Yes / Yego…………..1 Previously approved ammendments to protocol Protocal 144 Nshobora gupima umuzenguruko w’ikizigira cy’akaboko kawe? ____________ cm/ santimetero No/ Oya…………….0 SECTION VIII: BEHAVIOR CHANGE COMMUNICATION/IKIGANIRO KIGAMIJE GUHINDURA IMYITWARIRE 97 In the past year, have you participated in a week-long training on child feeding and food preparation led by a CHW? Mu mezi 12 ashize, waba warigeze witabira inyigisho zitangwa n’abajyanama b’ubuzima zimara icyumweru zijyanye no kugaburira umwana no gutegura amafunguro mu mudugudu? Yes/ Yego............ ……………1 No/Oya .................................. 0 Don’t Know/ Simbizi………………..88 101 101 98 (IF YES) How many times? NIBA ARI YEGO ,wazigiyemo inshuro zingahe ? Once/ Rimwe………………………………1 Twice/ Kabiri………………….………...…2 Three or more/Gatatu cyangwa karenga…………………………….3 99 When was the most recent time you participated in such a week-long training? Month/Ukwezi _______________ Previously approved ammendments to protocol Protocal 145 Ni ryari uherutse gukurikirana izo nyigisho zimara icyumweru? Year/ Umwaka _______________ 100 How many of the days did you participate? Wazitabiriye iminsi ingahe? Number / Umubare…………………. Don’t know/ Simbizi………………..…88 No response/ Ntagisubizo………….9 101 Did you receive a visit from your CHW in the past month? Waba warigeze usurwa n’umujyanama w’ubuzima muri uku kwezi gushize? Yes/ Yego.............................. 1 No/ Oya ................. ………..…0 Don’t Know/ Simbizi………………….88 End/ Iherezo End Iherezo 102 If yes, what was the purpose of the visit? Niba ari yego,ni iki cyamugenzaga? H. FOLLOW UP ON SICK CHILD,/ GUKURIKIRANA UMWANA URWAYE I. PROVIDE HEALTH EDUCATION ON MALARIA PREVENTION GUTANGA INYIGISHO ZO KWIRINDA MALARIYA J. PROVIDE HEALTH EDUCATION ON DIARRHEA PREVENTION GUTANGA INYIGISHO ZO KWIRINDA IMPISWI K. PROVIDE HEALTH EDUCATION ON PNEUMONIA GUTANGA INYIGISHO KU NDWARA Y’UMUSONGA L. PROVIDE HEALTH EDUCATION Previously approved ammendments to protocol Protocal 146 ON NUTRITION GUTANGA INYIGISHO KU MIRIRE M. PROVIDE HEALTH EDUCATION ON IMMUNIZATION GUTANGA INYIGISHO KU IKINGIRA N. OTHER/ IKINDI: _____________________. Thank you. Murakoze. Previously approved ammendments to protocol Protocal 147 Draft Interview and Focus Group Discussion Guides with Translation 8. Draft Interview Guide with Mothers Participants in NW (had Exit interview)/ Ibibazo byo kongera kubaza ababyeyi bitabiriye icyumweru cy’imirire a. How many children do you have?/Ufite abana bangahe? b. What did you learn about Nutrition from the Nutrition Week?/Ni iki mwize ku mirire mugihe cy’icyumweru cyahariwe imirire? c. What did you like about the Nutrition Week? Benefits?/Ni iki cyabashimishije mugihe cy’icyumweru cy’imirire? Ni iki byabunguye? d. What did you not like about the Nutrition Week?/Ni iki kitabashimishije mu cyumweru cy’imirire? e. What did you change in your family based on training received in NW?/ Ni iki mwahinduye mu miryango yanyu mushingiye ku nyigisho mwahawe mugihe cy’icyumweru cy’mirire ? f. What are the challenges you are facing to implement NW teachings in your family? Probe to know if any barriers related to food availability, affordability and acceptance.Ni izihe ngorane muhura nazo mugushyira mubikorwa ibyo mwigishijwe mu cyumweru cy’imirire?Komeza ubabaze kugira ngo umenye niba hari ingorane bahura nazo (zirebana n’ ibiribwa bitaboneka, badashobora kugura cyangwa batemerewe kurya) . How did you respond to the challenges? / byo bibazo mwabicyemuye mute? g. Who in your family support you in the application of the new behavior? How? Ni bande bo mu muryango wanyu babafasha gushyira mubikorwa imyifatire mishya? babafasha bate? h. Is there anything you would like to tell me about how to improve the groups? We are very interested in your opinions to change to make it better./ Ese hari ikintu mwumva mwatubwira cyateza imbere imirimo y’amatsinda mu gihe Previously approved ammendments to protocol Protocal 148 cy’icyumweru cy’imirire? Ibitekerezo byanyu ni ingenzi mugutuma habaho impinduka. 9. Draft FGD Guide with Mothers Participants in NW (did not have prior exit interview)/ Ibibazo bibaza ababyeyi bitabiriye icyumweru cy’imirire ariko batabajijwe a. Did you participate in the NW held in your village? / Mwaba mwaritabiriye icyumweru cy’imirire mu mudugudu wanyu? b. What did you learn about Nutrition from the Nutrition Week?/Ni iki mwize ku mirire mugihe cy’icyumweru cyahariwe imirire? c. What did you like about the Nutrition Week? Benefits?/Ni iki cyabashimishije mugihe cy’icyumweru cy’imirire? Ni iki byabunguye? d. What did you not like about the Nutrition Week?/Ni iki kitabashimishije mu cyumweru cy’imirire? e. What did you change in your family based on training received in NW?/ Ni iki mwahinduye mu miryango yanyu mushingiye ku nyigisho mwahawe mugihe cy’icyumweru cy’mirire ? f. What are the challenges you are facing to implement NW teachings in your family? Probe to know if any barriers related to food availability, affordability and acceptance.Ni izihe ngorane muhura nazo mugushyira mubikorwa ibyo mwigishijwe mu cyumweru cy’imirire? Komeza ubabaze kugira ngo umenye niba hari ingorane bahura nazo (zirebana n’ ibiribwa bitaboneka, badashobora kugura cyangwa batemerewe kurya) . How did you respond to the challenges? /Ibyo bibazo mwabicyemuye mute? g. Who in your family support you in the application of the new behavior? How? Ni bande bo mu muryango wanyu babafasha gushyira mubikorwa imyifatire mishya? Babafasha bate? h. Is there anything you would like to tell me about how to improve the groups? We are very interested in your opinions to change to make it better./ Ese hari ikintu mwumva mwatubwira cyateza imbere imirimo y’amatsinda mu gihe Previously approved ammendments to protocol Protocal 149 cy’icyumweru cy’imirire? Ibitekerezo byanyu ni ingenzi mugutuma habaho impinduka. 10. Draft FGD Guide with Father participants in NW/ ITSINDA RY’ABAGABO BITABIRIYE ICYUMWERU CYIMIRIRE CYO MUMUDUGUDU a. Did you participate in the NW held in your village? / Mwaba mwaritabiriye icyumweru cy’imirire mu mudugudu wanyu? b. What did you learn about Nutrition from the Nutrition Week?/Ni iki mwize ku mirire mugihe cy’icyumweru cyahariwe imirire? c. What did you like about the Nutrition Week? Benefits?/Ni iki cyabashimishije mugihe cy’icyumweru cy’imirire? Ni iki byabunguye? d. What did you not like about the Nutrition Week?/Ni iki kitabashimishije mu cyumweru cy’imirire? e. What did you change in your family based on training received in NW?/ Ni iki mwahinduye mu miryango yanyu mushingiye ku nyigisho mwahawe mugihe cy’icyumweru cy’mirire ? f. How men in this village are involved in child feeding? Probe to know more./Mu mudugudu wanyu, nigute abagabo bagira uruhare mu kugaburira abana? Komeza ubabaze kugirango umenye byinshi. g. What are the challenges you are facing to feed properly your children?/Ni izihe ngorane muhura nazo mu kugaburira abana banyu neza? h. What can be done to improve men participation to NW sessions in the community?/ Ni iki cyakorwa kugirango abagabo barusheho kwitabira icyumweru cy’imirire mu mudugudu wanyu? i. What can be done to improve NW participation and to implement successfully NW sessions in the community? / Ni iki cyakorwa kugirango icyumweru cy’imirire kirusheho kwitabirwa no gushyirwa mu bikorwa neza mu mudugudu? Previously approved ammendments to protocol Protocal 150 11. Draft FGD Guide with Father non-participants in NW a. Did you hear about the NW held in your village? What did you learn about Nutrition Week? /Mwigeze mwumva bavuga iby’ icyumweru cy’imirire cyabereye mu mudugudu wanyu? Mwabyumviseho iki? b. Did you participate to NW sessions? What are the challenges that prevent you to attend the NW?/ Mwaba mwaritabiriye icyumweru cy’imirire cyo mumudugu? Ni iki cyatumye mutitabira icyumweru cy’imrire? c. How men in this village are involved in child feeding? Probe to know more.Mu mudugudu wanyu, abagabo bagira uruhe ruhare mu kugaburira abana? Komeza ubabaze kugirango bakubwire n’ibindi. d. What are the challenges you are facing to feed properly your children?/ Ni ibihe bibazo muhura nabyo bishobora gutuma mutagaburira abana banyu neza? e. What can be done to improve men participation to NW sessions in the community?/ Hakorwa iki kugirango abagabo barusheho kwitabira icyumweru cy’imirire mu mudugudu? f. What can be done to improve NW participation and to implement successfully NW sessions in the community? / Ni iki cyakorwa kugira ngo icyumweru cy’imirire kirusheho kwitabirwa no gushyirwa mu bikorwa neza mu mudugudu? Previously approved ammendments to protocol Protocal 151 12. Draft FGD Guide with Modified Care Groups h. What are your main responsibilities in Community health?/Ni izihe nshingano z’ingenzi mufite kubijyanye n’ubuzima bw’abaturage? i. How do you collaborate (Binome CHW & ASM & Religious & Local Leaders) to mobilize community for behavior change? Probe to get details and more examples on their collaboration. /Mukorana mute (n’abajyanama b’ubuzima n’abahagarariye amadini ndetse n’abayobozi b’inzego z’ibanze) kugirango mushishikarize abantu guhindura imyifatire? Komeza ubabaze kugira ngo baguhe ubusobanuro n’ingero zifatika zijyanye n’uko bakorana. j. How do you appreciate the CG member’s attendance? Probe to estimate the attendance?/ Mubona mute ubwitabire bw’abagize itsinda ? Komeza ubabaze kugirango umenye ikigereranyo cy’ubwitabire. k. What are the main barriers that prevent volunteers to attend CG trainings? What can be done to improve CG attendance? / Ni izihe mbogamizi zituma abagize amatsinda batitabira cyane? Hakorwa iki kugira ngo ubwitabire bwiyongere? l. To what extend people or families apply in their lives the health messages they received from CHWs? What is the most challenging health behavior? How do you face to that challenge? / Ni gute mubona imiryango ishyira mu bikorwa inyigisho z’ubuzima bigishijwe n’Umujyanama w’ubuzima? Ni uwuhe mwifato mubona uruhije guhindura kuruta iyindi? Mubyifatamo gute? m. In what ways has the CG training impacted you and your family’s health? Probe to learn more changes occurred? / Ni gute inyigisho muhabwa mu matsinda zagize impinduka kuri mwe no ku miryango yanyu? Komeza ubabaze kugirango bavuge n’izindi mpinduka zabaye. n. Based on the report provided by the CHWs, the # of households visited monthly is still low. What are the main challenge CG members are facing that prevent them to accomplish more home visits? Probe to learn more about how the CG members share the HHs, and if no many HHs per each./ Duhereye kuri raporo zitangwa n’abajyanama b’ubuzima, umubare w’ingo zisurwa mu kwezi uracyari hasi. Ni ibihe bibazo bibangamira abagize amatsinda bikababuza gusura ingo nyinshi ? Komeza ubabaze neza kugirango umenye uburyo abagize amatsinda bagabana ingo no kumenya niba badafite ingo nyinshi. Previously approved ammendments to protocol Protocal 152 13. Draft Program Implementation Review Meeting Guide with Health Center and Hospital staff a. Have you observed any health changes in the community since last year? What? Probe to learn more. /Uhereye umwaka ushize kugeza ubu, haba hari ibyo mwabonye byahindutse mungo? Ni ibihe? Komeza ubabaze kugirango bakubwire ibyahindutse byose. b. Have you visited NW? How many visit this year? (Only for Kaduha participants) / Mwigeze musura amatsinda yo mu cyumweru cy’imirire? Mwayasuye incuro zingahe muri uyu mwaka? (iki kibazo kibazwa ab’i Kaduha gusa). c. Since NW began in your community what changes have you notice? (Only for Kaduha participants)/ Kuva icyumweru cy’imirire cyatangira mu midugudu yanyu, Hari impinduka mumaze kubona?(iki kibazo kibazwa ab’i Kaduha gusa). d. Have you visited CGs? How many visit in last three months?/ Mwaba mwarasuye amatsinda y’ubuzima (C.G) ? Mwayasuye inshuro zingahe mu mezi atatu ashize? e. What are the main barriers that prevent you to supervise CHWs effectively? What can be done in order to improve supervisions to CHWs?/ Ni izihe nzitizi zituma rimwe na rimwe mudasura uko bikwiye ibikorwa by’ abajyanama b’ubuzima? Ni iki cyakorwa murwego rwo kuzamura ikurikirana bikorwa ry’abajyanamab’ubuzima? f. What community health concerns do you believe need to be better addressed?/ Ni ibihe bibazo by’ubuzima bw’abaturage mubona bikwiye kwitabwaho by’umwihariko? g. What can be done to better involve communities in health promotion? Hakorwa iki kugira ngo abaturage barusheho kugira uruhare mu bukangurambaga bw’ubuzima mu mudugudu? h. What can be done to better train communities in Health promotion?/ Ni iki cyakorwa kugirango abantu bigishwe kurutaho ku bijyana n’ubuzima i. What can be done to sustain community health programs?/ Ni iki cyakorwa ngo ibikorwa by’ubuzima mu mudugudu birusheho kuramba? Previously approved ammendments to protocol Protocal 153 14. Draft Guide for Program Implementation Review Meeting with Sector and Cell Leaders/ Ibibazo bizifashishwa mu nama n’abayobozi b’akagali n’umurenge a. Now, what are your responsibilities in community health?/ Ubu ni izihe nshingano mufite kubirebana n’ubuzima bw’abaturage? b. Since BCC and NW began in your sector, what changes have you observed? Probe to learn more. / Guhera aho ubukangurambaga na gahunda z’icyumweru cy’imirire zatangiriye mu murenge wanyu, ni izihe mpinduka mwabonye. Komeza ubabaze kugira ngo ubashe kumenya byinshi. c. Have you visited CGs ? NW? How many visits in last three months? / Mwigeze musura amatsinda y’ubuzima (CG)? Icyumweru cy’imirire? Mwasuye inshuro zingahe mu mezi atatu ashize? d. What are the main barriers that prevent you to supervise CG or NW effectively? What can be done in order to improve supervisions to CHWs?/ Ni izihe nzitizi muhura nazo mu gusura amatsinda y’ubuzima (CG) cyangwa gusura amatsinda y’icyumweru cy’imirire uko bikwiye? Ni iki cyakorwa kugirango ibikorwa by’isura birusheho kugenda neza? e. What is an area of need for health promotion in your sector/cell?/ Ni iki mwifuza ko cyatezwa imbere byumwihariko kubirebana n’ubukangurambaga bw’ubuzima muri uyu murenge/akagali? f. What could be done differently to meet your sector need?/ Ni ibihe bikorwa bitandukanye byakorwa kugira ngo haboneke ibisubizo by’ibibazo umurenge wanyu ufite? g. What are if any barriers faced when addressing your sector about health promotion? / Ni izihe nzitizi mwahuye nazo mu guteza imbere ubuzima mu murenge wanyu? h. What can be done to sustain community health programs?/ Ni iki cyakorwa kugira ngo hashimangirwe gahunda y’ubuzima bw’abaturage mu buryo burambye? Previously approved ammendments to protocol Protocal 154 Previously approved ammendments to protocol Protocal 155 15.Draft Guide for Program Implementation Review Meeting with Religious Leaders Ibibazo bizifashishwa mu nama n’abahagarariye amatorero a. As the church leaders, how are you involved in health promotion activities? Nk’abantu bahagarariye amatorero/amadini, mwibona cyangwa mwisanga gute mu bikorwa byo guteza imbere ubuzima bw’abaturage? b. In your community health role, with who do you collaborate more? And How? Ku birebana n’inshingano zanyu mu by’ubuzima bw’abaturage, ni bande mukorana kenshi? Kandi mukorana mute? c. Since BCC and NW began in your community r, what changes have you observed? Probe to learn more./ Kuva aho ubukangurambaga na gahunda z’icyumweru cy’imirire zatangiriye mu midugudu, ni izihe mpinduka mwabonye? Komeza ubabaze kugira ngo urusheho kumenya byinshi. d. What are the main challenges you are facing to promote health? What did you do or can be done to respond to the challenges?/ Ni izihe ngorane zikomeye muhura nazo mu guteza imbere ubuzima? Ni iki mwakoze cyangwa mubona cyakorwa kugira ngo izo ngorane zikemuke? e. What can be done to sustain community health programs?/ Ni iki cyakorwa kugira ngo hashimangirwe gahunda y’ubuzima bw’abaturage mu buryo burambwe? Previously approved ammendments to protocol Protocal 156 16.Draft Focus Group Discussion Guide with CHWs on NW implementation/ Ibibazo bigenewe abajyanama b’ubuzima ku mirimo y’icyumweru cy’imirire i. Have learn about NW? What did you like about the Nutrition Week? Benefits? What did you not like about the Nutrition Week? /MWigeze MUbona inyigisho zijyanye n’icyumweru cy’imirire? Ni iki cyabashimishije ku bijyanye n’icyumweru cy’imrire? Ni iki kitabanyuze mu bijyanye n’icyumweru cy’imirire? j. What did you change in your family based on training received in NW? / Nyuma yo guhabwa amahugurwa kubijyanye n’icyumweru cy’imirire, ni iki mwahinduye mu muryango? k. What are the challenges you are facing to implement NW in your community? Probe to know all challenges. How do you respond to each challenge? / Ni izihe ngorane muhura nazo mugushyira mubikorwa icyumweru cy’imirire mu mudugudu? Komeza ubababaze kugirango bavuge ingorane zose. Ni iki mukora kuri buri kibazo? l. What need of training you feel in order to improve your skills for leading NW activities? m. Mwumva mwahabwa ayahe mahugurwa murwego rwo kongera ubushobozi bwanyu mu bikorwa by’icyumweru cy’imirire? n. Who support you more during the implementation of the five-day NW? or from whom you ask advice for implementing NW? How often he/she visited you during the last implementation of NW? / Ninde ubaha ubufasha cyane mugihe cy’iminsi itanu y’icyumweru cy’imirire? Ninde musaba inama zibafasha muri gahunda y’icyumweru cy’imirire? Yabasuye kangahe mu cyumweru cy’imirire giheruka? o. After NW, have you visited the families that attended NW? What are the behaviors taught they applied more and what behaviors they did not apply? p. Nyuma y’icyumweru cy’imirire mwaba mwarasuye ingo zacyitabiriye? Ni ibiki mwasanze bakora cyane, Ni ibiki mwabonye badakora? q. Is there anything you would like to tell me about how to improve NW? We are very interested in your opinions to change to make it better./ Ni ikihe gitekerezo mwatanga mu rwego rwo Previously approved ammendments to protocol Protocal 157 kurushaho gutunganya icyumweru cy’imirire? Twifuza cyane kumenya ibitekerezo byanyu byatuma icyumweru cy’imirire kirushaho kugenda neza 17. Draft Focus Group Discussion Guide with I CSP Staff/Ibibazo bibazwa abakozi ba ICSP Tangiraneza a. What are the main ICSP accomplishments have you observe in the project areas? What were the big challenges?/ Ni ibihe bikorwa by’ingenzi umushinga ICSP wagezeho? Ingorane zikomeye mwahuye nazo ni izihe? b. How the I CSP planning process was and what effect did this have on the implementation process?/Ese iteganyabikorwa ry’umushinga ryari rimeze gute? Ese ryagize uruhe ruhare mu gutangiza ibikorwa? c. To what extent was the work plan practical? What could be added to the Work Plan that would have strengthened the implementation? / Ese iteganyabikorwa mwabonye kurishyira mubikorwa bikoreka? Ni iki cyakongerwa ku iteganya bikorwa gishobora kongerera ingufu ibirebana no gutangiza ibikorwa? d. What were the gaps in the Work Plan and how were they addressed by the project staff? / Ni ibihe bibazo mwahuye nabyo mu iteganyabikorwa kandi mwabyitwayemo gute? e. What change is there in the knowledge, skills and competencies of the project and Partner’s staff? Is there evidence that the staff has applied these skills both within the project?/ Ni ibiki byahindutse mu bumenyi n’ubushobozi by’abakozi b’umushinga ndetse n’abafatanyabikorwa? Ese hari icyemeza ko abakozi bakoresheje neza ibyo bize mu mushinga? f. What will you do differently in terms of planning, training, partnership, human resources, financial management in order to improve the program delivery quality? Ni iki mwakora (kinyuranye n’ibyo mwakoraga) kubijyanye no Guteganya, Guhugura,ubufatanya bikorwa, kuyobora abakozi no gucunga umutungo kugirango ibikorwa bya porogaramu birusheho kugenda neza? g. What are some strategies that can be used to help strengthen the link between community and facility in delivering MCH programs in a sustainable way? Ni izihe ngamba zafatwa kugirango ubufatanye bw’ikigo nderabuzima n’abaturage bugire ingufu mu rwego rwo kubungabunga ubuzima bw’umwana n’umubyeyi mu buryo burambye? Previously approved ammendments to protocol Protocal 158 h. What are some strategies for effectively engaging churches, and other behavioral influencers in health promotion? / Ni izihe ngamba zafatwa kugirango itorero hamwe n’abandi bafite ubushobozi bwo guhindura barusheho kuzamura ubuzima mugiturage? Previously approved ammendments to protocol Protocal 159 18. Draft Focus Group Discussion with I CSP Manager a. How has the project contributed to improving MCH coverage in Nyamagabe District? / Ni gute umushinga wagize uruhare mu kugeza gahunda zo kwita ku buzima bw’umwana n’umubyeyi mu karere ka Nyamagabe. b. The project wants to facilitate health staff and District staff in the implementation of the behavior change strategies through CG and NW interventions. Do you think using the modified CG , Church leaders and community leaders have been effective to promote new behaviors? What were the strengths and the weaknesses?/ Umushinga urashaka gufasha abakozi b’ibigo nderabuzima n’ab’akarere gushyiraho ingamba zo guhindura imyifatire binyujijwe mu matsinda (CG) no muri gahunda z’icyumweru cy’imirire. Mutekereza ko kwifashisha amatsinda, abahagarariye amadini n’abayobozi b’inzego z’ibanze byaba byarafashije mu gutuma habaho impinduka nshya? Ibyagenze neza ni ibihe? Ibitaragenze neza ni ibihe? c. How can the project more effectively facilitate the Health staff to integrate all MCH activities at the community-level through modified CG network in order to reduce missed opportunities? / Ni gute umushinga warushaho gufasha abakozi ba Ministeri y’ubuzima mu gushyira mu bikorwa ibikorwa birebana no kwita ku buzima bw’umwana n’umubyeyi ku rwego rw’umudugudu binyujijwe mu matsinda (CG) kugira ngo hatagira ikiburizwamo? d. What are the overall lessons learned from the project, in terms of integrating CCM, MNC, Nutrition and crosscutting Community Mobilization and M&E interventions?/ Ni ayahe masomo mwigiye ku mushinga ku bijyanye no guhuriza hamwe ibi bikorw: (Ubuvuzi bw’ibanze, Kwita ku buzima bw’umwana n’umubyeyi, Imirire, ubukangurambaga no kugenzura no gukurikirana ibikorwa? e. What are some other strategies that can be used to help strengthen the link between community and facility in implementing Nutrition Weeks? / Ni ubuhe bundi buryo bwakoreshwa kugirango hongerwe imbaraga mu guhuza imidugudu n’amavuriro mu gushyiraho icyumweru cy’imirire? f. What are some strategies for effectively engaging churches, and other behavioral influencers in MCH activities? / Ni ubuhe buryo bwakoreshwa kugira ngo amatorero n’abandi bavuga rikijyana bagire ibikorwa by’ubuzima bw’umwana n’umubyeyi ibyabo? Previously approved ammendments to protocol Protocal 160 Consent Forms – English (Kinyarwanda traslations follow) 1. Written Consent for Interviews with Mothers (on KPC survey or on Nutrition Week) Instruction In the case of respondents who are not able to read, this form is to be read aloud by someone other than the interviewer, preferably by a Community Health Worker. Introduction This consent form will explain the study that we would like you to join. I will go over this form with you in detail. You can ask questions about the study before you agree to join. You can also ask questions at any time after you join the study. Why is this study being done? The Nutrition Innovation Child Survival Program is jointly implemented with the district Ministry of Health to improve the health and nutrition of children in Nyamagabe District. This interview will be used to assess nutrition practices using a detailed interview of mothers in the region about their nutrition practices. From these, we will adapt the “Nutrition Week” curriculum as well as the implementation of NW, a hands-on Nutrition program in the community. In this interview we will ask you questions about how you feed your babies and children, and some related health practices, such as hygiene. What are the interview procedures? What will I be asked to do? If you agree to help with this study, you will be asked to respond to questions in your home, and we will also observe feeding and hygiene practices in your home. This will last about one hour. We will take notes on the discussions that we will keep for our records. What are the risks or inconveniences of the interview? You will not face many risks by being in this study. We do not expect that you will be stigmatized by sharing your experiences. What are the benefits of the survey? Your answers will be put together with the answers from mothers in other sectors/cellules/communities. You may benefit from this survey because the information you share with us during will be used to help improve the Nutrition Weeks curriculum. Will I receive payment for participation? You will not be paid to be in this interview. Are there costs to participate? There are no costs to you to participate in this interview. Previously approved ammendments to protocol Protocal 161 How will my personal information be protected? If you agree to participate, all information about you will be kept as private as possible. No personal information such as your name will be reported. Can I stop being in this survey and what are my rights? You do not have to be in this survey if you do not want to. If you agree to be in the survey, but later change your mind, you may contact us. You also may choose to skip any questions that you do not wish to answer. There are no penalties or consequences of any kind if you decide that you do not want to participate. Who do I contact if I have questions about the study? We will be happy to answer any questions you have about this survey. If you have further questions about this survey, want to voice concerns or complaints about the research, or if you have a research-related problem, you may contact Melene Kabadege, research team member, at telephone number 250788306586. Or, if you have questions about the research, you may call the Innovation CSP office in Nyamagabe District at telephone number 0788307570. If you would like to discuss your rights as a research participant, discuss problems, concerns or questions; obtain information; or offer input with an informed individual who is unaffiliated with the specific research, you may also contact the Rwanda National Ethics Committee by calling Dr. Justin Wane, Chairperson of the ethics committee, at 0788500499 or Dr. Emmanuel Nkeramihigo, Secretary of the Ethics Committee, at 0788557273 I will provide you a copy of this information should you have any other questions. Previously approved ammendments to protocol Protocal 162 Comments/Questions: Are you willing to participate? Interviewer circle: YES NO Documentation of Consent: This consent document has been read and explained to me and I have decided that I will participate in the survey described above. Its purpose, what I will be asked to do and all possible risks and inconveniences have been explained to me. I understand that I can withdraw at any time. My signature or thumb print also indicates that I have received a copy of the contact information. ____________________________________________ _____________ Respondent Date ____________________________________________ _____________ Guardian (if respondent is under age 21) Date ____________________________________________ _____________ Person Obtaining Consent Date Previously approved ammendments to protocol Protocal 163 1. Written Consent for Focus Group Discussions with Mothers; Fathers; Care Groups; or Community Health Workers Instruction In the case of respondents who are not able to read, this form is to be read aloud by someone other than the interviewer, preferably by a Community Health Worker. Introduction This consent form will explain the study that we would like you to join. I will go over this form with you in detail. You can ask questions about the study before you agree to join. You can also ask questions at any time after you join the study. Why is this study being done? The Nutrition Innovation Child Survival Program is jointly implemented with the district Ministry of Health to improve the health and nutrition of children in Nyamagabe District. The Group discussions with mothers, fathers, CHWs and Care Groups will be used to assess the nutrition practices and the Nutrition Week program implemented in this District. Then, key recommendations will be developed in order to improve NW curriculum and NW program implementation. In this survey we will ask the group questions on your ideas, thoughts and experiences with child feeding and Nutrition Week program. What are the interview procedures? What will I be asked to do? If you agree to help with this study, you will be asked to respond to questions and to provide ideas on Nutrition program. This will last about one hour. We will take notes on the discussions that we will keep for our records. What are the risks or inconveniences of the interview? You will not face many risks by being in this study. We do not expect that you will be stigmatized by sharing your experiences. What are the benefits of the survey? Your answers will be put together with the answers from mothers in other sectors/cellules/communities. You may benefit from this survey because the information you share with us during will be used to help improve the Nutrition Week Program. Will I receive payment for participation? You will not be paid to be in this survey. Are there costs to participate? There are no costs to you to participate in this survey. How will my personal information be protected? If you agree to participate, we will keep all the information that we collect from you private. Only study team members will have access to the Previously approved ammendments to protocol Protocal 164 information. We will write out the discussions. We will also erase any information that could identify you by name from the discussions. We will destroy the notes of the discussions when we have completed the study. Can I stop being in this survey and what are my rights? You do not have to be in this survey if you do not want to. If you agree to be in the survey, but later change your mind, you may contact us. You also may choose to skip any questions that you do not wish to answer. There are no penalties or consequences of any kind if you decide that you do not want to participate. Who do I contact if I have questions about the study? We will be happy to answer any questions you have about this survey. If you have further questions about this survey, want to voice concerns or complaints about the research, or if you have a research-related problem, you may contact Melene Kabadege, research team member, at telephone number 250788306586. Or, if you have questions about the research, you may call the Innovation CSP office in Nyamagabe District at telephone number 0788307570. If you would like to discuss your rights as a research participant, discuss problems, concerns or questions; obtain information; or offer input with an informed individual who is unaffiliated with the specific research, you may also contact the Rwanda National Ethics Committee by calling Dr. Justin Wane, Chairperson of the ethics committee, at 0788500499 or Dr. Emmanuel Nkeramihigo, Secretary of the Ethics Committee, at 0788557273 I will provide you a copy of this information should you have any other questions. Previously approved ammendments to protocol Protocal 165 Comments/Questions: Are you willing to participate? Interviewer circle: YES NO Documentation of Consent: This consent document has been read and explained to me and I have decided that I will participate in the survey described above. Its purpose, what I will be asked to do and all possible risks and inconveniences have been explained to me. I understand that I can withdraw at any time. My signature or thumb print also indicates that I have received a copy of the contact information. Names and Signatures of participants (Indicate Mothers; Fathers; CG or CHWs as appropriate) Mothers:____________________ Fathers:_____________________ Care Group:____________________ CHWs :_____________________ No Name Are you willing to participate? Signature Date 1. YES NO 2. YES NO 3. YES NO 4. YES NO 5. YES NO 6. YES NO 7. YES NO 8. YES NO 9. YES NO 10. YES NO If someone does not wish to sign or chooses NO, he or she may leave the FGD without negative comment by interviewers. Name and signature of person obtaining consent Date _____________________________________________ _____________ Previously approved ammendments to protocol Protocal 166 Consent Forms – Kinyarwanda Ubwumvikane bwanditse burebana n’ubushakashatsi ku mirire- Interview Amabwiriza: Mu gihe ubazwa adashobora gusoma, uru rupapuro rw’ubwumvikane rusomerwa ubazwa. Akarusomerwa n’undi muntu utari mu itsinda ry’abashakashatsi, nk’ umujyanama w’ubuzima cyangwa undi. Iriburiro Ubu bwumvikane burasobanura iby’ ubushakashatsi twifuza ko wagiramo uruhare. Ngiye kugusobanurira ibibukubiyemo mumagambo arambuye. Ushobora kubaza ibibazo mbere yuko wemera kugira uruhare muri ubu bushakashatsi,ushobora no kubibaza nyuma. Kuki ubu bushakashatsi bugiye gukorwa? Uyu mushinga wita ku bana n’ababyeyi ushyirwa mubikorwa kubufatanye na Minisiteri y’Ubuzima mu rwego rwo guteza imbere ubuzima n’imirire myiza mu bana bari munsi y’imyaka itanu bo mu karere ka Nyamagabe. Ubu bushakashatsi buzakorwa hakoreshejwe ikiganiro cyimbitse n’umubyeyi kigamije gusesengura uburyo agaburira abana be. Amakuru tuzabona azafasha mu kurushaho gutegura inyigisho ngiro zitangwa mu cyumweru cy’imirire myiza muri aka karere.Turi hano rero kugira ngo tukwigireho uko ugaburira abana bawe n’uko mwita k’ubuzima bwabo ,isuku n’ibindi. Ubu bushakashatsi buzakorwa bute? Jye ndasabwa gukora iki? Niba wemera gufasha muri ubu bushakashatsi , urasabwa gusubiza ibi bibazo no kutwemerera kureba uko mugaburira abana n’ibirebana n’isuku hano mu rugo rwanyu. Iki kiganiro kiramara nk’isaha imwe . Turandika ibyavuye mu kiganiro kuko tuzabikenera. Ni izihe ngorane cyangwa imbogamizi zo muri ubu bushakashatsi? Nta ngorane uzahura nazo muri ubu bushakashatsi . Ntiduteganya ko uzahabwa akato kuberako twaganiriye kubyo uzi. Ni izihe nyungu z’ubushakashatsi ? Ibisubizo byawe bizashyirwa hamwe n’iby’abandi babyeyi bo mu yindi mirenge , utugali ndetse n’indi midugudu. Muri ubu bushakashatsi amakuru yanyu azafasha mu rwego rwo kuzamura gahunda y’imirire Previously approved ammendments to protocol Protocal 167 mu karere. Ibyo muzatubwira bizadufasha kunoza inyigisho zizajya zitangwa mu cyumweru cy’ imirire myiza. Hari igihembo nzahabwa ? Ntagihembo uzabona muri ubu bushakashatsi. Hari ikiguzi mu kwitabira? Nta kiguzi kuri wowe muri ubu bushakashatsi. Ni gute amakuru mbahaye azabungwabungwa? Turakubaza amakuru ajyanye n’ubuzima bwawe bwite nk’imyirondoro yawe, igitsina, umwuga cyangwa amashuli wize. Tuzayabika mu buryo bw’ibanga. Uretse abakoze kuri ubu bushakashatsi nibo bonyine bemerewe kumenya aya makuru. Tuzandika ibyo twaganiriye twirinde kugaragaza izina ryawe mu makuru azatangwa. Ni nde nabaza ngize ikibazo kuri ubu bushakashatsi? Turishimira kugusubiza ikibazo icyo aricyo cyose wagira kuri ubu bushakashatsi. Uramutse ugize ikindi kibazo kigendana n’ubu bushakashatsi wabaza Melene Kabadege, umwe mubagize itsinda ry’ubushakashatsi, kuri nomero ya telefoni 0788306586 cyangwa ubuyobozi bw’umushinga wa World Relief /Tangiraneza kuri telefoni 0788307570 . Mugihe wifuza kugira icyo umenya ku burenganzira bwawe nk’uwagize uruhare mu bushakashatsi, cyangwa kumenyekanisha ibibazo bikomeye wagize wahamagara Dr. Justin Wane uhagarariye komite ishinzwe kurengera uburenganzira bw’abakoreweho ubushakashatsi mu Rwanda kuri terefone 0788500499, cyangwa Dr.Emmanuel Nkeramiheto, umunyamabanga wiyo komite kuri 0788557273. Ndaguha kopi y’iyi nyandiko iriho nimero mwahamagara mu gihe hari ikindi kibazo ugize. Ibibazo/Ibitekerezo: _____________________________________________________________________________ _____________________________________________________________________________ Mwemeye kuba mwagira uruhare muri ubu bushakashatsi?: YEGO / OYA Previously approved ammendments to protocol Protocal 168 Amasezerano y’ubwumvikane Aya masezerano y’ubwumvikane nayasomye / nayasomewe kandi ndayasobanukirwa, nemera kujya muri ubu bushakashatsi nkuko aya masezerano abivuga haruguru.Ibyo nzabazwa n’ingorane cyangwa imbogamizi zaboneka muri ubu bushakashatsi nabisobanuriwe.Nasobanukiwe ko nshobora kureka kugira uruhare muri ubu bushakashatsi igihe cyose mbishakiye. Umukono wanjye cyangwa igikumwe;byerekanako nahawe kopi y’aya masezerano y’ubwumvikane. ____________________________________________ _____________ Amazina n’umukono by’uwitabiriye Itariki ____________________________________________ _____________ Amazina n’umukono by’uwishingiye ubazwa Itariki (Niba ubazwa atarageza ku myaka 21 ) ____________________________________________ _____________ Amazina n’umukono by’uwakiriye inyandiko y’ubwumvikane Itariki Previously approved ammendments to protocol Protocal 169 Ubwumvikane bwanditse burebana n’ubushakashatsi ku mirire- FGDs Amabwiriza Mu gihe ubazwa adashobora gusoma, uru rupapuro rw’ubwumvikane rusomerwa ubazwa. Akarusomerwa n’undi muntu utari mu itsinda ry’abashakashatsi, nk’ umujyanama w’ubuzima cyangwa undi. Iriburiro Ubu bwumvikane burasobanura ibyo ubushakashatsi twifuza ko wagiramo uruhare. Ngiye kugusobanurira ibikubiyemo mumagambo arambuye. Ushobora kubaza ibibazo mbere yuko wemera kugira uruhare muri ubu bushkashatsi. Ushobora no kubibaza nyuma. Kuki ubu bushakashatsi ku matsinda bugiye gukorwa? Uyu mushinga wita ku bana n’ababyeyi ushyirwa mubikorwa kubufatanye na Ministere y’Ubuzima murwego rwo guteza imbere ubuzima n’imirire myiza mubana bo mu Karere ka Nyamagabe. Ubu bushakashatsi buzakorwa hakoreshejwe ibiganiro bihuriweho n’ababyeyi, abagabo, abajyanama b’ubuzima cyangwa amatsinda yabo. Ibi biganiro bigamije gusesengura uburyo ababyeyi bagaburira abana babo n’uko umushinga urimo gushyirwa mu bikorwa. Amakuru tuzabona azafasha mu kurushaho gutegura inyigisho ngiro zizatangwa mu cyumweru kizaharirwa kwita ku mirire myiza muri aka karere.Turi hano rero kugira ngo mutuganirire uko mugaburira abana banyu ndetse n’uko mubona Icyumweru cy’Imirire n’uburyo cyarushaho kunozwa. Ubu bushakashatsi buzakorwa bute? Jye nzasabwa gukora iki? ? Niba mwemera gufasha muri ubu bushakashatsi , murasabwa gusubiza ibibibazo no kwemera gutanga ibitekerezo biganisha mu kunoza gahunda yo guteza imbere imirire myiza. Iki kiganro kiramara nk’isaha imwe . Turandika ibyavuye mu kiganiro kuko tuzabikenera. Ni izihe ngorane cyangwa imbogamizi zo muri ubu bushakashatsi? Nta ngorane muzahura nazo muri ubu bushakashatsi . Ntimuzahabwa akato kuberako twaganiriye kubyo muzi. Ni izihe nyungu z’ubushakashatsi? Ibisubizo byanyu bizashyirwa hamwe n’iby’abandi bo mu yindi Mirenge / Utugali ndetse n’indi Midugudu.Muri ubu bushakashatsi amakuru yanyu azafasha mu rwego rwo kuzamura gahunda y’imiririre mu karere. Ibyo muzatubwira bizadufasha kunoza inyigisho na gahunda zose z’icyumweru cyahariwe imirire myiza. Hari igihembo tuzahabwa ? Ntagihembo muzabona muri ubu bushakashatsi. Hari ikiguzi mu kwitabira? Ntakiguzi kuri mwe muri ubu bushakashatsi. Ni gute amakuru tubahaye azabungwabungwa? Previously approved ammendments to protocol Protocal 170 Turababaza amakuru ajyanye n’ubuzima bwanyu Tuzayabika mu buryo bw’ibanga. Uretse abakoze kuri ubu bushakashatsi nibo bonyine bemerewe kumenya aya makuru. Tuzandika ibyo twaganiriye twirinde kugaragaza amazina yanyu mu makuru azatangwa. Ni nde mwaabaza mugize ikibazo kuri ubu bushakashatsi? Turishimira kubasubiza ikibazo icyo aricyo cyose mwagira kubushakashatsi. Muramutse mugize ikindi kibazo kigendana n’ubu bushakashatsi mwabaza Melene Kabadege, umwe mubagize itsinda ry’ubushakashatsi, kuri nomero ya telefoni 0788306586cyangwa ubuyobozi bw’umushinga wa World Relief: Tangiranezabwa kuri telefoni 0788307570 Mugihe mwifuza kugira icyo mumenya ku burenganzira bwanyu nk’abagize uruhare mu bushakashatsi cyangwa kumenyekanisha ibibazo bikomeye mwaba mwagizemwahamagara Dr. Justin Wane uhagarariye komite ishinzwe kurengera uburenganzira bw’abakoreweho ubushakashatsi mu Rwanda kuri terefone 0788500499, cyangwa Dr.Emmanuel Nkeramiheto, umunyamabanga wiyo komite kuri 0788557273. Ndabaha kopi y’iyi nyandiko iriho nimero mwahamagara mu gihe hari ikindi kibazo Ibibazo/Ibitekerezo: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Mwemeye kuba mwagira uruhare muri ubu bushakashatsi?: YEGO / OYA Amasezerano y’ubwumvikane Aya masezerano y’ubwumvikane nayasomewe kandi ndayasobanurirwa, nemera kujya muri ubu bushakashatsi nkuko aya masezerano abivuga haruguru.Ibyo nzabazwa n’ingorane cyangwa imbogamizi zaboneka muri ubu bushakashatsi nabisobanuriwe.Nasobanukiwe ko nshobora kureka kugira uruhare muri ubu bushakashatsi igihe cyose mbishakiye. Umukono wanjye cyangwa igikumwe;byerekanako nahawe kopi y’aya masezerano y’ubwumvikane. Amazina n’imikono y’abitabiriye Previously approved ammendments to protocol Protocal 171 Shyira ikimenyetso kubo iki ikiganiro kigenewe Ababyeyi b’abagore Ababyeyi b’abagabo______________ Abajyanama b’ubuzima:____________________  Amatsinda y’abajyanama b’ubuzima_____________________ Niba hari udashatse gushyiraho umukono we cyangwa niba hari usubije OYA, Ahite agenda kandi ntacyo mugomba kubivugaho kandi nta n’nkurikizi nimwe igomba kumugeraho. Izina n’umukono by’uhawe ubwumvikane bwanditse Italiki ____________________________________________ _____________ Amazina Wemeye kugira uruhare mu Kiganiro? Umukono 1. YEGO/OYA 2. YEGO/OYA 3. YEGO/OYA 4. YEGO/OYA 5. YEGO/OYA 6. YEGO/OYA 7. YEGO/OYA 8. YEGO/OYA 9. YEGO/OYA 10. YEGO/OYA Previously approved ammendments to protocol Protocal 172 C. Additional and Replacement Documentation Timeline for Year 2 May-December Budget for Year 2 Additional CV for Co-Investigator Updated Table 5: Indicator Table Previously approved ammendments to protocol Protocal 173 C. Additional and Replacement Documentation ICSP Tangiraneza Year 2 KPC & OR Timeline, May – December, 2013 Activity May June July August September October November December 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Meeting with MOH Co￾Investigator to prepare OR Stakeholder’s meeting to provide updates on OR Develop study protocol including consent forms, draft questionnaires, Interview & FGD guides and sampling frame: April-May 2013 Submit protocol to MOH for sign-off – May 14, 2013 Submit protocol to RNEC for ethical approval – May 17, 2013 Previously approved ammendments to protocol Protocal 174 Activity May June July August September October November December 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Prepare electronic data collection software - May – June 2013 Prepare enumerator training: May 20-24 2013 Train ICSP M&E Officers : May 28 – 29, 2013 Train Supervisors June 4- 5, 2013 Train data collection teams June 10 - 12, 2013 Conduct pilot exercise June 13, 2013 Revise questionnaire and software for electronic data collection – June 14, 2013 Field data collection for KPC June 17-26, 2013 Previously approved ammendments to protocol Protocal 175 Activity May June July August September October November December 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Data cleaning July 1-5, 2013 Data analysis July 8-20 Train teams collecting Qualitative information July 8-9, 2013 Conduct Qualitative assessment July 10-12, 2013 Qualitative Data Analysis and Reporting July 15– 26, 2013 Presentation of preliminary results to MOH and partners August 22, 2013 MT assessment Report writing August - September, 2013 ICSP Year-3 Report writing Previously approved ammendments to protocol Protocal 176 Activity May June July August September October November December 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Share the results with Nutrition Technical Working Group District Stakeholder meeting after the study to share results Disseminate the study results with Sector Nutrition Committees Disseminate the study results to Village Nutrition Committees and Modified Care Groups Submit the Annual report including the study report to MoH & USAID [February 2015] 177 ICSP Year 2 Evaluation Budget ACTIVITIES Units Quantity Days Rate TOTAL (RwFrs) I. Household Survey Training of supervisors on HH Survey Supervisors from District Person 1 1 5,000 5,000 Supervisors from I-CSP Person 3 salaried Research Coordinator Person 1 salaried Tea break for Participants 5 1 1,500 7,500 Lunch for Participants Lunch 5 1 3,000 15,000 Water bottle 5 1 400 2,000 29,500 Training of surveyors on HH Survey Enumerators from Health Facilities & Sectors Person 26 3 19,500 1,521,000 Enumerators from I- CSP Person 6 Supervisors from District Person 1 3 5,000 15,000 Supervisors from I-CSP Person 3 salaried Research Coordinator Person 1 salaried Tea break for Participants 37 3 1,500 166,500 Lunch for Participants Lunch 37 3 3,000 333,000 Transport cost for HC & Sector participants Person 26 2 10,000 520,000 Water bottle 37 3 400 44,400 2,599,900 Household Survey Enumerators from Health Facilities & Sectors Person 26 8 15,000 3,120,000 Supervisors from District Person 1 8 15,000 120,000 Lunch for Project surveyors Lunch 3 8 2,000 48,000 Overnights for Project surveyors -HH Survey Overnight 6 8 12,000 576,000 Research Coordinator 1 salaried Water bottle 74 8 400 236,800 Community guides person 16 8 3000 384,000 4,484,800 Previously approved ammendments to protocol Protocal 178 ACTIVITIES (continued) Units Quantity Days Rate TOTAL (RwFrs) II. Interviews & Focus Group Discussions Training of surveyors on Qualitative research Surveyors from Kaduha Health Facilities & Sectors Person 15 2 19,500 585,000 Surveyors from Kigeme Health Facilities & Sectors Person 4 2 5,000 40,000 Surveyors from ICSP Person 9 salaried Research Coordinator Person 1 salaried Tea break for Participants 29 2 1,500 87,000 Lunch for Participants Lunch 29 2 3,000 174,000 Transport cost for HC & Sector participants Person 19 1 10,000 190,000 Water bottle 38 2 400 30,400 1,106,400 Data collection- Interviews & FGDs Surveyors from Kaduha Health Facilities & Sectors Person 15 2 5,000 150,000 Surveyors from Kigeme Health Facilities & Sectors Person 4 1 5,000 20,000 Overnights for Project surveyors -QA Overnight 9 2 12,000 216,000 Lunch for Project surveyors Lunch 4 1 2,000 8,000 Research Coordinator Person 1 salaried Water Bottle 33 8 400 105,600 499,600 Supplies & Logistics flipchart pc 2 1 6,000 12,000 markers pc 1 1 3,500 3,500 pens pc 37 1 100 3,700 folders and Note books pc 37 1 3,500 129,500 vehicle rental- HH survey veh 2 8 100,000 1,600,000 vehicle rental-QA veh 1 2 100,000 200,000 phone cards card 36 1 1,000 36,000 Renewal fees 1 1 425,000 425,000 2,409,700 Grand Total $18,550 USD Previously approved ammendments to protocol Protocal 179 11,129,900 CURRICULUM VITAE: ALPHONSINE NYIRAHABINEZA 2012 CURRICULUM VITAE 1. PERSONAL INFORMATION Names: NYIRAHABINEZA ALPHONSINE Date of birth: 09/ 09/ 1976 Telephone/cell phone: 0783280554 Email: nyiralphonsine@yahoo.fr Citizenship: Rwandese Gender: Female Marital status: Married Religion: Christian Address: Kigali/ Rwanda 2. SPOKEN AND WRITTEN LANGUAGES • Kinyarwanda : Mother tongue • English: Fluent • French: Fluent • Kiswahili: little 3. EDUCATION 2006-2008: Master of Sciences (M.SC) in Applied Human Nutrition Program at the University of Nairobi, Kenya; 1998-2001: Bachelor of Sciences (A0) in Home Economics at Allahabad Agriculture Deemed University, India; 1991-1997: Secondary education (A2) in Biology and Chemistry at the ‟Institut Sainte Famille” de Nyamasheke; Cyangugu, Rwanda 1983-1991: Primary education at EPA school, Kigali; Rwanda 4. EMPLOYMENT HISTORY • October 2009 to date: nutrition expert in the MOH/Rwanda • July 2005- September 2009: Employed by the Ministry of Health/ Rwanda as a Professional in Charge of Nutrition. • September 2002- February 2004: Employed by the Ministry of Gender and Women Promotion/Rwanda, in charge of Women Economic Development; Previously approved ammendments to protocol Protocal 180 5. WORKING EXPERIENCES Key responsibilities: o Head of the Nutrition Desk and Nutrition Technical Working Group in the Ministry of Health since 2005 up to now; serving as a NUTRITION EXPERT. Key seminars/ Trainings and major activities: o I have been involved in different nutrition activities aiming at improving the nutrition status of the population especially women and children at the national level: trainings on different nutrition issues; o I have been participating in different meetings, seminars and workshops aiming at improving the nutrition and health status of the population; o Preparation and implementation of the 1st Rwandan Nutrition summit; o I have been involved in the elaboration of Nutrition curricula of secondary schools in Rwanda in September 2001; o I have been participating in different trainings in administration; o I had a two month attachment in Kenyatta National hospital (Kenya), in the Dietetics and Nutrition Department in the year 2008 and a two week attachment in M.P. Shah hospital (Kenya), in the Department of Dietetics and Nutrition; Key documents produced I participated in the elaboration of different national nutrition documents including: • the national guidelines and protocols on food, nutritional support and care for People Living with HIV/AIDS, • the National Nutrition Policy, • the national protocol for the Management of Protein Energy Malnutrition, • the national Code on marketing of breastfeeding substitutes, • the Nutrition Profiles documents;  the National Multi-sectoral strategic plan to Eliminate Malnutrition,  production of BCC tools and programs on Nutrition;  the report on data corrected during the emergency plan to Eliminate Malnutrition I have been working on the Initiation of Food Fortification in Rwanda since 2009; I have been involved and coordinated the development of new national Mother, Infant and Young Child Nutrition tools designed for Community Health Workers in education mothers and other caregivers and other national current activities such as:  The District Plans to eliminate malnutrition  The Joint action Plan to eliminate Malnutrition  And many others… Presentation of papers: Emergency plan to Eliminate malnutrition in Rwanda: o Food Fortification conference in Rwanda, January 2010 Previously approved ammendments to protocol Protocal 181 o MCH Conference Rwanda: July 2010 I did my Master’s Project Dissertation on food and nutrition of people living with HIV/AIDS; the title of the dissertation being Utilization of National Guidelines for Food, Nutritional Support and Care for People with HIV/AIDS in Rwanda in the Capacity Project Supported Health Centers. I have been involved in preparation and validation of different studies in nutrition. I recently presented a paper in the 13th World congress on “The Emergency in the Horn of Africa and Sahel, Food Availability and Public Health” in Addis Ababa, Ethiopia, April 2012. 6. COMPUTER KNOWLEDGE • Microsoft Word, Excel , Internet and Power Point • SPSS 7. DRIVING EXPERIENCES I am a holder of a Rwandan driving license of the B category. I, NYIRAHABINEZA Alphonsine, certify that the above given information is true. NYIRAHABINEZA Alphonsine [February 2015] 182 Table 5: Proposed Project and OR Indicators to be measured by KPC Surveys (updated from Protocol) Proposed Indicators (“Key Indicators” are strongly recommended by USAID) Required 2008 Rapid CATCH OR Indicato r Additiona l Project Indicator s Source and Frequency of Collection Nutrition and Breastfeeding (40% Level of Effort) Maternal iron consumption during pregnancy:Percentage of mothers who received tablets during last pregnancy; average number of days consumed of those who received pills. OR X KPC Y1 Y2 Y3 Y4 Early initiation of breastfeeding: Percentage of children 0-5 months who were put to the breast within one hour of birth. OR X KPC Y1 Y2 Y3 Y4 Prelacteal feeding: Percent of children 0-23 months given liquids prior to the initiation of breastfeeding. X KPC Y1 Y2 Y3 Y4 Exclusive breastfeeding: Percentage of children age 0-5 months who were exclusively breastfed during the last 24 hours. RC6 OR KPC Y1 Y2 Y3 Y4 Dietary diversity: Percentage infants and young children age 6-23 months fed according to the Minimum Dietary Diversity RC7 OR X KPC Y1 Y2 Y3 Y4 Meal frequency: percentage of infants and young children age 6-23 months fed according to the Minimum Meal Frequency OR X KPC Y1 Y2 Y3 Y4 Minimum Acceptable Diet: infants and young children age 6-23 months fed according to the Minimum Acceptable Diet *WHO 2008 definition OR X KPC Y1 Y2 Y3 Y4 Consumption of iron-rich foods: percentage of infants 6–23 months of age who consumed food rich in iron. X KPC Y1 Y2 Y3 Y4 Age appropriate introduction of semi-solid foods: Proportionof infants 6–8 months of age who receive solid, semi-solid or soft foods by mother’s 24-hour recall OR X KPC Y1 Y2 Y3 Y4 Responsive feeding: Caregiver assists child when eating (of children who consume soft, semi-solid or solid foods) OR KPC Y1 Y2 Y3 Y4 Vitamin A Supplementation in the last 6 months: Percentage of children age 6-23 months who received a dose of Vitamin A in the last 6 months: card verified or mother’s recall. RC8 KPC Y1 Y4 Previously approved ammendments to protocol Protocal 183 Underweight: Percentage of children 0-23 months who are underweight (-2 SD for the median weight for age, according to WHO reference population) RC18 OR KPC Y1 Y2 Y3 Y4 Wasted: Percentage of children 0-23 months who are underweight for height (-2SD for the median height for age, according to WH0 reference population) OR KPC Y1 Y2 Y3 Y4 Acute Malnutrition: Percent of children 6-23 months and percent of pregnant mothers of children 0-23 months acutely malnourished as measured by MUAC OR KPC Y1 Y2 Y3 Y4 Stunted: Percentage of children 0-23 months who are under height/length for age (-2SD for the median height for age, according to WHO reference population) OR KPC Y1 Y2 Y3 Y4 Maternal Newborn Care (35% Level of Effort) Antenatal Care: Percentage of mothers of children age 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child. RC1 X KPC Y1 Y2 Y4 ANC first trimester: Percentage of mothers of children age 0-23 months who had antenatal visit in the first trimester when they were pregnant with the youngest child X KPC Y1 Y3 Y4 Maternal TT Vaccination: Percentage of mothers with children age 0-23 months who received at least two Tetanus toxoid vaccinations before the birth of their youngest child. RC2 KPC Y1 Y3Y4 Skilled Birth Attendant: Percentage of children age 0-23 months whose births were attended by skilled personnel. RC3 KPC Y1 Y3 Y4 Post-natal visit to check on newborn within the first 2 days after birth: Percentage of children age 0-23 who received a post-natal visit from an appropriate trained health worker within two days after the birth of the youngest child. RC4 X KPC Y1 Y3 Y4 Current Contraceptive Use Among Mothers of Young Children: Percentage of mothers of children age 0-23 months who are using a modern contraceptive method. RC5 KPC Y1 Y4 Immediate breastfeeding of newborns: percent of children 0-23 months put to the breast within one hour of delivery (Key Indicator) See this same indicator listed above under Nutrition and Breastfeeding Comparison of Diarrheal Diseases (15% Level of Effort) Point of Use (POU): Percentage of households of children age 0-23 months that treat water effectively. RC15 OR KPC Y1 Y2 Y4 Appropriate Hand washing Practices: Percentage of mothers of children age 0-23 months who live in RC16 OR KPC Y1 Y2 Y3 Previously approved ammendments to protocol Protocal 184 households with soap at the place for hand washing. Y4 Hand washing at all four key times: Percentage of mothers of children age 0-23 months who wash hands with soap at all four key times X KPC Y1 Y2 Y3 Y4 Percentage of households of children age 0-23 months that have a toilet facility in appropriate X KPC Y1 Y2 Y3 Y4 Safe feces disposal: Percentage of mothers of children 0-23 months who disposed of the youngest child’s feces safely the last time s/he passed stool. (Key Indicator) USAID Key Indicator KPC Y1 Y3 Y4 Two week prevalence of diarrhea: Percentage of children 0-23 months with diarrhea in the previous two weeks USAID Key Indicator KPC Y1 Y2 Y3 Y4 ORT use: 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. RC13 KPC Y1 Y2 Y3 Y4 Increased fluid intake during diarrheal episode: Percentage of children 0-23 months with diarrhea in the last two weeks who were offered more fluids during the illness. (Key Indicator) USAID Key Indicator KPC Y1 Y2 Y3 Y4 Continued feeding during a diarrheal episode: Percentage of children 0-23 months with diarrhea in the last two weeks who were offered the same amount or more food during the illness. (Key Indicator) USAID Key Indicator KPC Y1 Y2 Y3 Y4 Zinc: Percentage of children 0-23 months with diarrhea in the last two weeks who were treated with zinc supplements. (Key Indicator) USAID Key Indicator KPC Y1 Y2 Y3 Y4 Pneumonia Case Management (10% Level of Effort) Appropriate Care Seeking for Pneumonia: Percentage of children age 0-23 months with chest￾related cough and fast and/ or difficult breathing in the last two weeks who were taken to an appropriate health provider. RC14 KPC Y1 Y3 Y4 Two week prevalence of suspected pneumonia: children 0-23 months with cough and rapid and/or difficult breathing during two weeks prior to survey KPC Y1 Y3Y4 Immunization Measles vaccination: Percentage of children age 12- 23 months who received a measles vaccination RC9 KPC Y1 Y4 Access to immunization services: Percentage of children aged 12-23 months who received DTP1 according to the vaccination card or mother’s recall RC10 KPC Y1 Y4 Previously approved ammendments to protocol Protocal 185 by the time of the survey Health System Performance regarding Immunization services: Percentage of children aged 12-23 months who received DTP3 according to the vaccination card or mother’s recall by the time of the survey. RC11 KPC Y1 Y4 Malaria Treatment of Fever in Malarious Zones 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. RC12 KPC Y1 Y4 Child sleeps under an insecticide-treated bednet: Percentage of children age 0-23 months who slept under an insecticide-treated bed net (in malaria risk areas, where bed net use is effective) the previous night. RC17 KPC Y1 Y4 Process Indicators Contact with CHW: Percent of households with children 0-23 months that received health information from a CHW in the past month, according to location (home visit, community meeting, health facility, Nutrition Week) OR KPC Y1 Y2 Y3 Y4 CHW home visits: Percent of households with children 0-23 months that received a visit from a CHW in the past month, according to reported purpose OR KPC Y1 Y2 Y3 Y4 Participation in Nutrition Weeks: Percentage of mothers with children 0-23 months who participated in “Nutrition Week” intervention OR KPC Y1 Y2 Y3 Y4 [February 2015] 186 A. Summary of Changes Made in 2014 Please note the following amendments to the original protocol, as detailed below and reflected in the version of the protocol included for this annual review: 1. Contact Persons: Updated World Relief Home Office contacts in Baltimore, MD, USA. Removed Melanie Morrow, who is not currently employed by World Relief, and added Rachel Hower, Health Advisor at World Relief Home Office in Baltimore. 2. Roles and Responsibilities: updated to reflect changing individuals and responsibilities. Changes made in 2014 highlighted in green. Previously approved ammendments to protocol Protocal 187 Additional Documentation Timeline for Year 3 May-December Budget for Year 3 ICSP Tangiraneza Year 3 KPC & OR Timeline, May – December, 2014 Activity May June July August September October November December 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Meeting with MOH Co￾Investigator to prepare OR Stakeholder’s meeting to provide updates on OR Develop study protocol including consent forms, draft questionnaires, Interview & FGD guides and sampling frame: April-May 2014 Submit protocol to MOH for sign-off – May 22, 2014 Submit protocol to RNEC Previously approved ammendments to protocol Protocal 188 Activity May June July August September October November December 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 for ethical approval – May 26, 2014 Prepare electronic data collection software - May – June 2014 Prepare enumerator training: June 2014 Train ICSP M&E Officers : June, 2014 Train Supervisors June, 2014 Train data collection teams July, 2014 Conduct pilot exercise July, 2014 Revise questionnaire and software for electronic data collection – July, 2014 Field data collection for KPC July, 2014 Previously approved ammendments to protocol Protocal 189 Activity May June July August September October November December 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Data cleaning August 2014 Data analysis August – September 2014 Train teams collecting Qualitative information August, 2014 Conduct Qualitative assessment August, 2014 Qualitative Data Analysis and Reporting August – September 2014 Presentation of preliminary results to MOH and partners September, 2014 MT assessment Report writing August - September, 2014 ICSP Year-3 Report writing Previously approved ammendments to protocol Protocal 190 Activity May June July August September October November December 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 Share the results with Nutrition Technical Working Group District Stakeholder meeting after the study to share results Disseminate the study results with Sector Nutrition Committees Disseminate the study results to Village Nutrition Committees and Modified Care Groups Submit the Annual report including the study report to MoH & USAID [February 2015] 191 ICSP Year 3 Evaluation Budget ACTIVITIES Units Quantity Days Rate TOTAL (RwFrs) I. Household Survey Training of supervisors on HH Survey Supervisors from District Person 1 1 5,000 5,000 Supervisors from I-CSP Person 3 salaried Research Coordinator Person 1 salaried Tea break for Participants 5 1 1,500 7,500 Lunch for Participants Lunch 5 1 3,000 15,000 Water bottle 5 1 400 2,000 29,500 Training of surveyors on HH Survey Enumerators from Health Facilities & Sectors Person 26 3 19,500 1,521,000 Enumerators from I- CSP Person 6 Supervisors from District Person 1 3 5,000 15,000 Supervisors from I-CSP Person 3 salaried Research Coordinator Person 1 salaried Tea break for Participants 37 3 1,500 166,500 Lunch for Participants Lunch 37 3 3,000 333,000 Transport cost for HC & Sector participants Person 26 2 10,000 520,000 Water bottle 37 3 400 44,400 2,599,900 Household Survey Enumerators from Health Facilities & Sectors Person 26 8 15,000 3,120,000 Supervisors from District Person 1 8 15,000 120,000 Lunch for Project surveyors Lunch 3 8 2,000 48,000 Overnights for Project surveyors -HH Survey Overnight 6 8 12,000 576,000 Research Coordinator 1 salaried Water bottle 74 8 400 236,800 Community guides person 16 8 3000 384,000 4,484,800 Previously approved ammendments to protocol Protocal 192 ACTIVITIES (continued) Units Quantity Days Rate TOTAL (RwFrs) II. Interviews & Focus Group Discussions Training of surveyors on Qualitative research Surveyors from Kaduha Health Facilities & Sectors Person 15 2 19,500 585,000 Surveyors from Kigeme Health Facilities & Sectors Person 4 2 5,000 40,000 Surveyors from ICSP Person 9 salaried Research Coordinator Person 1 salaried Tea break for Participants 29 2 1,500 87,000 Lunch for Participants Lunch 29 2 3,000 174,000 Transport cost for HC & Sector participants Person 19 1 10,000 190,000 Water bottle 38 2 400 30,400 1,106,400 Data collection- Interviews & FGDs Surveyors from Kaduha Health Facilities & Sectors Person 15 2 5,000 150,000 Surveyors from Kigeme Health Facilities & Sectors Person 4 1 5,000 20,000 Overnights for Project surveyors -QA Overnight 9 2 12,000 216,000 Lunch for Project surveyors Lunch 4 1 2,000 8,000 Research Coordinator Person 1 salaried Water Bottle 33 8 400 105,600 499,600 Supplies & Logistics flipchart pc 2 1 6,000 12,000 markers pc 1 1 3,500 3,500 pens pc 37 1 100 3,700 folders and Note books pc 37 1 3,500 129,500 vehicle rental- HH survey veh 2 8 100,000 1,600,000 vehicle rental-QA veh 1 2 100,000 200,000 phone cards card 36 1 1,000 36,000 Renewal fees 1 1 425,000 425,000 2,409,700 Grand Total 11,129,900 $18,550 USD Prior Ethical Approval 193 IV.Prior Ethical Approval from RNEC Prior Ethical Approval 194 Prior Ethical Approval 195 Prior Ethical Approval 196 Prior Ethical Approval 197 APENDIX: Original Protocol from April 2012 – with minor updates Protocol on Data Collection for Assessments And Operations Research Related To The World Relief Rwanda Innovation Child Survival Project Nyamagabe District, Rwanda Funding Agency and Duration USAID Child Survival and Health Grants Program October 2011-September 2015 Research Partners Ministry of Health University of British Columbia District of Nyamagabe Submitted to the National Ethics Committee Original: February 13, 2012; Corrected 29 March 2012 Amended: 14 May 2013 Appendix: Original Protocol from April 2012 with minor updates A1 Contents Acronyms and Abbreviations ..................................................................................................................... A4 Contact Persons........................................................................................................................................... A5 Synopsis ..................................................................................................................................................... A7 I. Background............................................................................................................................................. A8 A. Project Rationale......................................................................................................................... A8 B. Problem Statement..................................................................................................................... A9 C. Nutrition education, stunting, and self-efficacy ....................................................................... A10 D. The innovation .......................................................................................................................... A10 E. Project/study location and population..................................................................................... A11 II. Aims, Objectives& Strategy ................................................................................................................ A11 A. Aims.......................................................................................................................................... A11 B. Objectives & Strategy................................................................................................................ A12 Table 1: Project Results Framework ................................................................................................. A12 Table 2: Key Activities for the Selected High Impact Technical Interventions.................................. A13 III.Conceptual Framework for Innovation............................................................................................. A14 IV. Operations Research, Formative Phase ........................................................................................... A17 A. Formative Research Objective ...................................................................................................... A17 B. Formative Research Questions..................................................................................................... A19 C. Phases of formative research ....................................................................................................... A20 Phase 1) Design................................................................................................................................. A20 Phase 2) Materials development and pilot testing........................................................................... A23 V. Operations Research, Evaluative Phase ............................................................................................ A26 A. Operational Research Objective ..................................................................................................... A1 B. Operational Research Questions.................................................................................................... A1 C. Type of study design ....................................................................................................................... A1 D. Limitations of the study .................................................................................................................. A1 E. Hypothesis....................................................................................................................................... A2 F. Study arms ...................................................................................................................................... A2 G. Study Population............................................................................................................................. A3 H. Evaluation Methods........................................................................................................................ A3 Appendix: Original Protocol from April 2012 with minor updates A2 VI. Process Documentation...................................................................................................................... A6 VII. Ethical Considerations ....................................................................................................................... A6 A. Confidentiality................................................................................................................................. A6 B. Informed consent........................................................................................................................... A6 C.Ethical approval ............................................................................................................................... A6 VIII. Logistics ............................................................................................................................................. A7 A. Distribution of responsibilities...................................................................................................... A7 B. Timetable .................................................................................................................................... A8 C. Budget....................................................................................................................................... A12 Annexes .................................................................................................................................................... A13 Annex A: CVs for Principal Investigators and Co-Investigator ............................................................. A13 Personal Informations............................................................................................................................. A16 Education............................................................................................................................................. A16 Professional Work Experience ........................................................................................................... A16 Annex B. Project Indicators................................................................................................................... A21 Annex C: Positive Deviance Inquiry (PDI).............................................................................................. A24 C1. Written Consent form for Positive Deviance Inquiry.................................................................. A24 C2. Positive Deviance Inquiry Data Collection Forms........................................................................... A27 Annex D: Maternal Exit Interview for Nutrition Weeks Innovation .................................................... A33 Annex E: Written Consent for KPC survey ........................................................................................... A35 Annex E: KPC Survey Draft Questionnaire ............................................................................................ A37 Annex G: Population Lists of Communities by Hospital Catchment Area............................................. A80 Annex H: Baseline Characteristics of Study Arms................................................................................. A94 Annex I.Standard KPC Survey Methodology......................................................................................... A96 Annex J: Letters of Support................................................................................................................... A99 Annex K: Changes to May 12, 2013 version of Protocol.................................................................... A101 Appendix: Original Protocol from April 2012 with minor updates A3 Appendix: Original Protocol from April 2012 with minor updates A4 Acronyms and Abbreviations BCC Behavior change communication CATCH Core assessment tool on child health CBNP Community-Based Nutrition Program CG Care Group CHW Community health worker C-IMCI Community-based integrated management of childhood illnesses CSP Child survival program DHS Demographic and Health Survey EIP Expanded Impact Child Survival Project HC Health center IFA Iron folic acid INATEK Institute of Agriculture, Technology and Education of Kibungo KPC Knowledge, Practice and Coverage LOE Level of effort MCH Maternal and child health MCHIP ` Maternal and Child Health Integrated Program MNP Micronutrient powders MOH Ministry of Health MUAC Mid-upper arm circumference PASW Predictive Analytics Software PD/Hearth Positive Deviance/Hearth TOT Training of trainers WRR World Relief Rwanda Appendix: Original Protocol from April 2012 with minor updates A5 Contact Persons Principal Investigators Dr. Judy McLean, PhD Assistant Professor, Food Nutrition and Health University of British Columbia Mail: FNH 215-2205 East Mall, Vancouver, BC V6T 1Z4 Phone: 604-822-6195; Fax: 604-822-5143; Email: judy.mclean@ubc.ca; Dr Fidele Ngabo, MD, MSc, PhD Candidate Director of Maternal and Child Health Unit Ministry of Health Phone: 0788 304750 Email: ngabog@yahoo.fr Co-Investigator and Operations Research Coordinator Melene Kabadege, Dip Nursing, BS, MA Maternal & Child Health Regional Technical Advisor (Burundi, Congo & Rwanda) Contact in Rwanda: World Relief Rwanda Box 6052 Kigali, Rwanda Phone: +250.584.664; Mobile: +250.(0)78.830.6586 Email: mkabadege@wr.org Co-Investigator Alphonsine Nyiransabimana Head of Nutrition Desk Ministry of Health Phone: 0783280554 Email: nyiralphonsine@yahoo.fr Other Participants in Research Grace Umutoni Beatrice Nyiranzeyimana Marie Grace Niyotugendana Narcisse Ngiruwonsanga Claire Uwimana Muhire Fidel Ntawukuriryayo Chantal Uwamahoro Fiacre Harerimana Germaine Rusagara World Relief Rwanda Box 6052 Kigali, Rwanda Phone: +250.584.664 Appendix: Original Protocol from April 2012 with minor updates A6 Rachel Hower, MPH Email: rhower@wr.org World Relief 7 East Baltimore St. Baltimore, MD 21202 USA Phone: +1-443-451-1900, +1-301-807-7901 Appendix: Original Protocol from April 2012 with minor updates A7 Synopsis World Relief Rwanda is a recipient of a USAID’s Child Survival and Health Grants Program (CSHGP) Innovation Grant. The CSHGP is committed to contribute to sustained improvements in child survival and health outcomes, particularly within vulnerable populations, by supporting the innovative, integrated community oriented programming of private voluntary organizations/non-governmental organizations and their in-country partners. To this end, the overall goal of this World Relief Rwanda Innovation Child Survival Project is to reduce morbidity, mortality and underlying undernutrition of children under five and pregnant women in Nyamagabe District of Rwanda. The project’s intervention areas and corresponding levels of effort are as follows: Nutrition and Breastfeeding (40%), Maternal and Newborn Care (35%), Control of Diarrheal Diseases (15%), and Pneumonia Case Management (10%). The project will be conducted from October 1, 2011-September 30, 2015 by World Relief Rwanda, in collaboration with Rwanda Ministry of Health and University of British Columbia and District of Nyamagabe. The majority of the project’s intervention activities focus on building the capacity of MOH staff to train and supervise government-sanctioned community health workers in the implementation of their community-based packages district-wide. However, as agreed to by the MOH and mandated by USAID, the project will also introduce an innovation and evaluate it using operations research. In this case the innovation is a complement to the government’s Community Based Nutrition Program intended to enhance the prevention of undernutrition during the first 1000 days of life. The “Nutrition Week” innovation will facilitate hands-on skill building and small group learning to boost the adoption of improved maternal, infant and young child feeding practices. The addition of thrice-yearly Nutrition Weeks to the standard CBNP will be compared to implementation of the standard CBNP alone. Both intervention and control areas (Kaduha Hopsital catchment and Kigeme Hospital catchment, respectively) will also receive the aforementioned interventions in maternal and newborn care, control of diarrheal diseases and pneumonia case management. This protocol outlines the plan for baseline assessments and evaluation related to implementation of the overall project, including the operations research component. Data collection includes a formative phase (desk review, market survey, positive deviant inquiry and exit interviews) and an evaluative phase (two 30-cluster household surveys). In order to maximize limited resources, the same household survey used to measure project objectives and indicators will also be used to measure indicators for the operations research. Results related to the project as a whole and to the OR study will be used both for management purposes and to contribute to learning about effective strategies for improving maternal￾child health and nutrition. Appendix: Original Protocol from April 2012 with minor updates A8 The principal investigators for the OR component is from Rwanda Ministry of Health and the University of British Columbia. At all stages of the project and operational research, representatives from Nyamagabe District and the Ministry of Health are invited to contribute to the design, implementation, dissemination and application of findings such that the results will be relevant to Rwanda. I. Background A. Project Rationale The 2010 Rwanda Demographic and Health Survey (DHS) showed that “Forty-four percent of children under five are short for their age; of those children, approximately two in five (17 percent) are severely stunted. Three percent of Rwandan children were found to be wasted at the time of the survey, including about one percent who were severely wasted. About one in ten children (11 percent) are underweight, including two percent who are severely underweight.” The government of Rwanda has made a significant commitment to eradicate malnutrition among its people. The November 2011 Second National Nutrition Summit consensus statement stated Rwanda’s commitment to “address the elimination of malnutrition especially in children in a holistic way and among other issues, prevention of acute and chronic malnutrition especially in children (presenting as stunting), through a multi-sectoral approach featuring multiple well proven and evidence-based interventions with a focus on community based nutrition programmes.”12 In support of the government’s priority to eradicate malnutrition, WRR applied for and was awarded an Innovation Child Survival Project from USAID Washington for work in Nyamagabe District from October 1, 2011-September 30, 2015. The project’s goal is to reduce morbidity, mortality and underlying undernutrition of children under five and pregnant women in Nyamagabe District of Rwanda. The project will target all of Nyamagabe District, which has an estimated population of 337,116 people with 54,949 children under-five and 79,559 women 15-49 years-old. The project’s Strategic Objective is “improved capacity of MOH staff and CHWs to implement high impact maternal, newborn and child health interventions at the community level.” The project’s intermediate results are: IR 1) Improved geographic access to and demand for high quality MNCH services; IR 2) Improved coordination of and impact of community health activities; and IR 3) Innovation tested to improve the effectiveness of the Community Based Nutrition Program. 12Second National Nutrition Summit in Rwanda, 2011 Consensus Statement http://nns2rwanda.org/index.php/conference-information/nns2-consensus-statement Appendix: Original Protocol from April 2012 with minor updates A9 The operations research outlined in this study protocol is the focal point of IR 3, though the project will be assisting the MOH to implement interventions across the following areas: Nutrition (40%), Maternal and newborn Care (35%), Diarrhea (15%) and Pneumonia 10%. B. Problem Statement Rwanda has developed numerous national policies and strategies to integrate food security and nutrition with poverty alleviation. In particular, there is a NationalStrategy to Eliminate Malnutrition (NSEM, 2010), Vision 2020, the Poverty Reduction StrategyPaper, the National Policy on Health, and the National Policy on Agriculture, all of which have afocus on the promotion of better nutrition for the population and introduce steps that will have an impact, particularly for young children. As stated in the NSEM, “Thenutritional situation in Rwanda remains persistently poor. For the last two decades,undernutrition remains a significant public health problem contributing to the high infant, childand maternal mortality.” The Nutrition Weeks methodology is designed to support government initiatives to reducing undernutrition with a focus on nutrition education, in particular to supplement the Community-based Nutrition Program (CBNP) with more hands-on practical learning. Starting in 1998, UNICEF assisted the MOH to develop and implement the Community Based Nutrition Program with the objective to reduce by 30% all forms of malnutrition in Rwanda by 2013.13 However, the final evaluation reported that impact assessment of the program was not possible since most of the implementation districts did not have baseline data. Given the high prevalence of undernutrition in Rwanda14 and the lack of quantitative data on the effectiveness of the CBNP, this operational research study aims to identifya feasible way to reduce and prevent undernutrition in the first 1000 days of life of children in Nyamagabe District, Rwanda through formative research, andthen to test the innovated intervention, namely, “Nutrition Weeks” to evaluate if the addition of the intervention is more effective than the standard CBNP alone. In addition, this operational research (OR) study will provide data not only from the intervention area but also from the comparison area where the standard CBNP will be implemented, thereby yielding data on the standard CBNP. If the OR findings indicate that the incorporation of the Nutrition Weeks intervention into CBNP is more effective than the standard CBNP, the data will inform the MoH’s decision-making process and will contribute to the international body of knowledge on feasible approaches to prevent undernutrition. 13 Evaluation of processes and perceptions on the CBNP in Rwanda, 2010 14 Measure DHS, Rwanda 2005 Appendix: Original Protocol from April 2012 with minor updates A10 In summary, the problem in Rwanda is how to create an effective and feasible community-based nutrition program that the MOH can implement with CHWs, that will improve key infant and young child feeding (IYCF) beliefs and practices, and which can lead to overall improved nutritional status. The proposed OR is designed to address this problem. C. Nutrition education, stunting, and self-efficacy In the Lancet series on maternal and child undernutrition, Bhutta et al reviewed interventions for maternal and child undernutrition and nutrition related outcomes. They found that education about complementary feeding increased height-for-age Z scores by 0.25 (95% CI 0.01-0.49) in populations with sufficient food.15 Results of a meta-analysis of 16 nutrition programs successful in improving infant growth in different countries, showed that a key factor for success was that the programs not only gave messages on what to feed, but also included counseling, home visits or other activities that showed mothers how to feed their child.16 However, the standard CBNP protocol does not focus on activities that showed mothers how to feed their child. Self-efficacy has been shown to be a modifiable factor that is positively associated with the duration of breastfeeding in a recent literature review17; however, the standard CBNP does not build self-efficacy or skills in mothers in infant and young child feeding practices. Moreover, the standard CBNP does not foster peer support among mothers. D. The innovation The proposed intervention, “Nutrition Weeks” will be developed by World Relief in collaboration with MOH and District based on findings from the formative research phase of the OR. This intervention will go through pre-testing, revisions and pilot-testing prior to implementation. Nutrition Weeks will be introduced into the CBNP in the intervention area. The CHWs will receive training and a step-by-step guide to implement Nutrition Week, which will be scheduled three times a year. The Nutrition Week will include all women with children under two and pregnant women who will spend two hours a day in 15Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HP, Shekar M (2008). What works? Interventions for maternal and child undernutrition and survival.The Lancet. Vol 371 February 2, 2008. 16Caulfield, L, Huffman, S., Piwoz, E. (1999). Interventions to improve intake of complementary foods by infants 6 to 12 months of age in developing countries: Impact on growth and on the prevalence of malnutrition and potential contribution to child survival. Food and Nutrition Bulletin, Vol. 20, No. 2, 1999 17Meedya S, Fahy K, Kable A. (2010). Factors that positively influence breastfeeding duration to 6 months: a literature review. Women Birth. 2010 Dec;23(4):135-45. Epub 2010 Mar 17. Appendix: Original Protocol from April 2012 with minor updates A11 small groups of up to ten, participating in a session modeled after Hearth, with a goal of learning about foods, feeding practices, and other behaviors that will prevent undernutrition. This will engage mothers in active learning to build self-efficacy and empower the trained CHWs to more effectively promote behavior change. It will do this by giving the mothers an opportunity to practice behaviors instead of just hearing messages. The study intervention is a hybrid of the Positive-Deviance Hearth (PD/H) model for community-based rehabilitation of malnourished children AND the 100% coverage and saturation-teaching method of the Care Group model. An important difference is that where PD/H focused on malnourished children, Nutrition Weeks will bring together ALL mothers in a village who are pregnant and/or have children under two years old to prevent undernutrition. The key IYCF practices that will be taught will be discovered from PD Inquiries during formative research, as well as from the MOH Community-based Nutrition Program curriculum. The difference between the CBNP program and Nutrition weeks lies in the practice with real foods (as opposed to listening to a flip-chart lecture), communication among mothers (not only from the teacher to the mothers), and a realistic acknowledgement and discussion of the barriers most mothers face to adopting these key IYCF practices. E. Project/study location and population The project and related studies will be conducted in Nyamagabe District of Rwanda. The project will target all of Nyamagabe District, which has an estimated population of 337,116, with 54,949children under-five and 79,559 women 15-49; the OR will cover Kaduha Hospital catchment area (intervention arm) with an approximate total population of 159,195 and Kigeme Hospital catchment area (comparison arm) with an approximate total population of 166,581. II. Aims, Objectives& Strategy A. Aims Overall Project Aim: The overall goal of the World Relief Rwanda Innovation Child Survival Project is to reduce morbidity, mortality and underlying undernutrition of children under five and pregnant women in Nyamagabe District of Rwanda. Operational Research Aim: The aim of the operational research component of the project is to identify a feasible way to reduce and prevent undernutrition in the first 1000 days of life of children in Nyamagabe District, Rwanda. The results of the project will yield valuable data relevant to scaling up the approach in Rwanda and contribute to the international body of knowledge on feasible approaches to prevent undernutrition. WR with Health Centers will field test a practical hands-on nutrition curriculum for CHWs aimed at improving knowledge, attitudes and practices related to Infant and Young Child Feeding as a complement to the MOH Community Based Nutrition Protocol. Appendix: Original Protocol from April 2012 with minor updates A12 B. Objectives & Strategy Overall Project Objective: The strategic objective of the project is to improve the capacity of MOH staff and CHWs in implementing high impact maternal, newborn and child health interventions at the community level. The intermediate results that are expected in the project are stated in Table 1.Project Results Framework. Table 1: Project Results Framework Project Goal: To reduce morbidity, mortality and underlying malnutrition of children under five and pregnant women in Nyamagabe District of Rwanda. Strategic Objective: Capacity of MOH staff and CHWs improved to implement high impact maternal, newborn and child health interventions at the community level. IR 1. Improved geographic access to and demand for high quality MNCH services IR 2. Improved coordination of and impact of community health activities IR 3. Innovation tested to improve the effectiveness of the Community Based Nutrition Protocol Activities: Activities: Activities: 1) Build capacity of Community Health Supervisor and Hygienist from all 16 Health Centers to train and supervise CHWs using MOH protocols and tools. 2) Train 3,216 CHWs (binome, MNC/ASM, Soc Af. and palliative care) in CBNP. 3) Train CBN Village Committees on ‘Nutrition Week’ pilot (see below) 4) Train 536 maternal health CHWs (ASM) in MNC package. 1) CHWs, religious leaders and community representatives meet monthly to: •Make action plans based on data reported by CHWs ; •Cross-train in BCC for key family practices based on barrier analysis and BC strategy; •Coordinate regular home visits •Improve referral to appropriate CHW and/or health facility. 2) Build capacity of Sector and Cell level In￾Charge of Social Affairs to support BCC. 3) Mobilize churchesto assist vulnerable households with kitchen gardens & tippy taps. 1) Conduct Operations Research comparing standard CBNP activities vs. the addition of the ‘Nutrition Week’ intervention. Evaluate with regard to feasibility for scale up. 2) Participate in Nutrition Technical Working Group; Improve awareness, solicit input and share findings. 3) Improve CHW reporting system. Overall Project Strategy: Project resources will build the capacity of MOH staff to train and supervise government-sanctioned CHWs in the implementation of their community-based packages. WR will implement through the MOH staff rather than directly intervening in the communities. Integration of interventions at community Appendix: Original Protocol from April 2012 with minor updates A13 level and local problem solving will be enhanced by forming the MOH cadre of CHWs into groups with additional members drawn from local and religious leaders and a member of the Hygiene Club executive committee. These modified Care Groups will meet monthly for one to two hour meetings where they receive training in BCC on all intervention topics. Then, they will divide up the village geographically amongst themselves to facilitate more regular home visits for BCC. The CHWs will retain their specialized responsibilities, as defined by the MOH, yet they will work together and with the additional ICG members to more effectively mobilize the community for behavior change and appropriate care seeking. The proposed project will include interventions as follows: Nutrition (40%), Maternal Newborn Care (35%), Diarrhea (15%), and Pneumonia (10%). The following table shows key activities for each intervention. These will be implemented at the community level by the CHWs under guidance of MOH staff responsible for the CHWs. World Relief staff with Supervisors from Hospital will train the HCstaff, and accompany them in providing intensive supportive supervision to the CHWs. Table 2: Key Activities for the Selected High Impact Technical Interventions Nutrition – 40% Level of Effort (LOE) • Community-Based Growth Monitoring held every month with quality counseling based on weight for age growth plots • Underweight children screened with MUAC and severely underweight or GAM cases referred to health centers • Pregnant women screened with MUAC and referred for supplemental food if under 18.5 cm • Children enrolled in OTP and those discharged from IMU will be followed up by CHWs. • Integrated Care Groups use the Triple A process (per MOH protocol) to seek and implement solutions to malnutrition in community • Results of growth monitoring shared with churches to elicit specific support for families with malnourished children • Nutrition Weeks (described in Section 4 Innovation) held in each community 2 or 3 times per year including de-worming and Vitamin A • Promotion of Kitchen Gardens as recommended by the MOH and with technical assistance from government agronomists or NGOs in the district working in agriculture • Provision of rabbits and or guinea pigs for community breeding to improve access to animal-source foods (paid by matching funds) Maternal Newborn Care – 35% LOE • Support the MOH to train the maternal health CHWs (ASM) to identify and register WRA and pregnant women, promote ANC, birth preparedness, institutional deliveries, use of family planning, attend postnatal checks for mothers and newborns and refer women and newborns with danger signs to health facilities. • Orient the Integrated Care Groups to key MNC messages they will promote to women and men including: • Attending ANC, value of institutional deliveries • Recognition of danger signs in pregnancy, delivery, post-partum, in the newborn • Maternal nutrition and decreased work load during pregnancy • Consumption of Iron-folic acid (IFA) and acquisition of Vitamin A supplements post-partum • Child spacing • ASMs help families make a birth plan and promote savings for the related costs or mutuelle enrollment • Integrated Care Groups develop emergency transport plan and community savings for medical emergencies. Diarrhea – 15% LOE • Coordinate refresher training for CHWs in CCM with emphasis on use of zinc • Integrated Care Groups promote point of use water purification, Community-Led-Total Sanitation, and treatment seeking for diarrhea to improve utilization rates for zinc in addition to oral rehydration solution (ORS). Appendix: Original Protocol from April 2012 with minor updates A14 • Collaboration with Hygiene Clubs through participation of Executive Committee member in Integrated Care Group. • Hygiene promotion through churches Pneumonia – 10% LOE • Collaboration with Ministry of Infrastructure and on-going projects to promote improved stoves to reduce indoor smoke • Hygiene promotion to prevent transmission of respiratory infections • Integrated Care Groups promote recognition of danger signs and prompt care-seeking based on C-IMCI package. Operational Research Objective:The main objective of the operational research component is to document implementation of the Nutrition Weeks innovation when added to the standard CBNP. The proposed intervention is expected to improve the nutritional status of infants and young children of ages 6m-23m from baseline to end of study in the intervention area compared to that of the comparison area, as a result of improved Infant and Young Child Feeding (IYCF) practices, assessed by surrogate indicators: 1. Increase in proportion of infants and young children of ages 6-23m fed according to minimum appropriate feeding practices. (Primary Outcome) 2. Increase in number of food groups consumed in 24 hours for breastfeeding and non￾breastfeeding infants and young children 6-23 months in a 24 hour period. 3. Increase in meal frequency (per day). 4. Increase in proportion of infants and young children having timely introduction of complementary foods. 5. Increase in proportion of infants and young children who are actively fed (whether someone assists the child with feeding). The project will also measure indicators related to maternal nutrition including the consumption of iron folic acid during pregnancy. Operational Research Strategy:WR will help HC staff to train and to support CHWs in the Kaduha Hospital catchment area to implement the Nutrition Weeks curriculum. WR will also support the MOH in implementing the standard CBNP in both Kaduha and Kigeme Hospital catchment area. The comparison will be between CBNP + Nutrition Weeks in Kaduha and the standard CBNP in Kigeme. III.Conceptual Framework for Innovation Determinants of undernutrition are multi-factorial as illustrated in figure 1 but this study proposes to intervene at several levels in the pathway to undernutrition, by providing adequate and continuous training to CHWs to improve the knowledge, attitudes and practices of mothers with regards to infant and young child feeding, and building self-efficacy and skills in mothers in food preparation, practice of good hygiene and improved use of available foods. Appendix: Original Protocol from April 2012 with minor updates A15 Figure 1: UNICEF Conceptual Framework for Determinants of Nutritional Status Appendix: Original Protocol from April 2012 with minor updates A16 Source: Complementary feeding of young children in developing countries: a review of current scientific knowledge, WHO 1998. The primary outcome of the OR is also a Core Indicator recommended by WHO as a summary for infant and young child feeding practices, which is, the proportion of infants and young children of ages 6-23m fed according to a minimum acceptable diet. In addition to meal frequency, this also captures the dietary diversity in the diet of infants and young children which has been shown to be associated with undernutrition, particularly stunting. In a study by Rah JH et al18 indicated that among 165,111 children under five years of age in rural Bangladesh, dietary diversity is associated with overall quality and nutrient adequacy of the diet. Using a 18 Rah JH et al (2010). Low dietary diversity is a predictor of child stunting in rural Bangladesh. European Journal of Clinical Nutrition (2010) 64, 1393-1398. Intervention addresses these levels Appendix: Original Protocol from April 2012 with minor updates A17 dietary diversity score developed by the authors, the multivariate analyses showed a 15% reduction in stunting among children 6-11 months with high dietary diversity compared to those with low dietary diversity, a 26% reduction in stunting among children 12-23 months with high dietary diversity compared to those with low dietary diversity, and a 31% reduction in stunting in older children 24-59 months with high dietary diversity compared to those with low dietary diversity ((odds ratio (OR) = 0.85, 95% confidence interval (CI): 0.76–0.94; OR= 0.74, 95% CI: 0.69–0.79; OR= 0.69, 95% CI: 0.66–0.73). In addition, the intervention addresses several gaps in the standard CBNP. First, CHWs will be provided adequate and continuous training based on a practical hands-on nutrition curriculum for CHWs aimed at improving knowledge, attitudes and practices related to Infant and Young Child Feeding as a complement to the MOH Community Based Nutrition Protocol. In addition, they will be provided a step￾by-stepguide to implement Nutrition Weeks. The proposed Nutrition Weeks for community learning differ from the existing CBNP in that they are interactive and skills-based, not limited to passive listening to messages, flip chart presentations, or even nutritional counseling that is divorced from actual practice - cooking and feeding the recommended food groups. As the mothers prepare the food, practice good hygiene and feed their children with the encouragement of the CHW, self-efficacy to carry out these optimal behaviors is built in mothers. By working together in small groups, mothers have the opportunity to discuss among themselves solutions to barriers they face in feeding their child or practicing key behaviors. Through repeated daily practice, they will develop these skills of food preparation and infant and young child feeding, which were not imparted by the standard CBNP. At all stages of the project and operational research, representatives from Nyamagabe District and the Ministry of Health, Rwanda will be engaged to ensure relevance, quality, dissemination and application of the project such that the results of the project will contribute to the national Community-Based Nutrition Program. The results of the study will inform the MoH’s decision-making process in introducing Nutrition Weeks into the CBNP, which is scalable since it relies on present MOH staffing and CHWs to implement across a district of 337,116 after TOT training. In the future, a similar TOT team could roll out the program in each district in Rwanda in turn, starting with the 6 priority districts that have the highest malnutrition and stunting rates. WR in collaboration with the MOH will create a TOT manual for Master Trainers and step-by-step guide for CHWs to use as a job aid in implementing Nutrition Weeks to further facilitate replication by MOH and partners in other districts. Furthermore, the results of the study will contribute to the international body of knowledge on feasible approaches to prevent undernutrition. IV. Operations Research, Formative Phase A. Formative Research Objective Appendix: Original Protocol from April 2012 with minor updates A18 The objective of the formative research phase of the OR study is to refine development of the Nutrition Weeks intervention content, including the corresponding curriculum and reminder materials that will be used to train CHWs in its implementation. Nutrition Weeks are patterned after Positive Deviance/Hearth because of said methodology’s documented success in building the self-efficacy of caregivers to use locally available foods to rehabilitate moderately malnourished children in the community. However, adjustments to the methodology need to be made in order to 1) focus on the prevention of malnutrition; and 2) include all pregnant women and mothers with children under the age of two using existing human resources (CHWs and local leaders) for implementation. In recent years, the Ministry of Health, in partnership with UNICEF, and the Kabeho Mwana Expanded Impact (of which World Relief was the EIP consortium partner responsible for leading behavior change communication) conducted considerable qualitative research on nutrition and health practices in all regions of the country in order to develop appropriate messages for community curriculum on C-IMCI. UNICEF recently published Dr. Judy McLean’s Phase 1 report online: The Implementation of In-Home Fortification andNutrition Education to Combat Anaemia andMicronutrient Deficiencies Among Children 6-23Months in Rwanda. Dr. McLean’s work in Rwanda for the Micronutrient Powders (MNP) project shares some of the same formative research goals and findings with this WR Innovation project; please refer to this link for the full report: http://www.unicef.org/rwanda/events_10335.html. Selected findings included gaps in the following areas (emphasis added): “Our findings make clear that caregivers’ understanding of appropriate feeding practices for youngchildren is very limited with a highly apparent lack of knowledge regarding the importance of energy dense foods or key foods important for reducing the risk of micronutrient deficiencies.Energy dense foods are particularly important in Rwanda as stunting is highly prevalent and fatintake is considered to be the lowest in the world. Stunting, low ‘height for age’, is a commonlyconsidered to be a physiological response to inadequate nutrition during the first ‘1000 days’ oflife, or conception to about 2 years of age. Early child growth is dependent on children beingintroduced to complementary foods that are timely, of adequate quantity, consistency, frequency,and quality.” “The focus in Rwanda among mothers and caregivers is on a ‘balanced diet’, which may or may not meet the energy needs of a growing child. Of importance, the diet is very low in animal foods that are key sources of minerals, particularly iron, as well as providers of high quality protein and essential fatty acids. It is clear thatthese foods are not accessible on a regular basis to most families making preventing deficiencies challenging… It is widely apparent that a strong complementary feeding education protocol is needed… Messages for caregivers will be targeted tothe needs of young children for growth to include frequent feedings of energy dense thickporridge made from grains, with added foods such as meat, eggs, fish, ground nut paste,avocadoes, where available. Oil or other fat should be added to porridge every time inaccordance with the current ‘Essential Nutrition Actions’. Fruits and Appendix: Original Protocol from April 2012 with minor updates A19 vegetables add smallamounts of micronutrients, and variety promotes a wider acceptance of food but they aregenerally lower in energy density and micronutrient bioavailability, other than vitamin C.Poverty is an obvious issue but nutrition knowledge can still play a role as foods such as oil maybe present but family members may not know the high needs children have for fat in the diet.Similarly small amounts of organ meats, rich in iron and vitamin A, can be added to children’sfood and may be present but their value not known.” “Of importance, caregivers want clear andaccurate information. Messages must be developed with that in mind and community healthworkers and health staff must be trained such that they can provide answers to caregivers’ questions.Caregivers discussed important sources of information or where they would like to hear aboutMNP and (nutrition) recommendations included radio, community health workers and other health careproviders. It is recognized that messages must be consistent, clear and frequently delivered ifthey are to be effective at changing behaviours.” The Phase 2 report on the pilot for the MNP project is being completed by Dr. McLean and will be available in the near future. With so much existing information and experience related to maternal, infant and young child feeding practices, formative research on the Nutrition Weeks intervention will not seek to repeat collection of the same general information but rather to focus on identifying replicable solutions that enable caregivers to raise well-nourished children even in the face of limited resources. B. Formative Research Questions 1. What key behaviors should be promoted in the Nutrition Weeks to have the greatest impact on child growth and nutrition from conception to age two years? 2. What locally available foods, feeding and other health-related practices do caregivers of well￾nourished children 6-23 months employ? 3. What barriers and positive coping strategies exist to practice of ideal maternal and child feeding practices? Specifically: a. Timely introduction of complementary foods b. Adequate dietary diversity c. Use of energy dense foods d. Recommended feeding frequency e. Appropriate preparation methods for children f. Intake of iron/folic acid and additional food during pregnancy g. Caregiver time, mothers’ work outside the home, who cares for the child 4. What are the perceived characteristics and benefits of a well-nourished child? Appendix: Original Protocol from April 2012 with minor updates A20 5. Do the training of trainers curriculum and CHW reminder materials facilitate faithful implementation of the intervention? Is the content understood by trainers, CHWs and mothers? 6. Which strategies promoted by the Nutrition Weeks for achieving the appropriate minimum feeding practices (dietary diversity and frequency of feeding) prove to be the most readily adopted by participants in the program? C. Phases of formative research Phase 1) Design: Define priority information and behaviors related to the first 1000 days to target for initial inclusion in the Nutrition Weeks curriculum. This phase will last 10 days beginning February 20, 2012 (pending IRB approval) and will contribute to answering research questions 1-4. Method 1.1 Desk Review Identify and review relevant international guidelines, including the WHO standards for IYCF, Essential Nutrition Actions and the Community Based Nutrition Protocol used in Rwanda. Identify and review existing documentation of local practices, using findings from the most recent Demographic and Health Survey, the MNP Project, other nutrition studies done in Rwanda, the project KPC and other findings on extant practices. Analysis Plan 1.1 Data will be organized as demonstrated in the following illustrative table: Table 3: Desk Review Matrix Recommended practice Prevalence in Rwanda (data source) Impact on child growth and stunting (High, Medium, Low) Application of Results 1.1 Practices with a high impact on child growth and relatively low levels of uptake will be recommended for particular emphasis in the curriculum; they will also inform development of instruments used in the community for qualitative data collection, to better understand what underlies the desired behavior or its absence, as the case may be. Method 1.2 Market Survey to confirm local cost and availability of foodstuffs and related supplies. Project staff will visit local markets to determine availability and pricing of foodstuffs and related supplies. They will be given a list of specific items to look for as well as note other finds. Food lists will include those rich in protein, fats, iron and other micronutrients. Additionally, they will note prices of supplies related to food preparation, water treatment and storage, and hand washing including soap. Appendix: Original Protocol from April 2012 with minor updates A21 Sampling 1.2 Three local markets will be purposely selected in the vicinity of the pilot intervention communities and visited by project staff. Analysis Plan 1.2 Findings from the market survey will be compiled in a table such as the illustrative one that follows. Table 4: Market Survey Findings Market 1:_____ Market 2:______ Market 3:_______ Key Nutrient Contributions (+/-) Date: Date: Date: Item Price/ Quantity Price/ Quantity Price/ Quantity Average Cost Protein Energy Iron Vit A After the items have been compiled, the team will circle the most affordable, nutritious options available at the time of the survey. Application of Results 1.2 Findings from the market survey will be combined with information from positive deviance inquiries and other sources of foods that people produce themselves or otherwise have available in their home food stores. The most affordable, energy and nutrient dense foods will be incorporated into suggested recipes and promoted during the Nutrition Weeks, recognizing that season affects the price and availability of items. Recipe Creation/ Development exercises where caregivers modify traditional recipes to increase nutrient density (but still stay culturally acceptable) may also be done, if needed. Method 1.3 Positive Deviance Inquiry using Semi-Structured Interviews and Observations In the context of nutrition programming, “positive deviants” are mothers or families who manage to have well-nourished children despite their poverty. For a family to be considered a positive deviant for the purposes of this study, it must have a well-nourished child 6-23 months-old despite being of low economic status. The PD Inquiry is an approach for conducting observations and semi-structured interviews related to child feeding and health care practices that was developed for use in PD/Hearth programming. The sample tool included in “Designing a Community-Based Nutrition Program Using the Hearth Model and the Positive Deviance Approach”http://www.positivedeviance.org/pdf/fieldguide.pdf is intended to be adapted to the local context and program needs. Appendix: Original Protocol from April 2012 with minor updates A22 The methodology recommended for PD/Hearth calls for interviewing six positive deviant, two negative deviant (wealthy household with malnourished child), and two non-deviant (undernourished child in a poor household) in a village. The findings from the different households are then compared and contrasted to identify positive behaviors and coping strategies that would be feasible for broad application in the community. The traditional approach to PDI calls for repeating the process in every village where Hearth is to be implemented, even if the context is uniform, in order to stimulate a process of self-discovery. However, as that would be prohibitive for national scale up—the Nutrition Weeks methodology will instead limit use of the PDI to a sufficient number of positive deviant households to inform curriculum development, keeping in mind the extensive amount of data that has already been collected and even project staff experience implementing PD/Hearth in Nyamagabe District and elsewhere. Nonetheless, additional data collection is required when seasonality affects the viable coping strategies and before expanding to a heterogeneous region. Rather than fostering local discovery via the PDI process, the Nutrition Weeks curriculum will include opportunities for mothers to share experiences and discover from each other strategies for achieving optimal infant feeding. The PDI will be conducted in Kaduha hospital zone by one team of 2-3 project staff. The Co-Investigator was originally trained in PD/Hearth and use of the PDI by Drs. Warren and Gretchen Berggren, early pioneers of the Hearth model. She has since implemented PDIs and trained others to do so on multiple occasions. The PDI will take place four days in late March, upon completion of KPC survey data collection and entry (in order to use anthropometry data from the KPC to find PD children.) Home visits for PDIs take up to two hours and are best conducted during meal preparation and feeding times to maximize opportunities for direct observation. The observation checklist includes practices related to hygiene, feeding, breastfeeding, family interactions, food preparation and water usage. The semi-structured interview includes general questions about the family, questions for mothers on feeding practices, caring practices and health seeking practices; and additional questions for older sibling caregivers, fathers and grandmothers. Data and observations are recorded on the interview form, including information on household composition and nutritional status of children 6-23 months-old. Because the PDI is best suited for capturing present nutritional practices, appropriate weight for age and MUAC (rather than stunting) will be considered the pre-requisites for inclusion based on nutritional status. Wealth classification will be based on a recent participatory poverty assessment led by the Ministry of Local Government (MINALOC) with support from the MoH and involvement of community members. The six strata are defined from lowest to highest as: abject poverty, the very poor, the poor, the resourceful poor, the food rich, and the money rich. Sampling 1.3 Purposive sampling will be used to yield in-depth information about child feeding and care practices in low-income households with well-nourished children 6-23 months in age. The team will conduct PDI interviews in at least 5 households intentionally selected from five different health center catchment Appendix: Original Protocol from April 2012 with minor updates A23 areas, intended to capture any variation in predominant agricultural practices, livelihoods and any other factors thought to impact food availability. To reduce time spent searching for eligible well-nourished children, anthropometric data from the KPC Survey and or other available sources will be used to identify possible candidates. Children on that list will be cross-referenced with the household’s wealth ranking, as defined by the government into six levels. To confirm the child/household’s status as a positive deviant, the child’s weight and MUAC score will be measured and along with the age in months, prior to proceeding with the rest of the interview. Analysis Plan 1.3 Findings from the PDIs are reviewed by the team and compiled in a matrix to help analyze the findings. Table 5: Sample Matrix to Analyze PD Findings Household Good Foods; Good Feeding Good Child Care Good Health Seeking Behavior From amongst the positive practices identified, those foods and behaviors that should be accessible to the majority of people can be circled. Application of Results 1.3 Those positive deviant foods, behaviors and coping strategies that should be widely applicable across the population will be recommended for inclusion in the Nutrition Weeks curriculum. Phase 2) Materials development and pilot testing: Develop and pilot test materials and training with CHW trainers, CHWs and caregivers. Revise intervention based on user feedback (trainers and caregivers) for continuous improvement of intervention content and execution. This phase of the formative research will contribute to answering research questions 5-6 and will last twelve weeks from March 18 to June 8, 2012. Following design of the training materials, the pilot phase will be implemented in Musebeya Health Center catchment area, specifically in five villages of Rusekera Cell of Musebeya Sector. A Training of Trainers for ten participants (3 Innovation CSP staff, 1 HC nutritionist, 1 staff in-charge of social affairs at sector level and 5 staff in charge of social affairs at cell level) will be conducted from April 9-10, 2012. Additionally, the nutrition committees for each of the five villages (6 CHWs and 1 Village Head = 7 committee members/village) will be trained together (35 total participants) April 12-13, 2012. The pilot Nutrition Weeks in each village will likely have 30 women divided into three groups. This will enable the 6 CHWs per village to work in pairs, each responsible for one group over the course of the week. Feedback from CHWs and participants will be used to refine curriculum prior to expansion to the Appendix: Original Protocol from April 2012 with minor updates A24 remaining health centers and villages in Kaduha Hospital catchment area, to take place June 10-July 27, 2012. Method 2.1 Test of CHW knowledge after Nutrition Weeks training. The CHWs will be given written pre- and post-tests related to the content and execution of the Nutrition Weeks curriculum before and after their training. The pilot training of CHWs will be April 12-13, 2012. Sample 2.1 All CHWs participating in the Nutrition Weeks pilot will be given pre and post-tests. In the pilot phase this would be 30 CHWs. Analysis Plan 2.1 Following the exams, the CHWs will rotate papers such that each assists with scoring the exam of a peer based on the percent of correct responses. The mean and median scores will be calculated for each class and cumulatively. Application 2.1 The exam will serve multiple purposes. The pre-test will establish the baseline knowledge level of CHWs related to nutrition. The post-test will 1) allow for immediate discussion with the CHWs to clarify any common areas of misunderstanding; and 2) If common themes of weakness emerge, they will be used to reinforce aspects of the training in future cycles. Tracking results in CHW trainings after the pilot phase would also enable documentation of CHW proficiency prior to implementation of the intervention during expansion of the intervention to the remainder of the hospital catchment area. Method 2.2Feedback meetings with CHW trainers and CHWs Following the pilot TOT and then pilot implementation of Nutrition Weeks, a feedback meeting will be held with participants the week of April 29th to capture feedback on their experience with the training and suggestions for improvement. Sample 2.2 All ten trainers and 35 trainees. Analysis Plan 2.2 Field staff will record feedback in written form; in discussion with HO tech support, recommendations will be made for revisions to the curriculum and implementation plan. Application 2.2 Suggestions will be applied to revision of the Nutrition Weeks training content and materials. Appendix: Original Protocol from April 2012 with minor updates A25 Method 2.3 Maternal Exit Interviews following Nutrition Weeks intervention. The purpose of these interviews is to learn about the experience of Nutrition Weeks participants, to improve the intervention and to understand the impact it is having on feeding and care practices in the households of participants. The interviews will examine what the participants learned, what they liked and disliked about the week, new behaviors they plan to adopt/have adopted and any factors that prevent them from practicing what they have learned at home. The exit interviews will be conducted within one week of completion of the Nutrition Week then again at least4 weeks later. As the Nutrition Week pilot is scheduled for the week of April 22, 2012, week one data would be collected April 27-May 4 and week five data May 24-31. The exit interviews will be used to create case studies of intervention participants. Interviews may be conducted by the two M&E Staff, two Nutrition staff and one Health Center staff. UBC graduate students will help with writing up the case studies in English. Sample 2.3: Two participants from each of the five Nutrition Week pilot groups will be interviewed at each time interval. Preferably the same individual would be interviewed at both time intervals to create a total of 10 case studies from the pilot group. Analysis Plan 2.3: Table 6: Responses of exit interviews will be reviewed and compiled, as in the sample matrix below Respondent Learned Liked Disliked New foods/behaviors Application at home The responses will be reviewed for common themes and helpful insights. From this, a list of lessons learned and suggestions for modification of the intervention will be generated. Application Plan 2.3 Findings from the exit interviews will be used to further refine the Nutrition Weeks intervention and also to understand how the participants are responding to the intervention. If the response is positive, the information will contribute to advocacy for scaling up the approach. Appendix: Original Protocol from April 2012 with minor updates A26 V. Operations Research, Evaluative Phase In this section, the evaluative research component of the operational research will be described. The below figure illustrates the rationale informing the study objectives. Figure 2: Adaptation of the Precede-Proceed Model Intervention: Nutrition Weeks held 2 times per year along with CBNP Predisposing factors: Increase in IYCF knowledge and attitude Reinforcing factors: Builds skills and self￾efficacy of mothers in food preparation, practice of good hygiene and feeding their children; improved use of available foods Enabling: Peer support through small groups of mothers and positive feedback from trained CHWs. Provides opportunity to express challenges and barriers they face in feeding their children or practicing key behaviors, and to work out solutions. Behavior Change: Improved IYCF practices, assessed by: Increase in proportion of infants and young children of ages 6-23m fed according to a minimum of appropriate feeding practices. (Primary Outcome) 1. Increase in number of food groups consumed in 24 hour period, for breastfeeding and non-breastfeeding children 6-23 months. 2. Increase in meal frequency (per day). 3. Increase in proportion of infants and young children having timely introduction of complementary foods. 4. Increase in proportion of infants and young children who are actively fed (whether someone assists the child withfeeding). Improved nutritional status of infants and young children 6-23m of age (weight-for-age, height-for-age, weight￾for height -2 SD for median weight for age, according to WHO reference population, and MUAC). Improved Health and Survival (decline in Infant mortality rate) Appendix: Original Protocol from April 2012 with minor updates A1 A. Operational Research Objective The objective of the operational research component of the project is to identify afeasible way to reduce and prevent undernutrition in infants and young children of ages 6 months to 23 months in Nyamagabe District, Rwanda. B. Operational Research Questions 6. Is there an improvement in nutritional status of infants and young children of ages 6m-23m from baseline to end of study in the intervention area compared to that of the comparison area, as a result of improved Infant and Young Child Feeding (IYCF) practices, assessed by surrogate indicators? Surrogate indicators measured are: i. Proportion of infants and young children age 6m-23m fed according to a minimum acceptable diet. (Primary Outcome) ii. Increase in number of food groups consumed in 24 hours for breastfeeding and non-breastfeeding children 6-23 months. iii. Meal frequency (per day). iv. Proportion of infants and young children having timely introduction of complementary foods. v. Proportion of infants and young children who are actively fed (whether someone assists the child with feeding). 7. What is the cost in USD of the intervention package per child? 8. What is the acceptance rate of the intervention package? 9. What is the perception of the intervention package by participants and relevant stakeholders? C. Type of study design This is a quasi-experimental two-arm (CBNP + Nutrition Weeks compared with standard CBNP) design, with one intervention area (Kaduha Hospital catchment area) and a comparison area (Kigeme Hospital catchment area). Please refer to figure 3. D. Limitations of the study Random assignment to the intervention and comparison arms will not be employed due to lack of feasibility and likelihood of cross-contamination.However, we will compare key baseline sociodemographic characteristics in the two study areas to ensure that systemic bias (i.e., selection bias) was not introduced. Statistical adjustments will be made where group characteristics differ significantly on potential confounding variables. As the study is conducted in only one district in Rwanda, generalizability of results to the entire country may be limited. Finally, addressing other determinants of nutritional status such as poverty-alleviation and agricultural improvement is beyond the scope of this study. Appendix: Original Protocol from April 2012 with minor updates A2 E. Hypothesis Hypothesis testing is based on the primary outcome. Ho: The difference in proportion of infants and young children of ages 6m-23m fed according to a minimum of appropriate feeding practices, from baseline to end of study in the intervention area is less than 15% than that of the comparison area. Ha: The difference in proportion of infants and young children of ages 6m-23m fed according to a minimum of appropriate feeding practices, from baseline to end of study in the intervention area is at least 15% more than that of the comparison area. F. Study arms This is a quasi-experimental two-arm (CBNP + Nutrition Weeks compared with standard CBNP) design, with one intervention area (Kaduha Hospital catchment area) and a comparison area (Kigeme Hospital catchment area). The intervention to be implemented and tested is “Nutrition Weeks” added to the MOH’s Community-Based Nutrition Program (CBNP). World Relief staff and HC trainers will train and support CHWs in the intervention area to implement the Nutrition Weeks curriculum, which will be based on findings from our formative research. WR will also support the MOH in implementing the standard CBNP in both intervention and comparison areas. The intervention area and comparison area will be similar expect for the intervention tested, namely, Nutrition Weeks. All other project activities in nutrition, maternal newborn care, diarrhea, pneumonia will be implemented in both the intervention and comparison areas. Random assignment to the intervention and comparison arms will not be employed due to reasons of feasibility and cross-contamination, rather participation of individuals in the intervention arm vs. comparison arm will be based on residency within the respective region. However, we will compare key baseline sociodemographic characteristics in the two study areas to ensure that systemic bias (i.e., selection bias) was not introduced. Statistical adjustments will be made where group characteristics differ significantly on potential confounding variables. The comparison area will be benefited by all other project activities expect for the intervention. However, if the results of the OR are positive and the OR yields valuable data on the success of the Nutrition Weeks intervention, this will be presented to the MOH to advocate for scaling up of the approach in Rwanda, thereby benefiting the comparison area as well. The results will also contribute to the international body of knowledge on feasible approaches to prevent undernutrition. Appendix: Original Protocol from April 2012 with minor updates A3 G. Study Population Intervention area :all infants and young children of ages 6m-23m resident in Kaduha Hospital catchment area. Comparison area :all infants and young children of ages 6m-23m resident in Kigeme Hospital catchment area. Note that for purposes of also measuring additional project indicators, children 0-5 months will also be included in the samples of both the intervention and comparison areas. H. Evaluation Methods Data collection:Data collection for the OR study is nested within the KPC due to limited resources (see appendix for details on project indicators and KPC ). However, adjustments to the standard 30-cluster sampling methodology with 10 households per cluster will be made, to ensure adequate sample sizes of two particular sub-groups of interest: children 6-23 months and children 0-5 months. The sample size calculation for the OR study is based on the primary outcome indicator, proportion of infants and young children ages 6m-23m fed according to the minimum acceptable diet, a combination of dietary diversity and feeding frequency. This is indicator is recommended by WHO in its 2008 guidance on Infant and Young Child Feeding (IYCF). Formula used for sample size calculation: n = D [(Zα + Zβ)2 * (P1 (1 - P1) + P2 (1 - P2)) / (P2 - P1)2 ] Where, D= 2; Zα =1.645; Zβ = 0.84; α= 0.05; β= 0.80 Table 1: Sample Size Calculations based on Primary Outcome and IYCF Indicator Proportion of infants and young children of ages 6m-23m fed according to a minimum of appropriate feeding practices in sample 1 p1 Proportion of infants and young children of ages 6m￾23m fed according to a minimum of appropriate feeding practices in sample 2 p2 ∆ n1 = n2 N 0.37* 0.47 0.10 596 1191 0.37 0.52 0.15 265 530 0.37 0.57 0.20 148 295 0.37 0.67 0.30 62 125 0.37 0.77 0.40 32 63 0.37 0.87 0.50 17 34 Appendix: Original Protocol from April 2012 with minor updates A4 * Source: Addendum to the 2005 Rwanda DHS (IYCF).http://www.measuredhs.com/pubs/pdf/FR183/Rwanda_IYCF_KM-2005.pdf From the above calculation, in order to detect a 15% or greater difference in the proportion of infants and young children of ages 6m-23m fed according to a minimum of appropriate feeding practices between baseline and end of study in the intervention area and in the comparison area, with α =0.05 and 80% power, we would need a total of 530 infants and young children of ages 6m-23m. The non￾response rate in KPC surveys is typically negligible, as household selection happens at the time of the interview, which is non-invasive and well-explained. Adjustment of KPC sample size to accommodate project indicators for children 0-5 months: The project as a whole will be measuring indicators in addition to those required for the operations research; two of those indicators (exclusive breastfeeding and early initiation of breastfeeding) are based on a subsample of children 0-5 months. According to USAID’s guidance on sampling for KPC surveys, a minimum of 75 children 0-5 months should be included in any given sample; this has been determined to be a reasonable tradeoff between precision and resources for project monitoring purposes. In order to sample a minimum of 75 children 0-5 months and 265 children 6-23 months in each arm of the study, we will increase the typical 30x10 KPC survy sample to 30x12, such that each cluster will have 3 children 0-5 months and 9 children 6-23 months, all from unique households. Note on Monitoring Surveys: To better use limited resources, monitoring surveys will use a sample of 30x 10 households with children 0-23 months and will not use parallel sampling to achieve pre￾determined samples by sub age groups. Timing and frequency of data collection: Data on proposed indicators will be collected at baseline and at the end of the study. In addition, since the OR study is nested within a larger project, in each year of the study period, data will be collected for monitoring of the overall project. The schedule of data collected is presented in table 6. Table 2: Data collection schedule Project Year Project Activity Survey Year 1 Baseline Double-30-cluster (30x12) KPC with OR questions, anthropometry; One each in Intervention and Control areas Year 2 Monitoring Double 30-cluster (30x10) KPC with OR questions, anthropometry in Intervention and Control areas. Year 3 Monitoring Abridged double 30-cluster (30x10) KPC with OR questions, anthropometry and additional project indicators in Intervention and Control areas. Year 4 Final Evaluation Double 30-cluster (30x12) KPC with OR questions, anthropometry, one each in Intervention and Control areas. Appendix: Original Protocol from April 2012 with minor updates A5 Data collection will be done using electronic devices (e.g. Windows Mobile HTC smart phones or similar) with technical support from MCHIP in Rwanda and in Washington, DC. This would remove the need for manual transfer of data from questionnaires to an electronic database. The feasibility of doing electronic data collection at baseline is contingent on the timely programming and successful pre-testing of the devices during the time allotted. Data analysis: All data will be entered into an excel database and transferred into PASW statistics 20 (formerly SPSS) or STATA 10. The data set will be cleaned and checked for errors and inconsistencies. Exploratory analysis and descriptive analysis will be performed. Hypothesis testing will be undertaken by Z test and significance of all other proportions by χ2. Figure 3: Framework of OR study design Baseline assessment Baseline assessment Intervention - End of study assessment End of study assessment Intervention area Comparison area Appendix: Original Protocol from April 2012 with minor updates A6 VI. Process Documentation It is important that the study provide information on how the intervention was implemented, changes made along the way, and community response to the intervention. This will enable future replication of the innovation being tested, and understanding of reasons for the success or failure of the intervention. The study will document the OR process as follows: • How Formative Research (Positive-deviance Inquiries) contributed to developing the content, key messages and format of the Nutrition Week intervention. • Complete curriculum content and lesson plans for the Nutrition Week intervention. • Curriculum for training CHWs and program staff on how to run a Nutrition Week. Reports on exit interviews conducted with caregivers who just completed a Nutrition week (NW) session (including their perceptions, family member’s perceptions, and what they liked and did not like about the NW, including how they plan to change their own IYCF behaviors as a result of what they experienced during the NW. VII. Ethical Considerations There is minimal ethical risk associated with the research components of the project. All phases of data collection are non-invasive and data will only be collected on those participants who give informed consent. The comparison group will receive and benefit from the standard MoH CBNP protocols. Meanwhile, the minimal risk to participating in the Nutrition Week intervention is similar to activities of daily life associated with food preparation. A. Confidentiality Participant confidentiality and privacy will be assured through the use of a unique identifier number on all questionnaires. Soft copies of the data will be kept in a password encrypted file and hard copies of questionnaires in a locked filing cabinet in the offices of World Relief in Kigali. B. Informed consent All data collection will involve informed consent; examples of consent forms are in the annexes with the sample instruments. C.Ethical approval The Project is seeking approval from the Rwanda National Ethics Committee, and the study will be conducted after approval from the RNEC. Appendix: Original Protocol from April 2012 with minor updates A7 VIII. Logistics A. Distribution of responsibilities The project is being implemented by World Relief Rwanda in partnership with the Ministry of Health and the University of British Columbia. Please see the table below for roles and responsibilities of specific individuals. Table 7: Roles and responsibilities: I-CSP Assessments No Names Affiliation Responsibilities 1. Dr. Judy McLean University of British Columbia Principal Investigator; Responsible for developing the research design; Providing technical oversight to tool development and methodology for KPC baseline & OR; Oversight of quality data collection and analysis; Facilitate the development of a memorandum of understanding (MOU) with University of British Columbia and students; Disseminate the results beyond Rwanda. 2.. Dr. Fidele Ngabo MOH Principal Investigator; Responsible for engagement of national level stakeholders, research design and contextualization to Rwanda, quality of implementation, analysis and national dissemination of results. 3. Melene Kabadege World Relief Lead Co-Investigator of Operations Research; provide technical assistant for tool and protocol development; Lead the KPC survey Implementation; overall coordination of data collection at field level, data analysis and reporting writing. 4. Nutrition Desk, Alphonsine Nyiransabimana MOH MOH Nutrition specialist; provide input to research; follow the results to ensure that the findings are relevant; facilitate the finding dissemination throughout Nutrition Technical Working Group. 5. District Health Team represented by the Director of Health or Medical Director MOH Implementing partner; Oversee the implementation of the survey in their respective district; provide surveyors and Supervisors; community mobilization. 6. UBC Nutrition Students Universityo f British Columbia Provide technical assistance for training, data collection,analysis and reporting 7. Dr. Monisha Jayakumar World Relief – Home Office Provide technical assistance for protocol development and report writingin Year 1 8. Melanie Morrow World Relief – Home Office Review protocol & tool development and report; Submit reports to USAID. (Years 1 – 2) 9. Rachel Hower World Relief – Home Office Review protocol & tool development and report; Submit reports to USAID. 10. Olga Wollinka World Relief – Provide technical assistance for tool, protocol development and reporting (Years 1-2) Develop MOU with UBC (Year 1) Appendix: Original Protocol from April 2012 with minor updates A8 Home Office 11. Grace Carmen Umutoni World Relief - Rwanda Contribute to protocol development, data analysis, and report writing; liaison with the district and MOH central level; Lead questionnaire and consent form translation process into Kinyarwanda; responsible for budgeting, logistics; Community mobilization 12. Maurice Kwizera World Relief Rwanda Submit study protocol to RNEC and KPC report to MOH. (Year 1-2) B. Timetable The key milestones for the project and OR study appear below. Table 3: FY 1 (October 2011-September 2012) Timeline Activities Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sep Hire staff, Begin OR refining with Principal Researcher X X X Write and Finalize Study protocol X X X Program data collection system (continues monthly) X X X X X X X X X Submit protocol to RNEC for ethical approval X Presentation to Rwanda Ethics Committee X Meeting with stakeholders three times annually Before OR (February) Before Nutrition Week (May) After OR to share results (August) X X X Univ. of British Columbia Research assistants arrive to help with KPC data analysis quality assurance and data entry X Prepare KPC and FG refresher training; Pilot data collection X Refresher training for surveyors from district MoH, INATEK and ICSP, including pilot exercise for KPC. X KPC Data collection – Control &Intervention areas X Positive deviant Inquiries X KPC data entry, cleaning and follow-up of data collection if necessary X KPC data analysis X Appendix: Original Protocol from April 2012 with minor updates A9 Field Visit by Primary Investigator, Dr. Judy McLean, week of April 5. X Participation in Nutrition Working Group, the last week of every month X X X X X X X X X Activities Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sep Draft KPC report X X Submit KPC report to MoH & USAID X Nutrition Week Design, Field Testing and Translation (see rows below) X X X X Phase 1 Nutrition Week Design (Desk Review, Market Survey and PDI) X Phase 2 Materials development and pilot testing (12 weeks total) X X X X Train CHW on Nutrition Interventions and program implementation CHW Pre- test X X x TOT for CSP and HC staff and sector-level staff in-charge of social affairs X X TOT for Nutrition Committees for each of the five villages X Feedback meetings with CHWs and Trainers X Community mobilization: Meeting with Local Leaders, Religious Leaders, and Health Leaders and then community meetings. Two weeks before Nutrition week X Nutrition Weeks Pilot in Rusekara Cell X Expansion of Nutrition Weeks to rest of Kaduha Hospital catchment area X X Program data collection (ongoing, monthly) X X X X Maternal Exit interviews for Caregivers 1 week and 4 weeks post-intervention. X X Feedback meetings with CHWs and Trainers X Write First Annual Report X Appendix: Original Protocol from April 2012 with minor updates A10 Table 4: FY 2, 3 and 4 (October 2012- September 2015) Timelineas of Year 1 Activities Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sep Program data collection system X X X X X X X X X X X Visit by Principal Researcher (TBA) 1-2 times per year Stakeholder meetings after survey results and pilot to share results X Nutrition Technical Working Group last week of every month. X X X X X X X X X X X X KPC in Intervention and Control Areas, data entry and Analysis X X Draft KPC report X Submit KPC report to MoH & USAID X X Refresher Training for CHW on Nutrition Week Program implementation Pre/Post test to CHW X X X X Activities Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sep Nutrition Week (The 1stnd Nutrition Week will be held in Jan-early Feb. The second one will be held during a week in June- August when it will not conflict with MCH Week). X X X X X Exit interview for Caregivers; analysis of post-Nutrition Week data from community and CHW surveys X X X X X Appendix: Original Protocol from April 2012 with minor updates A11 Appendix: Original Protocol from April 2012 with minor updates A12 C. Budget The budget is US $175,000 for 4 years. Baseline Evaluation Budget ACTIVITIES Units Quantity DAY RATE TOTAL (RwFrs) Training of surveyors and supervisors Enumerators from HCs Person 8 3 19,500 468,000 Enumerators from UNATEK Person 15 3 30,000 1,350,000 Enumerators from former EIP Person 5 3 30,000 450,000 Enumerators from I- CSP Person 8 Supervisors from District Person 3 3 19,500 175,500 Supervisors from I-CSP 2 Tea break for Participants Lunch 42 3 2,000 252,000 Lunch for Participants Lunch 42 3 4,000 504,000 Transport cost for HC participants Person 8 2 10,000 160,000 Water bottle 42 3 300 37,800 3,397,300 Field Survey Enumerators from HCs Person 8 10 19,500 1,560,000 Enumerators from UNATEK Person 15 10 30,000 4,500,000 Enumerators from former EIP Person 5 10 30,000 1,500,000 Supervisors from District Person 3 10 19,500 585,000 Lunch for Project surveyors Lunch 12 10 4,000 480,000 Transport cost for HC participants Person 8 2 10,000 160,000 Water bottle 42 3 300 37,800 Community guides person 15 10 3000 450,000 Data Entry & Cleaning Non I-CSP Staff Person 4 10 19,500 780,000 10,052,800 Supplies & Logistics location conference room Room 1 3 40,000 120,000 flipchart pc 1 1 6,000 6,000 markers pc 1 1 3,500 3,500 Pencil, rubber sharpner PC 40 1 250 10,000 pens pc 40 1 100 4,000 folders and Note books pc 40 1 3,500 140,000 Printing of questionnaires pc 16 600 20 192,000 vehicle rental veh 2 10 100,000 2,000,000 phone cards (1 per team) card 8 1 10,000 80,000 Review board fee 1 1 850,000 850,000 Appendix: Original Protocol from April 2012 with minor updates A13 3,405,500 Total 16,855,600 $ 28,092.67 Annexes Annex A: CVs for Principal Investigators and Co-Investigator Judy A. McLean Assistant Professor, Food Nutrition & Health Teaching areas: Food, Nutrition and Health, Integrated Studies in Land and Food Systems Contact: FNH 215-2205 East Mall, Vancouver, BC V6T 1Z4, Phone: 604-822-6195, Fax: 604-822-5143, Email: judy.mclean@ubc.ca, Website: InternationalNutrition Education Ph.D. (Human Nutrition) University of British Columbia B.Sc. (Human Nutrition) University of British Columbia Research Interests Global problems in food and nutrition including the political, social and cultural factors underlying malnutrition in different contexts.Assessment of nutritional status, maternal infant and child feeding habits, nutrition knowledge, food intake and household food security as a basis for culturally appropriate nutrition intervention programs.Micronutrients and development issues. Of primary interest is the development, implementation and assessment of cost-effective, evidence based means of addressing malnutrition among young children, adolescents and reproductive-age women, and improving pregnancy outcomes. Teaching At UBC my teaching focus is on global problems in nutrition and food security; analysis of the political, social and cultural complexities of food habits and malnutrition in various cultures around the world as well as the relationships between diet and disease in both the developed and developing world. I have also prepared and presented introductory nutrition courses in Africa which are regionally specific with attention to food availability, related nutrient deficiencies, as well as the cultural and socioeconomic factors that impact on food security in each region. Our International Nutrition group is currently working to assist others countries in developing post graduate courses in nutrition as education is a vital component of the Millennium Development Goals. We work collaboratively with international organizations and governments on applied food security and nutrition intervention projects. Courses ● FNH 355 — International Nutrition Appendix: Original Protocol from April 2012 with minor updates A14 ● FNH 455 — Advanced International Nutrition ● ASTU 400D — An Examination of Post-Conflict Societies ● FNH 490 sec 004 — Food Science Applications to Address Nutrient Deficiencies in Developing Countries Current and Recent Projects: ■ Principal Investigator: Ecological and socio-economic intensification for food security in smallholder agriculture in the Andes – CIDA/IDRC Food Security Grant (2011-2015) ■ WHO and the Asian Development Bank: Consultanton the Development of Training Curriculum in Public Health Nutrition, Mongolia to be incorporated into the medical school curriculum. (2011- current). ■ WHO: Primary Consultant on the Development of the National Policy and Implementation Guidelines on Preventing Micronutrient Deficiencies in Cambodia (2010-2011). Completed: March 1, 2011. ■ WHO: Consultant on the Development of a Master’s of Science in Nutrition at the NIPH, Cambodia (2010-ongoing). ■ WHO, WFP, UNICEF, UNESCO, ILO and FAO. Consultant to the UN Partners for the Baseline Survey Joint Programme for Children, Food Security and Nutrition in Cambodia, Spanish MDG Fund (2009-2012) ■ International Nutrition and Food Security Initiative (TLEF grant funded). A stream is being developed that will provide UBC students with a unique undergraduate experience that will include international service learning, fieldwork, or research options in the first undergraduate program in International Nutrition in North America. ■ Vitamin A and iron status of women and children pre and post interventions involving increasing homestead food production and nutrition education. With Helen Keller International, Cambodia. ■ Implementation of the Baby Friendly Community Initiative in Samlaut, Cambodia. A project designed to reduce infant and child morbidity and mortality through improved feeding practices in cooperation with the MJP Foundation and the Ministry of Health, Cambodia. ■ Maternal, infant and child feeding practices and food intake among the Batwa (community of potters), Rwanda. An assessment of current practices to provide baseline information for community based nutrition program for HDI Rwanda. Appendix: Original Protocol from April 2012 with minor updates A15 ■ Food Choices, Nutrition Knowledge and Food Security of Maasai Women in Rural Kenya. Assessment as the basis for recommendation for a school meal program and other nutrition interventions. Recent Publications and Reports Hien VT, Lam NT, Khan NC, Dung NT, Skeaff CM,Venn BJ, Walmsley T, George PM, McLean J, Brown MR, Green TJ. Folate and B12 Status of Women of Reproductive Age Living in Hanoi City and Hai Duong Province.Public Health Nutrition, 2008. McLean J, Leah, J. Maternal, infant and child feeding practices, food intake and food security in Samlaut, Cambodia. (for the MJP Foundation) 2009. McLean J. Weekly Iron/Folic Acid Supplementation Program Evaluation - Cambodia (for the WHO), 2009. McLean J. Chen N. Food Choices, Nutrition Knowledge and Food Security of Maasai Women in Rural Kenya. (for Impiripiri, Kenya), 2009. McLean J, Lutasingwa D, Kagaba, A. Maternal, infant and child feeding practices and food intake among the Batwa (community of potters), Rwanda. (in progress for HDI, Rwanda) 2009. McLean J. Mayange, Rwanda School Meal Program Review. (for the Millennium Villages Project) 2008. McLean J, Green T, Barckett A. Food intake, nutrition knowledge and food security among rural women of reproductive age in Kanyawegi, Kenya. ( for GIVE and Kasow) 2008. McLean J. Dertu: Report on Food Culture and Dietary Practices among Settled Pastoralists. (for the Millennium Villages Project) 2008. McLean J, Green T, Berring E. Nutrition, Health, family planning, sanitation habits and beliefs of women in rural communities of the Department of La Paz, Honduras. (in progress for GHI) Appendix: Original Protocol from April 2012 with minor updates A16 CV of Dr. Fidele NGABO Director of Maternal and Child Health Department, Ministry of Health, Rwanda Personal Informations Name : NGABO Fidele Profession : Medical Doctor, MD, MSc, PhD Candidate Date of birth : 07-05-1970 Sex : Male Nationality : Rwandese Civil status : Married Tel.. : +250-(0)788304750 (mobile Rwanda) Email : ngabog@yahoo.fr fidele.ngabo@moh.gov.rw Education November 2011 PhD Candidate, ULB Belgium July 2005 – September 2007 : Masters degree in Public Health, Epidemiology School of Public Health/ National University of Rwanda. 2004-2005 University diploma in HIV/AIDS and STI in RH, University Paris VII BICHAT Claude Bernard/France 1995-2000 Diploma in General Medicine National University of Rwanda Butare, Rwanda Professional Work Experience July 2008- March 2012 : Director of Maternal and Child Health Department in the Ministry of Health June 2005- June 2008 : Coordinator of Expanded Program of Immunization in the Ministry of Health. February 2004- Mai 2005 : Head of training and development of HIV and STI guidelines. Treatment and research on HIV/AIDS Center February 2002- January 2004 : In Charge of Care and treatment for HIV positives patients in PACFA Project Office of the First Lady July 2000- January 2002 Physician in Emergency Department Kigali teaching Hospital Professional affiliations 1. Head of Maternal and Child Health Technical working group 2. Head of Family Planning Technical Working group Appendix: Original Protocol from April 2012 with minor updates A17 3. Head of Fistula care and prevention Working Group 4. Member of Rwanda Medical Association 5. Member of Rwanda Medical Council 6. Member of Injection safety Working Group 7. Head of Contraceptive logistic Committee Research 1. Documenting the Incidence and Morbidity of Induced Abortion in Rwanda 2. Feasibility of immediate postpartum IUCD insertion 3. Integration of family planning into immunization services. 4. Barriers To Expended Contraceptive Use in Rwanda 5. Evaluation of the access and use of Fertility Awareness Based Methods in Rwanda 6. A rapid assessment prior to the implementation of Community Based Distribution of DMPA in Rwanda 7. Haemophilus Influenza type B conjugate vaccine impact against purulent meningitis in Rwanda 8. Assessment of Sexual and Gender Based Violence in Rwanda 9. Triangulation of data on treatments in the community in six districts in Rwanda. 10. Malaria cases in under-five children treated by Community Health Workers and Health facilities in Rwanda. 11. Contribution of community health workers in the management of Malaria in Rwanda. 12. Association of delivery at a health facility and insurance coverage 13. Saving mothers and newborn lives at the community using rapidSMS technology 14. Community health worker supervision and supply management: results from a rapid evaluation in Rwanda. 15. Case Study: Introduction of Seven-Valent Pneumococcal Conjugate Vaccine (PCV7) in Rwanda Selected review for publication. 1. Rwanda Demographic and Health Survey 2005 2. Interim Rwanda Demographic and Health Survey 2007 3. Rwanda Service Provision Assessment 2007 4. Universal access on family planning, key element for reproductive health service 5. Rwanda Demographic and Health Survey 2010 Selected conference and workshop presentation 1. Global Fund Financing of Condoms and Contraceptives for Reproductive Health Commodity Security 2. Food fortification and nutrition solution for Community Health in Rwanda 3. Integrating IEC messages on vaccination, birth spacing, and HIV in Rwanda 4. Community Health Workers in Rwanda Improve Access to care 5. Evaluation of the Maternal Death Audit in Rwanda 6. Reducing inequities: Ensuring Universal Access to Family Planning 7. Global New and Underutilized vaccines implementation meeting Appendix: Original Protocol from April 2012 with minor updates A18 Appendix: Original Protocol from April 2012 with minor updates A19 Melene Kabadege World Relief Maternal & Child Health Regional Technical Advisor Summary of Professional Experience Ms. Kabadege is a nurse and public health professional with extensive implementation experience related to community based nutrition and child survival programming. She has expertise in behavior change communication, community mobilization, monitoring and evaluation, Community-IMCI and Positive/Deviance Hearth. She has worked for World Relief since 2001, first as a Child Survival Program Manager and more recently building the capacity of others as a Regional Technical Advisor for Maternal and Child Health (MCH). She has provided Technical Assistance in PD/hearth to IntraHealth/Twubakane (2006) in Rwanda and to Management Sciences for Health in Burundi (2008-09); and also provided TA on Care Groups to the AXXES Project in DRC. Before joining World Relief, Ms. Kabadege worked as a health administrator, nurse manager and educator in Rwanda. Ms. Kabadege completed a Masters degree in Applied Community Change and Conservation from the Future Generations Graduate program and a Bachelor’s Degree in Public Health from the National University of Rwanda. Ms. Kabadege speaks fluent French and Kinyarwanda in addition to proficient English. She has prepared abstracts and presented professionally in international forums. Education M.A. in Applied Community Change and Conservation,Future Generations Graduate Program, West Virginia, USA, 2007; Master’s research:Neonatal Deaths in Kibogora Health District. B.S. in Public Health, National University of Rwanda. 1999 Student research:Household survey of Antenatal care practices in Kibogora Health District. Nursing Diploma,Nursing School in Rwamagana, Rwanda. 1976 Country Experience Burundi, Democratic Republic of Congo, and Rwanda plus field training in Bhutan, India, Mozambique, Nepal, Peru and United States. Professional Experience 2010-present Regional Technical Advisor for Maternal and Child Health World Relief Corporation, Kigali, Rwanda and Bujumbura, Burundi Provides first line technical support and training for World Relief MCH programs in Burundi, DR Congo and Rwanda.Develops new projects and reports for donors. 2006-2010 Community Mobilization Manager, Expanded Impact Child Survival Program (EICSP), World Relief Rwanda, Kigali, Rwanda Reported to the Project Team Leader as a member of project management team for USAID-funded EICSP and managed six Mobilization Officers working in six different districts. Led project-wide training and implementation of community mobilization and behavior change strategies for all six districts, Appendix: Original Protocol from April 2012 with minor updates A20 serving a total population in excess of 1.86 million people. Led adaptation of the Care Group Model for use with government CHWs; Led scale up of approach to include more than 13,000 CHWs in 648 groups.Facilitated formative research on diarrhea (2007-2008) and malaria, pneumonia, malnutrition, and maternal and newborn health (2008) in partnership with the MOH and Unicef. Developed community mobilization training manuals and counseling cards in the Behavior Change Communication sub-committee of the national Community-IMCI Technical Working Group of the MOH. Adapted and implemented monitoring and evaluation (M&E) tools for the Care Group Model in collaboration with M&E Manager. Prepared and managed program budget for Community Mobilization. Led BEHAVE Framework workshop; Kigali, Rwanda (2008). Facilitated Ministry of Health implementation of Integrated Community Case Management for Malaria, Diarrhea, Pneumonia and Nutrition. 2001-2006 Program Manager, Umucyo Child Survival Project, World Relief Rwanda,Kibogora, Rwanda. Led team of 50 staff members in implementation of the USAID-funded Umucyo Child Survival Project with interventions in hygiene and diarrhea case management, immunization, nutrition, malaria control, maternal and newborn care and HIV/AIDS prevention.Participated in development of project’s Detailed Implementation Plan, annual reports and work plans. Managed curriculum development on Nutrition, Malaria, Diarrhea, Immunization, Neonatal and Maternal Care, and HIV used by Health Promoters and by CHWs. Conducted training and supervised senior staff in Child Survival Project. Oversaw implementation of 300 community Care Groups for community health education and behavior change. Coordinated training for implementation of Positive Deviance/Hearth program in Child Survival Program catchment area; Oversaw implementation of 480 Positive Deviance/Hearth groups for malnourished children and their careers. Oversaw successful pilot implementation of Home Based Management of Malaria in partnership with the MOH and other partners.Managed budget with USAID and World Relief matching funds. 2001-2001 Administrator, Kibogora Health District, Ministry of Health, Kibogora, Rwanda 1999-2001 Headmaster of the Frank Adamson Nursing School in Kibogora, Rwanda 1994-1996 Head of Karengera Health Center, Karengera, Rwanda 1976-1996 Head Nurse, Maternity Ward of Kigeme Hospital, Kigeme, Rwanda Languages: Kinyarwanda, mother tongue, French, fluent, English, proficient Professional Presentations 2011 Presenter, Community Mobilization Using the Care Group Model, International Conference on Community Health; Kigali, Rwanda 2010 Presenter, Community Health Worker Program in Rwanda, Technical Advisory Group Meeting of the CORE Group; Washington, DC 2008 Presenter, White House Faith-Based and Community Initiatives Conference on Public-Private Partnerships and Economic Development; Kigali, Rwanda Appendix: Original Protocol from April 2012 with minor updates A21 Annex B. Project Indicators Table 5: Proposed Project and OR Indicators to be measured by KPC Surveys (Original; see update) Proposed Indicators (“Key Indicators” are strongly recommended by USAID) Required 2008 Rapid CATCH OR Indicator Additional Project Indicators Source and Frequency of Collection Nutrition and Breastfeeding (40% Level of Effort) (1) Early initiation of breastfeeding: Percentage of children 0-5 months who were put to the breast within one hour of birth. OR KPC Y1 Y2 Y3 Y4 (2) Prelacteal feeds: Percentage of children given liquids prior to the initiation of breastfeeding. KPC Y1 Y2 Y3 Y4 (3) Colostrum: Percentage of children 0-5 months who were breastfed during the first three days of life. KPC Y1 Y2 Y3 Y4 (4) Exclusive breastfeeding: Percentage of children age 0-5 months who were exclusively breastfed during the last 24 hours. RC6 OR KPC Y1 Y2 Y3 Y4 (5) Infant and Young Child Feeding: Percent of infants and young children age 6-23 months fed according to minimum acceptable diet (apart from breast milk). Breastfed children 6–23 months of age who had at least the minimum dietary diversity and the minimum meal frequency during the previous day AND Non-breastfed children 6–23 months of age who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day. Continued breastfeeding or feeding of milk or milk products; Feeding solid/semi-solid food the minimum number of times per day according to age and breastfeeding status; Related sub-indicators relate to the frequency; Feeding the minimum number of food groups per day according to breastfeeding status.) The IYCF indicator also allows for the calculation of consumption of food by type (rich in iron, vitamin A, animal protein) and frequency. Similar to RC7 but based on WHO definition OR KPC Y1 Y2 Y3 Y4 (6) Age appropriate introduction of semi-solid foods: Age in months when semi-solid foods were introduced to the child (by mother’s recall) OR KPC Y1 Y2 Y3 Y4 (7)Responsive feeding: Caregiver actively involved in feeding child 0-23months OR KPC Y1 Y2 Y3 Y4 (8) Underweight: Percentage of children 0-23 months who are underweight (-2 SD for the median weight for age, according to WHO reference population) RC18 OR KPC Y1 Y2 Y3 Y4 (9)Wasted: Percentage of children 0-23 months who are underweight for height (-2SD for the median height for age, according to WH0 reference population) OR KPC Y1 Y2 Y3 Y4 (10)Stunted: Percentage of children 0-23 months who are under height/length for age (-2SD for the median height for age, according to WHO reference population) OR KPC Y1 Y2 Y3 Y4 Appendix: Original Protocol from April 2012 with minor updates A22 (11) Acute Malnutrition: Percent of children 6-23 months and percent of pregnant mothers of children 0-23 months acutely malnourished as measured by MUAC OR KPC Y1 Y2 Y3 Y4 (12) Vitamin A Supplementation in the last 6 months:Percentage of children age 6-23 months who received a dose of Vitamin A in the last 6 months: card verified or mother’s recall. RC8 KPC Y1 Y2 Y4 Maternal Newborn Care (35% Level of Effort) (13) Antenatal Care: Percentage of mothers of children age 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child. RC1 KPC Y1 Y2 Y4 (14) Maternal TT Vaccination: Percentage of mothers with children age 0-23 months who received at least two Tetanus toxoid vaccinations before the birth of their youngest child. RC2 KPC Y1 Y2 Y4 (15) Skilled Birth Attendant: Percentage of children age 0-23 months whose births were attended by skilled personnel. RC3 KPC Y1 Y2 Y4 (16) Post-natal visit to check on newborn within the first 2 days after birth: Percentage of children age 0-23 who received a post-natal visit from an appropriate trained health worker within two days after the birth of the youngest child. RC4 KPC Y1 Y2 Y4 (17) Current Contraceptive Use Among Mothers of Young Children: Percentage of mothers of children age 0-23 months who are using a modern contraceptive method. RC5 KPC Y1 Y2 Y4 (18) Maternal Iron Supplementation During Pregnancy: Percent of mothers who received tablets; number of days consumed. OR KPC Y1 Y2 Y3 Y4 (18) Immediate breastfeeding of newborns: percent of children 0-23 months put to the breast within one hour of delivery (Key Indicator) See this same indicator listed above under Nutrition and Breastfeeding Control of Diarrheal Diseases (15% Level of Effort) (19) ORT use: 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. RC13 KPC Y1 Y2 Y4 (20) Point of Use (POU): Percentage of households of children age 0-23 months that treat water effectively. RC15 OR KPC Y1 Y2Y3 Y4 (21) Appropriate Hand washing Practices: Percentage of mothers of children age 0-23 months who live in households with soap at the place for hand washing. RC16 OR KPC Y1 Y2 Y3 Y4 (22) Increased fluid intake during diarrheal episode: Percentage of children 0-23 months with diarrhea in the last two weeks who were offered more fluids during the illness. (Key Indicator) USAID Key Indicator KPC Y1 Y2 Y4 (23) Continued feeding during a diarrheal episode: Percentage of children 0-23 months with diarrhea in the last two weeks who were offered the same amount or more food during the illness. (Key Indicator) USAID Key Indicator KPC Y1 Y2 Y3 Y4 (24) Zinc: Percentage of children 0-23 months with diarrhea in the last two weeks who were treated with zinc supplements. (Key Indicator) USAID Key Indicator KPC Y1 Y2 Y4 Appendix: Original Protocol from April 2012 with minor updates A23 (25) Use of medicine during diarrhea: Percentage of children 0- 23 months with diarrhea in last two weeks who were not treated with antidiarrheals or antibiotics. (Key Indicator) USAID Key Indicator KPC Y1 Y2 Y4 (26) Safe feces disposal: Percentage of mothers of children 0- 23 months who disposed of the youngest child’s feces safely the last time s/he passed stool. (Key Indicator) USAID Key Indicator KPC Y1 Y2 Y4 (27) Two week prevalence of diarrhea: Percentage of children 0-23 months with diarrhea in the previous two weeks USAID Key Indicator KPC Y1 Y2 Y3 Y4 Pneumonia Case Management (10% Level of Effort) (28) Appropriate Care Seeking for Pneumonia: Percentage of children age 0-23 months with chest-related cough and fast and/ or difficult breathing in the last two weeks who were taken to an appropriate health provider. RC14 KPC Y1 Y2 Y4 (29) Two week prevalence of suspected pneumonia: children 0-23 months with cough and rapid and/or difficult breathing during two weeks prior to survey KPC Y1 Y2 Y4 Immunization (30) Measles vaccination: Percentage of children age 12-23 months who received a measles vaccination RC9 KPC Y1 Y4 (31) Access to immunization services: Percentage of children aged 12-23 months who received DTP1 according to the vaccination card or mother’s recall by the time of the survey RC10 KPC Y1 Y4 (32) Health System Performance regarding Immunization services: Percentage of children aged 12-23 months who received DTP3 according to the vaccination card or mother’s recall by the time of the survey. RC11 KPC Y1 Y4 Malaria (33) Treatment of Fever in Malarious Zones 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. RC12 KPC Y1 Y4 (34) Child sleeps under an insecticide-treated bednet: Percentage of children age 0-23 months who slept under an insecticide-treated bed net (in malaria risk areas, where bed net use is effective) the previous night. RC17 KPC Y1 Y4 Process Indicators (35)Contact with CHW: Percent of households with children 0- 23 months that received health information from a CHW in the past month, according to location (home visit, community meeting, health facility, Nutrition Week, etc.) OR KPC Y1 Y2 Y3 Y4 (36)Participation in Nutrition Weeks: Percentage of mothers with children 0-23 months who participated in “Nutrition Week” intervention OR KPC Y1 Y2 Y3 Y4 Appendix: Original Protocol from April 2012 with minor updates A24 Annex C: Positive Deviance Inquiry (PDI) C1. Written Consent form for Positive Deviance Inquiry Instruction In the case of respondents who are not able to read, this form is to be read aloud by someone other than the interviewer, preferably by a Community Health Worker. Introduction This consent form will explain the study that we would like you to join. I will go over this form with you in detail. You can ask questions about the study before you agree to join. You can also ask questions at any time after you join the study. Why is this study being done? The Nutrition Innovation Child Survival Program is jointly implemented with the district Ministry of Health to improve the health and nutrition of children in Nyamagabe District. This interview will be used to assess nutrition practices using a detailed interview of mothers in the region about their nutrition practices. From these, we will design a “Nutrition Week” curriculum for implementing a hands-on Nutrition program in the community. In this interview we will ask you questions about how you feed your babies and children, and some related health practices, such as hygiene. What are the interview procedures? What will I be asked to do? If you agree to help with this study, you will be asked to respond to questions in your home, and we will also observe feeding and hygiene practices in your home. This will last about one hour. We will take notes on the discussions that we will keep for our records. What are the risks or inconveniences of the interview? You will not face many risks by being in this study. We do not expect that you will be stigmatized by sharing your experiences. What are the benefits of the survey? Your answers will be put together with the answers from mothers in other sectors/cellules/communities. You may benefit from this survey because the information you share with us during will be used to help improve the Nutrition Weeks curriculum. Will I receive payment for participation? Appendix: Original Protocol from April 2012 with minor updates A25 You will not be paid to be in this interview. Are there costs to participate? There are no costs to you to participate in this interview. How will my personal information be protected? We ask you for some personal information such as identification, gender, profession, or education level. We will keep all the information that we collect from you private. Only study team members will have access to the information. We will write out the discussions. We will also erase any information that could identify you by name from the discussions. We will destroy the notes of the discussions when we have completed the study. Who do I contact if I have questions about the study? We will be happy to answer any question you have about this study. If you have further questions about this study, want to voice concerns or complaints about the research, or if you have a research-related problem, you may contact Melene Kabadege research team member at telephone no. 0788306586. Or, if you have questions about the research, you may call the WR Burundi office in at T: +250.252.584664. If you would like to discuss your rights as a research participant, discuss problems, concerns, and questions; obtain information; or offer input with an informed individual who is unaffiliated with the specific research, you may also contact the Rwanda National Ethics Committee by calling Dr. Justin Wane, Chairperson of the ethics committee, at 0788500499 or Dr. Emmanuel Nkeramihigo, Secretary of the ethics committee, at 0788557273. I will provide you a copy of this information should you have any other questions. Appendix: Original Protocol from April 2012 with minor updates A26 Documentation of Consent: This consent document has been read and explained to me and I have decided that I will participate in the survey described above. Its general purposes, the particulars of involvement and possible risks and inconveniences have been explained to our satisfaction. We understand that we can withdraw at any time. Our signature or thumb print also indicates that we have received each a copy of the contact information. Comments/Questions: Are you willing to participate? Interviewer circle: YES NO Documentation of Consent: This consent document has been read and explained to me and I have decided that I will participate in the survey described above. Its purpose, what I will be asked to do and all possible risks and inconveniences have been explained to me. I understand that I can withdraw at any time. My signature or thumb print also indicates that I have received a copy of the contact information. ____________________________________________ _____________ Respondent Date ____________________________________________ _____________ Guardian (if respondent is under age 21) Date ____________________________________________ _____________ Person Obtaining Consent Date Appendix: Original Protocol from April 2012 with minor updates A27 C2. Positive Deviance Inquiry Data Collection Forms OBSERVATION CHECKLIST FOR PDI Name of Selected Child____________________ Date_________ Name of Family_________________________ Community__________ Ubudehe category:_________________ Child age:__________ Weight:____________ Height:__________ MUAC:_________ Select Category: (PD) (NPD) (ND) Starting Time:___________Ending Time:____________ I. Household Members: Observations: 1. Selected Child Is s/he well-nourished or malnourished? What is the child like? (energetic, content?) Is s/he clean or not? (body and clothes) 2. Primary Caregiver: Who is s/he? (the mother?) What is s/he like? Is s/he clean or not? 3. Secondary Caregiver: Who is s/he? (the grandmother?) What is s/he like? Is s/he clean or not? 4. Siblings of the Child: Are they well-nourished or malnourished? What are they like? Are they clean or not? 5. Father of the Child: Who is he? (the grandfather?) Appendix: Original Protocol from April 2012 with minor updates A28 What is he like? Is he clean or not? 6. Other Family Members: Who are they? What are they like? Are they clean or not? II. Practices: 1. Feeding Practices Wash hands before/after feeding child? Child eats from food picked off ground? Child eats food touched by animals? Washes plates/dishes? 2. Active/Passive Feeding Child is alone while eating? Type of feeding? What is the child eating? Consistency of food? Amount of food (in spoonfuls)? 3. Family Eating Practices Family eating together? Priority to males: quantity/frequency? 4. Interaction between Caregiver & Child Supervision and care for child? Loving behavior? Teaching the child to walk, talk, play? 5. Interaction of Family Members & Child Supervision and care for child? Loving behavior? Teaching the child to walk, talk, play? 6. Personal Hygiene Bathing the child? Child’s nails trimmed? Child away from animal excrement? Mother washes hands after toileting child? Mother’s nails trimmed? 7. Food Preparation Washes hands before preparing food? Keep food covered before/after cooking? Washes raw fruits and vegetables? Appendix: Original Protocol from April 2012 with minor updates A29 8. Water Boiled drinking water? Keep drinking water covered? Clean water for bathing? Source of water? Water source, close or far? (give approx. distance/time to walk to source) III. Food Availability Quantity and variety of foods? Foods from family garden? Foods from animal origin? Food storage? Food preservation and processing III. Home Environment 1. Home What is kitchen like? Sleeping quarters? 2. Latrine If there is one, is it clean or not? Is it close or far? If no latrine, where is excrement disposed? 3. Animals Do they come inside the house? Are they in a pen? Does the child play with them? ___________________________________________________________________ PDI SAMPLE SEMI-STRUCTURED INTERVIEW PDI Guidelines: Interviewing Caregivers during Home Visits I. General Questions 1. How many people live in the house? How many eat meals together? 2. How many children are there? How old are they? How many children are under three? 3. Do the older children go to school? If not, why? 4. What do you do for a living? Father?Other family members? 5. How much does the family earn per day? 6. How long do they work? (Morning?Evening?All day?All night?) 7. Where do they work? How long does it take to travel there? Does the child accompany them? II. Questions about Feeding Practices to Caregiver 8. Are you still breastfeeding this child? If yes, how often?At night? 9. What food do you give your child in addition to breastfeeding? Appendix: Original Protocol from April 2012 with minor updates A30 10. When did you start complementary feeding? What complementary food was used? 11. How many times a day do you feed your child? 12. How much food do you give your child? (Show with actual plate and spoon) 13. Who feeds the child and how does the child eat? (hand, spoon, chewing) 14. What have you fed your child so far today? (List food including breastfeeding.) 15. What will you feed your child this evening ? 16. Does your child get fed by other people? Who? (older siblings, neighbor, etc.) 17. What do you do when your child does not want to eat or has a small low appetite? 18. In your opinion what foods are not good for very young children? Why? 19. When your child is sick with diarrhea, do you feed him/her the same, more or less food and liquids? Why? 20. Do you buy food for the child outside? If yes, what food? (snacks, fresh food) 21. From whom (specific food stall vendor) and why? 22. For lactating mothers only: What do you do about breastfeeding when you are sick? III. Questions about Caring Practices 23. Beside you, with whom does your child interact? What do they do with the child? 24. When you are away, who looks after your child? 25. What advice do you give this person? (safety) 26. What do you do when your small child is naughty (dirty, breaks something, etc.)? Probing: How do you beat? Where? How often? 27. How do you put your child to sleep? 28. Do you encourage your child to play with other children? Why? Why not? 29. When do you play with your child? What do you do with him/her? 30. What do you feel is the most important thing a child needs? 31. What does your husband do for the children in the household? 32. How many children do you have? How many do you want? 33. Have you heard of child spacing? Are you interested in it? IV. Questions about Health-Seeking Practices 34. How often do you bathe your child? 35. How do you toilet train your child? 36. What do you use water for? soap? (hand washing before eating?) 37. Is your child immunized? 38. What kind of illnesses does your child have most often? 39. What do you do when your child has a cold? 40. What do you do when your child has diarrhea? 41. Has your child had diarrhea in the past two weeks? 42. If yes, how did you treat it? If ORS, how to prepare? 43. When your child has diarrhea, what do you feed him? 44. What do you avoid feeding him? 45. What are the danger signs of pneumonia? 46. What do you do if your child has these signs? 47. How do you know your child is sick? (signs of sickness) 48. Whom do you consult first? Then whom? 49. Who decides what to do when there is a severe health problem at home? 50. What are the health problems for young children you are most concerned about? 51. How do you solve these problems? V. Questions for older sibling caregiver 52. Do you go to school? 53. What do you do besides looking after your younger siblings? 54. What do you do with your younger sister/brother? 55. What do you do when he/she cries? Gets hurt? Is sick? Appendix: Original Protocol from April 2012 with minor updates A31 56. What do you do when the child is naughty? 57. What things do you like to do with your younger brother/sister? Why? 58. What things don’t you like to do? Why? 59. Do you involve him/her in your games? Why? 60. How do you feed the child? (Probing) VI. Questions for Father 61. In your opinion, how is your child? 62. How do you know your child is healthy? 63. How much time do you spend with your child every day? 64. What do you do when you are with your child during the day? 65. What do you do when your child is sick? 66. In your household, who decides what to do when your child is sick? 67. How many children do you have? How many do you want? 68. Have you heard of child spacing? Are you interested in it? VII. Questions for Grandmother or Mother-in-Law 69. In your opinion, at what age should a child be given food in addition to breast milk? 70. What are good foods for children less than three years old? Why? 71. What foods should NOT be given to children less than 3 years old? 72. Include questions from sections above on Feeding Practices and Care Seeking Behavior. Appendix: Original Protocol from April 2012 with minor updates A32 Appendix: Original Protocol from April 2012 with minor updates A33 Annex D: Maternal Exit Interview for Nutrition Weeks Innovation This form describes the process for selecting random participants, obtaining informed consent, and questions to ask. Purpose of Maternal Exit Interviews. The purpose of these interviews is to learn what Nutrition Weeks participants learned about infant and child feeding and how to prevent malnutrition. Confidentiality and consent • BEFORE beginning an interview, read the consent form to the interviewee and be sure that they understand all of it. After they have given consent to participate in the interview and you have signed the consent form, you can begin the interview. • Do not write the name of the interviewee on your notes. Instead, mark in the notes the day of the week, your initials, and the number of the interview (1 if it’s the first interview, 2 if it’s the second, etc.). • Please return all the notes and translations to the Program Director at the end of each day to assure confidentiality. The interviews will examine: • What participants learned about Nutrition during participating in Nutrition Week. • What they liked about the Nutrition Week. • What they did not like about the Nutrition Week. • New behaviors they plan to adopt based on what they learned at the Nutrition Week session they attended. • Their perspective on the feeding practices that they learned about. • Factors that prevent them from changing behaviors to prevent malnutrition. Notes to the interviewers • Use open questions instead of yes/no questions to obtain more in-depth and detailed responses in the interviews. (For example, why did you decide to get your child weighed? How could you tell that your child was malnourished?) • Probe for further comments in order to help the interviewee to add to their response; you want in-depth, detailed responses. Be comfortable with silence and give the interviewee time to think and to fully respond. • Pose follow-up questions when the interviewee gives a short response or when you want more detailed or precise information. (Ex: Exactly what do you mean? When you said X earlier in the interview, what did you really mean? Tell me more about X…. etc.) Appendix: Original Protocol from April 2012 with minor updates A34 • Avoid using leading questions, questions which guide the interviewee toward a certain response. We want original ideas and words from the interviewee. (Ex: Why did you is ORS the best treatment for diarrhea?) Interview theme: NUTRITION WEEK Below are several themes and topics to be covered in the interview. Probe to thoroughly explore full responses to each question. 1. How many children do you have? 2. What did you learn about Nutrition from the Nutrition Week? 3. What did you like about the Nutrition Week? Benefits? 4. What did you not like about the Nutrition Week? 5. Are there any new feeding practices that you plan to do now that you learned how to do at the Nutrition Week? 6. Are any of the practices too difficult for you or your neighbors to do? Why? 7. What did your family think about the Nutrition Week? Was it difficult to get away from home for the entire week? 8. Is there anything you would like to tell me about how to improve the groups? We are very interested in your opinions to change to make it better. Thank you for your time and opinions! Appendix: Original Protocol from April 2012 with minor updates A35 Annex E: Written Consent for KPC survey Instruction If the respondent does not read, this form is to be read aloud by someone other than the interviewer, preferably by a community health worker. Introduction You are invited to participate in a survey to learn more about the knowledge and practices of mothers of children under age five months in this community. This consent form will give you the information you will need to understand why this survey is being done and why you are being invited to participate. It will also describe what you will need to do to participate and any known risks, inconveniences or discomforts that you may have while participating. We encourage you to take some time to think this over and to discuss it with your family or friends. For this survey, we will interview approximately 600 mothers of children under five years. Why is this survey being done? World Relief has a project that has been helping to train community health workers to assess and treat children under five in this community. The purpose of the survey is to help us understand the health status of this community and how sick children are cared for. What are the survey procedures? What will I be asked to do? The questions in the survey are about your home, your health, and the health of your child under 2 years or one of your children 6-59 months who has been sick in the past 2 weeks. The survey will last about 20 minutes. I will ask to look quickly inside your house. What are the risks or inconveniences of the survey? There is a risk that some of the questions may make you feel uncomfortable. I want you to know that anything you tell me is completely confidential. We will not use your name in any of our materials or reports. We will not talk about particular children or families, but only about the situation overall in your district. No one will know who gave what answers. What are the benefits of the survey? Your answers will be put together with the answers from many other families in this community and will help us find out the best ways to help families like you lead healthier, happier lives. Will I receive payment for participation? You will not be paid to be in this survey. Are there costs to participate? There are no costs to you to participate. How will my personal information be protected? If you agree to participate, all information about you will be kept as private as possible. No personal information such as your name will be reported. Your name is not written anywhere on the forms containing your responses. Can I stop being in this survey and what are my rights? You do not have to be in this survey if you do not want to. If you agree to be in the survey, but later change your mind, you may contact us. You also Appendix: Original Protocol from April 2012 with minor updates A36 may choose to skip any questions that you do not wish to answer. There are no penalties or consequences of any kind if you decide that you do not want to participate. Who do I contact if I have questions about the survey? We will be happy to answer any questions you have about this survey. If you have further questions about this survey, want to voice concerns or complaints about the research, or if you have a research￾related problem, you may contact Melene Kabadege, research team member, at telephone number 250788306586. Or, if you have questions about the research, you may call the Innovation CSP office in Nyamagabe District at telephone number 0788307570. If you would like to discuss your rights as a research participant, discuss problems, concerns or questions; obtain information; or offer input with an informed individual who is unaffiliated with the specific research, you may also contact the Rwanda National Ethics Committee by calling Dr. Justin Wane, Chairperson of the ethics committee, at 0788500499 or Dr. Emmanuel Nkeramihigo, Secretary of the Ethics Committee, at 0788557273. I will provide you a copy of this information sheet with the contact information should you have any other questions. Comments/Questions: ___________________________________________________________________________ Are you willing to participate? Interviewer circle: YES NO Documentation of Consent: This consent document has been read and explained to me and I have decided that I will participate in the survey described above. Its purpose, what I will be asked to do and all possible risks and inconveniences have been explained to me. I understand that I can withdraw at any time. My signature or thumb print also indicates that I have received a copy of the contact information. ____________________________________________ _____________ Respondent Date ____________________________________________ _____________ Guardian (If respondent is under 21) Date Appendix: Original Protocol from April 2012 with minor updates A37 ____________________________________________ _____________ Person Obtaining Consent Date Annex E: KPC Survey Draft Questionnaire DRAFT Baseline KPC Survey Questionnaire – Not Yet Pre-Tested RESPONDENT IDENTIFICATION Cluster Number/ Nimero y’itsinda Household Number/Nimero y’urugo Informed consent obtained: Yes or No; If not, reason__________ Record Number/Nimero y’ubazwa Interviewer Name/Amazina y’ubaza Sector/Umurenge Village/Umudugudu NAME OF THE MOTHER /AMAZINA Y’UMUBYEYI _______________________________________________ AGE OF THE MOTHER (IN YEARS)................................................ IMYAKA Y’UMUBYEYI What is the name, sex, date of birth of your youngest child that you gave birth to and that is still alive?Umwana wawe muto wabyaye kandi ukiriho yitwa nde? Igitsina ke? Yavutse ryari? NAME OF THE CHILD LESS THAN 24 MONTHS AMAZINA Y’UMWANA URI MUNSI Y’AMEZI 24 _____________________________________________ SEX OF CHILD (1=MALE, 2=FEMALE) .............................. IGITSINA CY’UMWANA( 1=GABO, 2=GORE) DATE OF BIRTH ___ ___/___ ___/ ___ ___ ___ _ IGIHE YAVUKIYE AGE OF THE CHILD (IN MONTHS).................................... IMYAKA Y’UMWANA (MU MEZI) Appendix: Original Protocol from April 2012 with minor updates A38 Date of Interview/ Itariki y’ibazwa …………../…………../…………… Time interview began/ Isaha ibazwa ryatangiriye ……….AM Mbere ya saa sita ………………..PM Nyuma ya saa sita Time interview ended/ Igihe ibazwa ryarangiriye ……….AM Mbere ya saa sita ………………..PM Nyuma ya saa sita Appendix: Original Protocol from April 2012 with minor updates A39 # Questions/Ibibazo Responses/Ibisubizo bishoboka Skip/ Simbu ka Answer Igisubizo atanze SECTION I: SOCIO-DEMOGRAPHICS / Igice cya 1: imibereho rusange INSTRUCTIONS: ASK THE QUESTIONS EXACTLY AS THEY ARE WRITTEN. DO NOT READ RESPONSES UNLESS DIRECTED TO DO SO. WORDS IN ITALICS ARE INSTRUCTIONS FOR THE INTERVIEWER AND SHOULD NOT BE READ ALOUD. FOLLO SKIP PATTERNS AS DIRECTED. WRITE ANSWERS IN THE ANSWER BOX UNLESS OTHERWISE DIRECTED. AMABWIRIZA: BAZA IBIBAZO NKUKO BYANDITSE. IRINDE KUMUSOMERA IBISUBIZO. AMAGAMBO YANDITSE MUBURYO BUBERAMY NI AMABWIRIZA Y’UBAZA NTABWO UGOMBA KUYASOMERA UBAZWA. AHO UGOMBA GUSIMBUKA HASIMBUKE. ANDIKA IGISUBIZO MU KAZU K ABUGENEWE. 1. Have you ever attended school? Mwaba mwarageze mu ishuri? Yes/ Yego…………………………......……… No/ Oya…………………………….......… Don’t know/ Simbizi………………………….. 1 0 8 3 3 2. If yes, then ask: What is the highest grade or level of school you have completed? Niba ari yego, mubaze uti: Warangije ayahe mashuri? None/ Did not complete primary Ntayo/Ntiyarangije amashuri abanza Primary/ Amashuri abanza….…………...… Secondary/ Amashuri yisumbuye …….…… Past Secondary/ Amashuri makuru……… Other/ Ayandi………………………………… 0 1 2 3 4 5 3. How many people live in your household? Muri uru rugo mubamo muri bangahe? Number/ Umubare………………………..... Don’t know/ Simbizi………………………...... ## 88 4. What is your ubudehe category according to the participatory poverty assessment as defined by MINELOC? Mwashyizwe mukihe kiciri cy’ubudehe nyuma y’ubushakashatsi bwakozwe na MINALOC kubijanye n’ubukire cyangwa ubukene? 7. Umutindinyakujya(those in abject poverty) 8. Umutindi(the very poor) 9. Umukene(the poor) 10. Umukenewifashije(the resourceful poor) 11. Umukungu(the food rich) 12. Umukire(the money rich) (Source: Government of Rwanda Poverty Reduction- Strategy Paper, June 2002 – p.15.) 14. Umutindinyakujya(those in abject poverty) 15. Umutindi(the very poor) 16. Umukene(the poor) 17. Umukenewifashije(the resourceful poor) 18. Umukungu(the food rich) 19. Umukire(the money rich) Don’t know/ Simbizi………………. If the category is unknown, the interviewer should check the list at the health center so that data is entered for every household. If there is debate, use the category assigned by MINELOC. Niba ubazwa atazi ikiciri arimo, ubaza ajye kureba kuri lisiti yo ku Kigo Nderabuzima iriho ibyiciri by’ingo zose, Niba ubazwa ajya mpaka ku kiciri yashyizwemo, koresha ikiciri kiri ku ilisti ya MINALOC. 1 2 3 4 5 6 8 Appendix: Original Protocol from April 2012 with minor updates A40 SECTION II: MATERNAL AND NEWBORN CARE 5. How long should you wait after the birth of your child before you try to become pregnant again? Uzategereza igihe kingana iki kugirango wongere gusama indi nda? LESS THAN 2 YEARS/ MUNSI Y’ IMYAKA IBIRI……..1 2 TO 5 YEARS/ HAGATI Y’IBIRI N’ITANU ………….2 MORE THAN 5 YEARS/ ……………………………………3 HEJURU Y’IMYAKA ITANU DON’T KNOW/ SIMBIZI……………………………………. 8 6. What are the risks of getting pregnant too soon after the birth of a child?/Ni izihe ngorane zishobora kuboneka mugihe umubyeyi akurikije hakiri kare? DO NOT READ RESPONSES. RECORD ALL THAT ARE MENTIONED.IRINDE KUMUSOMERA IBISUBIZO. ANDIKA IBYO AGUSUBIJE BYOSE. BABY BORN TOO SMALL……………………………..…A UMWANA AVUKANA IBIRO BIDASHYITSE BABY BORN TOO EARLY…………………………….…B UMWANA AVUKA ATAGEJEJE KU GIHE MOTHER CAN DIE……………………………………….C UMUBYEYI ASHOBORA GUPFA MOTHER CAN HAVE MISCARRIAGE…………………D UMUBYEYI ASHOBORA GUKURAMO INDA MOTHER CAN SUFFER ANEMIA………………….…...E UMUBYEYI ASHOBORA KUBURA AMARASO OTHER / IBINDI..............................................................X ______________________________________________ (SPECIFY)/ (SOBANURA) 7. Are you currently doing something or using any method to delay or avoid getting pregnant? Hari uburyo ukoresha ngo wirinde gusama? YES/ YEGO………………………...……………………1 NO/ OYA…………………………………..…………….0 9 Questions/Ibibazo Responses/Ibisubizo bishoboka Skip/ Simbuka An we Igis bizo ata e Appendix: Original Protocol from April 2012 with minor updates A41 8. Which method are you (or your husband/ partner) using?/Ni ubuhe buryo ukoresha (cyangwa umugabo wawe)? DO NOT READ RESPONSES. CODE ONLY ONE RESPONSE. / IRINDE KUMUSOMERA IBISUBIZO. SHYIRA AKAMENYETSO KUCYO AKUBWIYE. IF MORE THAN ONE METHOD IS MENTIONED, ASK, / NIBA AKUBWIYE UBURYO BURENZE BUMWE, MUBAZE UTI What is your MAIN method that you (or your husband/ partner) use to delay or avoid getting pregnant?”/ Ni ubuhe buryo, wowe cyangwa umugabo wawe mukoresha kurusha ubundi kugirango wirinde gusama? IF REPONDENT MENTIONS BOTH CONDOMS AND STANDARD DAYS METHOD, CODE “12” FOR STANDARD DAYS METHOD/ AGAKINGIRIZO N’UBURYO BWA KAMERE SHYIRA AKAMENYETSO KURI “12” IF RESPONDENT MENTIONS BREASTFEEDING, CODE “15” FOR OTHER AND RECORD BREASTFEEDING./ NIBA AVUZE UBURYO BWO KONSA SHYIRA AKAMENYETSO KURI “15 “KANDI UBYANDIKE NO MUMAGAMBO IF RESPONDENT MENTIONS ABSTINENCE OR ISOLATION, CODE “15” FOR OTHER AND RECORD RESPONSE IN SPACE PROVIDED./NIBA AVUZE UBURYO BWO KWIFATA SHYIRA AKAMENYETSO KURI “15” KANDI UBYANDIKE NO MUMAGAMBO. FEMALE STERILIZATION/KWIFUNGISHA BURUNDU KU MUGORE ……………………………………………………………………………………………….1 MALE STERILIZATION/KWIFUNGISHA BURUNDI KU MUGABO…………………………………………………………………………..……2 PILL/ IBININI……..…………………………………………………..………………3 IUD/ AGAPIRA MU MUMURA……………………….…………………….…4. INJECTABLES/ URUSHINGE……………………………………...….………...5 IMPLANTS/ AGAPIRA MU KABOKO…………………………….....……...6 CONDOM/ AGAKINGIRIZO K’ABAGABO……………………………....7 FEMALE CONDOM/ AGAKINGIRIZO K’ABAGORE………….……….8 DIAPHRAGM/ AGAPIRA INKONDO Y’UMURA…………………………9 FOAM/JELLY/ AMAVUTA…………………………………………………..…10. LACTATIONAL AMEN. METHOD/ KONSA GUSA………………..…11. STANDARD DAYS METHOD/ CYCLEBEADS/ KUBARA IMINSI Y’UBURUMBUKE……………..…………………………………………………...12 RHYTHM METHOD (OTHER THAN STANDARD DAYS) UBUNDI BURYO BWO KUBARA…………………………….………………13. WITHDRAWAL/ KWIYAKANA……………………………………….……14 OTHER/ IBINDI……………………………………………………………………..15 _______________________________________________ (SPECIFY)/ (BISOBANURE) Appendix: Original Protocol from April 2012 with minor updates A42 9. During your pregnancy with (Name), did you see anyone for antenatal care?/Mugihe wari utwite Kanaka (Izina ry’ umwana muto) waba warigeze wipimisha inda ? IF YES: Whom did you see? Anyone else? NIBA AVUZE YEGO MUBAZE UTI : Ninde wagusuzumye ? Ntawundi? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN./ MUSOBANUZE NEZA WUMVE NIBA YARASUZUMWE N’UMUNTU UBUFITIYE UBUSHOBOZI DOCTOR/MEDICAL ASSISTANT/ MUGANGA/ UMUFASHA WE……………………………………………..….…A NURSE/ UMUFOROMO………………………………………..B MIDWIFE/ UMUBYAZA………………………………………….C TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA……………………………………………………………..D OTHER / ABANDI ____________________.........................X (SPECIFY/ BAVUGE) NO ONE/ NTA NUMWE………………………………………Y 16 Appendix: Original Protocol from April 2012 with minor updates A43 10. During your pregnancy with (Name), where did you receive antenatal care?/Mugihe wari utwite Kanaka ( Izina ry’umwana muto ) ni hehe wipimishirije inda ? CIRCLE ALL MENTIONED./ SHYIRA AKAZIGA KUGISUBIZO AGUHAYE IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. NIBA ARI KUBITARO, KUKIGO NDERABUZIMA CYANGWA KU IVURIRO RYIGENGA ,ANDIKA UKO HITWA.MUSOBANUZE NEZA KUGIRA NGO WANDIKE IGISUBIZO CY’UKURI _________________________________ (NAME OF PLACE/IZINA RYAHO YABYARIYE) HOME/ MURUGO YOUR HOME/ IWAWE …………………………………..A MIDWIFE/TBA HOME/ MURUGO RW’UMUBYAZA …B OTHER HOME/ MURUNDI RUGO….……………..……C PUBLIC SECTOR/ IVURIRO RYA LETA HOSPITAL/ IBITARO ………………………………………D HEALTH CENTER/ IKIGO NDERABUZIMA ………..…..E HEALTH POST/ IVURIRO RYUNGIRIJE …………….…..F OUTREACH/ KU MUDUGUDU/STRATEGIE AVANCE...G OTHER PUBLIC/ ANDI MAVURIRO YA LETA ______________________________________………...H (SPECIFY/SOBANURA) PRIVATE SECTOR/ AMAVURIRO YIGENGA PRIVATE HOSPITAL/ IBITARO BYIGENGA …………..…I PRIVATE CLINIC/ KIRINIKE YIGENGA ………………….J OTHER PRIVATE/ IRINDI VURIRO RYIGENGA ______________________________________................K (SPECIFY/ RIVUGE) OTHER/ AHANDI ____________________........................X (SPECIFY/ HAVUGE) 11. During your pregnancy with (Name), how many months pregnant were you when you first received antenatal care?/Mugihe wari utwite kanaka (Izina ry’umwana) wagiye kwipimisha bwa mbere inda ifite amezi angahe? MONTHS/ AMEZI……………………….… DON’T KNOW/ SIMBIZI…………………………….88 Appendix: Original Protocol from April 2012 with minor updates A44 12. During your pregnancy with (Name), how many times did you receive antenatal care?/ Mugihe wari utwite kanaka (Izina ry’umwana) wipimishije inda inshuro zingahe ? TIMES/ INSHURO……………………….… DON’T KNOW/ SIMBIZI…………………………………88 13. As part of your antenatal care during this pregnancy, were any of the following done at least once? Hari ibintu by’ingenzi bakorera umugore utwite iyo agiye kwipimisha,inda,muri ibi bikurikira ni iki baba baragukoreye nibura inshuro imwe ? E. Was your height taken?/Bagupimye uburerebure? F. Was your blood pressure measured?Bagufatiye umuvuduko w’amaraso? G. Did you give a urine sample?/Wigeze utanga ikizami cy’inkali? H. Did you give a blood sample?/Hari ikizami cy’amaraso wigeze utanga? YES/YEGO NO/OYA A. HEIGHT/ UBUREBURE…………….1 ………………….0 B. BP/ UMUVUDUKO W’AMARASO …1 ………………….0 C. URINE/ INKARI………………………1 ………………….0 D. BLOOD/ AMARASO…………………1 ………………….0 14. During (any of) your antenatal care visits, were you told about the signs of pregnancy complications? Mugihe wajyaga kwipimisha inda bigeze bakubwira ibimenyetso mpuruza kumugore utwite ? YES/ YEGO………………………...………………….…1 NO/ OYA……………………………………………….….0 DON’T KNOW/ SIMBIZI………………………………….8 16 16 15. Were you told where to go if you had any of these complications?/Bigeze bakubwira aho wajya mugihe ubonye kimwe muri ibyo bimenyetso? YES/ YEGO………………………...………………….…1 NO/ OYA……………………………………………….….0 DON’T KNOW/ SIMBIZI………………………………….8 Appendix: Original Protocol from April 2012 with minor updates A45 16. During pregnancy, woman may encounter severe problems or illnesses and should go or be taken immediately to a health facility. / Iyo umugore atwite ashobora guhura n’ibibazo cyangwa se uburwayi bishobora gutuma yihutira kujya kwa muganga . What types of symptoms would cause you to seek immediate care at a health facility (right away)?/Ni ibihe bimenyetso by’uburwayi bishobora kugutera kwihutira kujya kwa muganga mu gihe utwite? ASK: Anything else?/BAZA UTI: Nta bindi? DO NOT READ RESPONSES. RECORD ALL THAT ARE MENTIONED./ IRINDE KUMUSOMERA IBISUBIZO, SHYIRA AKAMENYETSO KU BISUBIZO AGUHAYE BYOSE VAGINAL BLEEDING/ KUVIRA KU NDA ……..………....A FAST/DIFFICULT BREATHING/ GUHUMEKA BIMUGOYE……………………………………….........................B FEVER/ UMURIRO ………………………..………….…….C SEVERE ABDOMINAL PAIN/ KUBABARA MU NDA CYANE………………………………………….. ……………...….D HEADACHE/BLURRED VISION/ KURIBWA UMUTWE/ KUTABONA NEZA ………………………………. ……………..E CONVULSIONS/ KUGAGARA…..………….……………....F FOUL SMELLING DISCHARGE/FLUID FROM VAGINA/ KUZANA IBINTU BY’URUZI BINUKA.............................G BABY STOPS MOVING/ INDA NTIYONKA……………….H LEAKING BROWNISH/GREENISH FLUID FROM THE VAGINA/ KUZANA IBINTU BY’URUZI BISA N’IKIGINA CYANGWA ICYATSI KIBISI……………………………..….I OTHER / IBINDI ………………………….. …………………………....................X _____________________________________ (SPECIFY/ BISOBANURE) 17. During your pregnancy with (Name of the child) did you receive an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth?/Mugihe wari utwite kanaka (Izina ry’umwana) wigeze ubona urukingo ku kaboko rukingira umwana tetanus(agakwega) kugagara? YES/ YEGO………………………...……………….……1 NO/ OYA ..…………………………………….………….0 DON’T KNOW/ SIMBIZI…………………………………. 8 19 19 18. While pregnant with (name of the child), how many times did you receive such an injection?/Igihe wari utwite kanaka (Izina ry’umwana muto) urwo rukingo warutewe inshuro zingahe? ONE/ RIMWE……………………………………….……..….1 TWO/ KABIRI…………………………..………………………2 THREE OR MORE/ INCURO 3 CYANGWA ZIRENGA ..…3 DON’T KNOW/ SIMBIZI……………..………………………..8 19. Did you receive any tetanus toxoid injection at any time before that pregnancy, including during a previous pregnancy or between pregnancies?/Mbere yo gutwita (Izina ry’umwana muto) wigeze uhabwa urukingo rwa tetanus ushyizemo mu gihe wari utwite iyabanjirije iy’uyu mwana cyangwa se mu gihe cyo hagati y’izo nda? YES/YEGO………………………...………………………1 NO/ OYA…………………………………………………...0 DON’T KNOW/ SIMBIZI…………………………………. 8 21 21 Appendix: Original Protocol from April 2012 with minor updates A46 20. Before the pregnancy with (Name of the child), how many times did you receive a tetanus injection? Mbere yo gutwita kanaka (izina ry’umwana muto) urwo rukingo warutewe inshuro zingahe? ONE/ RIMWE……………………………………….……..….1 TWO/ KABIRI…………………………..………………………2 THREE OR MORE/ INCURO 3 CYANGWA ZIRENGA .…3 DON’T KNOW/ SIMBIZI……………..………………………..8 21. During your pregnancy with (Name), were you given or did you buy any iron tablets/syrup?/Mu gihe wari utwite Kanaka (izina ry’umwana muto)wigeze uhabwa cyangwa ugura ibinini/umushongi bya feri byongera amaraso? SHOW TABLETS/ BIMWEREKE YES/YEGO………………………...………………………1 NO/ OYA…………………………………………………...0 DON’T KNOW/ SIMBIZI…………………………………. 8 23 23 22. During the whole pregnancy, for how many days did you take the tablets/syrup? / Igihe wari utwite, ibyo binini ibyo binini bya feri wabifashe mu minsi ingahe? IF THE ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS./NIBA IGISUBIZO AGUHAYE ATARI UMUBARE, KOMEZA UMUBAZE AGERERANYE MU MIBARE. DAYS/ IMINSI…………………………… DON’T KNOW/ SIMBIZI………………………..888 Appendix: Original Protocol from April 2012 with minor updates A47 23. Who assisted with the delivery of (Name)?/Ni nde wakubyaje kanaka(izina ry’umwana muto) ? Anyone else?/ Ntawundi PROBE FOR THE TYPE(S) OF PERSON(S) AND RECORD ALL MENTIONED. / KOMEZA UMUBAZE KUGIRA NGO UMENYE NIBA YARABYAJWE N’UMUNTU WABIHUGURIWE IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY./NIBA AVUZE KO NTAWE, KOMEZA UMUBAZE UMENYE NIBA HARI UMUNTU MUKURU WARI UHARI MU GIHE YABYARAGA. DOCTOR/ DOGITERI ……………………………………..A NURSE/ UMUFOROMO ……………….........................B MIDWIFE/ UMUBYAZA …………..……...……………….C AUXILIARY MIDWIFE/ UMUFASHA W’UMUBYAZA ...D OTHER HEALTH STAFF WITH MIDWIFERYSKILLS. / UNDI MUFOROFO UZI KUBYAZA ……………..….….…E TRAINED TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA WAHUGUWE ……...…...….F TRAINED COMMUNITY HEALTH WORKER/ UMUJYANAMA W’UBUZIMA WAHUGUWE.................G TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA UTARAHUGUWE ……………………….…….H COMMUNITY HEALTH WORKER/ UMUJYANAMA W’UBUZIMA UTARAHUGUWE ……………………..……....I RELATIVE/FRIEND/ UWO MUGIRA ICYO MUPFANA/INSHUTI/UMUTURANYI ……………….…..J NO ONE/ NTA N’UMWE ………………………………….Y 24. Was (NAME) dried (wiped) immediately after birth before the placenta was delivered? / Nyuma y’uko kanaka(Izina ry’umwana) avuka,yaba yarahanaguwe,agafubikwa ako kanya nyuma yo kuvuka mbere yuko iyanyuma isohoka YES/YEGO………………………...………………………1 NO/ OYA…………………………………………………...0 DON’T KNOW/ SIMBIZI…………………………………. 8 25. Was (NAME) wrapped in a warm cloth or blanket immediately after birth before the placenta was delivered?/Kanaka (Izina) yaba yarafubitswe mubintu bishyushye(Imyenda cg ikiringiti ) akimara kuvuka ? YES/YEGO………………………...………………………1 NO/ OYA…………………………………………………...0 DON’T KNOW/ SIMBIZI…………………………………. 8 Appendix: Original Protocol from April 2012 with minor updates A48 26. After (Name) was born, did any health care provider or traditional birth attendant check on (Name’s) health?/Nyuma yo kuvuka kwa, Kanaka hari ibindi uwafashije nyina amubyaba yaba yarakoreye uwo mwana mu rwego rwo kwita ku buzima bwe? YES/YEGO………………………...………………………1 NO/ OYA…………………………………………………...0 29 27. How many hours, days or weeks after the birth of (Name) did the first check take place?/Kanaka (amazina) yaba yarasuzumwe nyuma y’igihe kingana iki amaze kuvuka? IF LESS THAN ONE DAY, CIRCLE 0 AND RECORD HOURS; IF ONE TO SIX DAYS CIRCLE 1 AND RECORD DAYS; IF MORE THAN 6 DAYS CIRCLE 2 AND RECORD WEEKS./ NIBA ARI MUNSI Y’UMUNSI UMWE SHYIRA AKAMENYETSO KURI “0” KANDI WANDIKE “Amasaha”, NIBA ARI HAGATI Y’IMINSI UMWE KUGERA KURI ITANDATU SHYIRA AKAMENYETSO KURI RIMWE WANDIKE “Iminsi”, NIBA ARI HEJURU Y’IMINSI ITANDATU SHYIRA AKAMENYETSO KURI 2 KANDI WANDIKE “IBYUMWERU HOURS / AMASAHA 0 DAYS/IMINSI1 WEEKS/ IBYUMWERU 2 DON’T KNOW/ SIMBIZI……………..…88 Appendix: Original Protocol from April 2012 with minor updates A49 28. Who checked on (Name’s) health at that time?/Muri icyo gihe ninde wasuzumye uko ubuzima bwe bumeze? Anyone else?/Ntawundi? PROBE FOR THE MOST QUALIFIED PERSON AND RECORD ALL MENTIONED./ KOMEZA UMUBAZE WUMVE KO ARI UMUNTU UBIFITIYE UBUMENYI WAMUSUZUMYE KANDI ABO AKUBWIRA BOSE UBANDIKE. DOCTOR/ DOGITERI ……………………………………..A NURSE/ UMUFOROMO ……………….........................B MIDWIFE/ UMUBYAZA …………..……...……………….C AUXILIARY MIDWIFE/ UMUFASHA W’UMUBYAZA ...D OTHER HEALTH STAFF WITH MIDWIFERYSKILLS. / UNDI MUFOROFO UZI KUBYAZA ……………..….….…E TRAINED TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA WAHUGUWE ……...…...….F TRAINED COMMUNITY HEALTH WORKER/ UMUJYANAMA W’UBUZIMA WAHUGUWE.................G TRADITIONAL BIRTH ATTENDANT/ UMUBYAZA WA GIHANGA UTARAHUGUWE ……………………….…….H COMMUNITY HEALTH WORKER/ UMUJYANAMA W’UBUZIMA UTARAHUGUWE ……………………..……....I RELATIVE/FRIEND/ UWO MUGIRA ICYO MUPFANA/INSHUTI/UMUTURANYI ……………….…..J NO ONE/ NTA N’UMWE ………………………………….Y ECTION III: BREASTFEEDING AND CHILD NUTRITION 29. Did you ever breastfeed (NAME)?/Wigeze wonsa kanaka (izina ry’umwana muto)? YES/ YEGO.............................................1 NO/ OYA ................................................. 0 36 Appendix: Original Protocol from April 2012 with minor updates A50 30. How long after birth did you first put (NAME) to the breast?/Ukimara kubyara kanaka (izina ry’umwana muto) wamwonkeje bwa mbere amaze igihe kingana iki avutse? IF LESS THAN 1 HOUR, RECORD ‘00’ HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. NIBA ARIMUNSI Y’ISAHA IMWE SHYIRA AKAMENYETSO KURI 00, NIBA ARI MUNSI Y’AMASAHA 24, ANDIKA UMUBARE W’AMASAHA, NIBA ARI HEJURU Y’AMASAHA 24, ANDIKA IMINSI. ’ HOURS/ IGIHE KITAGEZE KU ISAHA 00 HOURS/ AMASAHA 1 |___|___| DAYS/ IMINSI 2 |___|___| 31. During the first three days after delivery, did you give (NAME) the liquid that came from your breasts?Muminsi itatu ya mbere umaze kubyara,waba waronkeje Kanaka ( IZINA RY’UMWANA MUTO)? YES/ YEGO............................................. 1 NO / OYA ................................................ 0 DON’T KNOW/ SIMBIZI ......................... 8 32. In the first three days after delivery, was (NAME) given anything to drink other than breast milk?/Muminsi itatu ya mbere umaze kubyara, hari ikindi kinyobwa wahaye KANAKA kitari amashereka ? YES/ YEGO............................................. 1 NO / OYA ................................................ 0 DON’T KNOW/ SIMBIZI ......................... 8  34 Appendix: Original Protocol from April 2012 with minor updates A51 33. What was (NAME) given to drink?Nibihe binyobwa wahaye Kanaka(IZINA RY’UMWANA MUTO) ? Anything else?Ntakindi ? DO NOT READ THE LIST/ NTUMUSOMERE IBISUBIZO. RECORD ALL MENTIONED BY CIRCLING LETTER FOR EACH ONE MENTIONED / SHYIRA AKAZIGA KUCYO AKUBWIYE MILK (OTHER THAN BREASTMILK) AMATA (ATARI AMASHEREKA) ………………... ......... …………………A PLAIN WATER / AMAZI.................................. ……………..…..B SUGAR OR GLUCOSE WATER / AMAZI ARIMO ISUKARI…..C GRIPE WATER/ AMAZI YO MUNGANDA ..... ………………..D SUGAR-SALT-WATER SOLUTION / AMAZI ARIMO UMUNYU N’ISUKARI ...................................... …………………E FRUIT JUICE/ UMUTOBE W’IMBUTO………. ……………...F INFANT FORMULA/ AMATA Y’ABANA YO MU BIKOMBE …..G TEA / INFUSIONS / ICYAYI........................... ………………..H HONEY/ UBUKI.............................................. …………………I OTHER/IBINDI __________________________X (SPECIFY/ SOBANURA) 34. Was (NAME) breastfed yesterday during the day or at night?/Kanaka ( Izina ry’umwanamuto) waramwonkeje ejo ku munsi cyangwa nijoro? YES/ YEGO.............................................. 1 NO / OYA ................................................ 0 DON’T KNOW/ SIMBIZI ......................... 8 -->36 Appendix: Original Protocol from April 2012 with minor updates A52 35. Sometimes babies are fed breast milk in different ways, for example by spoon, cup or bottle. This can happen when the mother cannot always be with her baby. Sometimes babies are breastfed by another woman, or given breast milk from another woman by spoon, cup or bottle or some other way. This can happen if a mother cannot breastfeed her own baby. / Rimwe na rimwe abana bonswa mu buryo butandukanye, urugero bagahabwa amashereka ku kayiko, mu gikombe cg mu icupa. Ibyo bishobora kuba uyo umubyeyi adashoboye kuba ari kumwe n’umwana we. Bishobora no kuba iyo umubyeyi adashobora konsa umwana we. Did (NAME) consume breast milk in any of these ways yesterday during the day or at night?Mbese KANAKA yaba yaronkejwe (yaranyoye amashereka) ejo kumanywa cg nijoro hakoreshejwe ubwo buryo maze kukubwira? YES/ YEGO.............................................. 1 NO / OYA ................................................ 0 DON’T KNOW/ SIMBIZI ......................... 8 36. Now I would like to ask you about some medicines and vitamins that are sometimes given to infants. Was (Name) given any vitamin drops or other medicines as drops yesterday during the day or night? Ubu ndashaka kukubaza ibyerekeranye n’imiti cyangwa amavitamini ajya ahabwa abana. Ese KANAKA yaba yarahawe ibitonyanga bya vitamini cyangwa indi miti ejo ku manywa cg nijoro? YES/ YEGO.............................................. 1 NO / OYA ................................................ 0 DON’T KNOW/ SIMBIZI ..... 8 37. Was (Name) given ORS yesterday during the day or at night? Haba hari uruvange rw’imyunyu n’isukari(SRO) waba warahaye kanaka (izina ry’umwana muto) haba mugitondo cyangwa nimugoroba? YES/ YEGO..............................................1 NO/ OYA ................................................. 0 DON’T KNOW/ SIMBIZI ........................... 8 38. Did (NAME) drink anything from a bottle with a nipple yesterday or last night? Kanaka(izina ry’umwana muto ) yaba yaranywesheje BIBERO ejo cyangwa iri joro ? YES/ YEGO..............................................1 NO/ OYA ................................................. 0 DON’T KNOW / SIMBIZI ......................... 8 Appendix: Original Protocol from April 2012 with minor updates A53 READ THE QUESTIONS BELOW PERTAINING TO Q. 39. READ THE LIST OF LIQUIDS ONE BY ONE AND MARK YES OR NO, ACCORDINGLY. AFTER YOU HAVE COMPLETED THE LIST, CONTINUE BY ASKING QUESTION 40 (SEE FAR RIGHT HAND COLUMN) FOR THOSE ITEMS (40B, 40C, AND/OR 40F) WHERE THE RESPONDENT REPLIED ‘YES’) SOMA IKIBAZO KIRI HASI. SOMA URUTONDE RW’IBINYOBWA KIMWE KIMWE USHYIREHO YEGO CYANGWA OYA,.NYUMA YO KUMVA URUTONDE, KOMEZA UBAZEIKIBAZO CYA 40, KURI IBI BIBAZO (40B, 40C, NA 40D/CYANGWA 40F) AHO IGISUBIZO ARI “YEGO”. No. QUESTIONS AND FILTERS CODING CATEGORIES QUESTIONS AND CODING CATEGORIES 39 Next I would like to ask you about some liquids that (Name) may have had yesterday during the day or at night . Did (Name) have any (ITEM FROM LIST)? Noneho ndiifuza kukubaza ibinyobwa waba wahaye umwana wawe ejo ku manywa cg nijoro. Hari ibyo waba wamuhaye? (IBIRI KU ILISTI) READ THE LIST OF LIQUIDS STARTING WITH ‘PLAIN WATER.’ SOMA URUTONDE RW’IBINYOBWA UHEREYE KU “AMAZI GUSA”. YES YEGO NO OYA DK SINZI 40 How many times yesterday during the day or at night did (Name) consume any (ITEM FROM LIST)?: Ibi binyobwa kanaka(izina ry’umwana muto) yabifashe inshuro zingahe ku munsi haba ku manywa cyangwa nijoro? READ QUESTION 40 FOR ITEMS B, C AND F, IF CHILD CONSUMED THE ITEM. RECORD 88 for DON’T KNOW. SOMA IKIBAZO CYA 40 KU BISUBIZO B, C NA F, NIBA UMWANA YARABINYOYE. WANDIKE 88 AHO YASHUBIJE SIMBIZI. A Plain water? Amazigusa? A………. 1 0 8 B Infant formula such as [INSERT LOCAL EXAMPLES]? Amata y’abana yo mu bikombe nka Kigozi, Rinda n’andi B……….. 1 0 8 B. TIMES/ IGIHE I__I__I C Milk such as tinned, powdered or fresh C……….. 1 0 8 C. TIMES/ IGIHE I__I__I Appendix: Original Protocol from April 2012 with minor updates A54 41 Please describe everything that (NAME) ate yesterday during the day or night, whether at home or outside the home/ Mwatubwira ibiribwa kanaka (IZINA RY’UMWANA MUTO) yagaburiwe ejo hashize kumanywa na nijoro murugo cyangwa ahandi. . g) Think about when (Name) first woke up yesterday. Did (NAME) eat anything at that time? IF YES: Please tell me everything (NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. IF NO, CONTINUE TO QUESTION b).Tekereza mugihe (kanaka) yamaraga kubyuka hari icyo kurya yaba yarahawe? NIBA ARI YEGO watubwira buri kimwe cyose yaba yarariye muri icyo gihe?KOMEZA UMUBAZE UTI: Ntakindi ? KUGEZA UBWO ASUBIZA KO NTA KINDI. NIBA NTACYO, KOMEZA KUKIBAZO CYA b) h) What did (NAME) do after that? Did (NAME) eat anything at that time? IF YES: please tell me everything (NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. Nyuma yibyo (kanaka) yakoze iki ? Hari ikintu (Kanaka) yariye muri icyo gihe? NIBA ARI YEGO: watubwira buri kimwe cyose yaba yarariye? KOMEZA UMUBAZE UTI: Nta kindi? KUGEZA UBWO ASUBIZA KO NTA KINDI. animal milk? Amata yo mu dukarito, ay’ifu cyangwa inshyushyu ( y’inka, ihene). D Juice or juice drinks? Umutobe w’ibitoke cyangwa ubundi bwoko bw’imitobe? D……….. 1 0 8 E Clear broth?Isupu imeze nk’amazi E……….. 1 0 8 F Yogurt? Yawurute? F……….. 1 0 8 F. TIMES/ IGIHE I__I__I G Thin porridge? Igikoma kidafashe? G………. 1 0 8 H Any other liquids such as [LIST other water￾based liquids available in the local setting]?Ibindi binyobwa nk’umutobe, umusururu n’ibindi H……….. 1 0 8 I Any other liquids? Ibindi binyobwa? I………… 1 0 8 Appendix: Original Protocol from April 2012 with minor updates A55 REPEAT QUESTION b) ABOVE UNTIL RESPONDENT SAYS THE CHILD WENT TO SLEEEP UNTIL THE NEXT DAY. IF RESPONDENT MENTIONS MIXED DISHES LIKE A PORRIDGE, SAUCE OR STEW, PROBE: SUBIRAMO IKIBAZO CYA b) CYO HARUGURU KUGEZA UBWO UBAZWA AKUBWIRA KO UMWANA YAGIYE KURYAMA AGAKANGUKA K’UWUNDI MUNSI. NIBA AGUSHUBIJE IBYO KURYA BIVANGAVANZE NK’IGIKOMA, ISOSI CYANGWA IBINDI BIRYO BITETSE, KOMEZA UMUBAZE UTI: i) What ingredients were in that (MIXED DISH)? PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE.Ni ibihe biribwa byari muri iyo MVANGE y’ibiryo? KOMEZA UMUBAZE UTI: Ntacyindi yariye? KUGEZA UBWO ASUBIZA KO NTA KINDI AS THE RESPONDENT RECALLS FOODS, UNDERLINE THE CORRESPONDING FOOD AND CIRCLE ‘1’ IN THE COLUMN NEXT TO THE FOOD GROUP. IF THE FOOD IS NOT LISTED IN ANY OF THE FOOD GROUPS BELOWWRITE THE FOOD IN THE BOX LABELLED ‘OTHER FOODS.’ IF FOODS ARE USED IN SMALL AMOUNTS FOR SEASONING OR AS A CONDIMENT, INCLUDE THEM UNDER THE CONDIMENTS FOOD GROUP. UKO USUBIZA AGENDA YIBUKA IBIRYO UMWANA YARIYE, UGENDE USHYIRAHO IKIMENYATSO KUCYO BIHUJE KANDI UZENGURUTSE AKAZIGA KURI”1” MU KUMBA KEGEREYE ITSINDA RY”IBIRIBWA. NIBA IBIRYO AVUZE BITARI KU ILISITI IRI HASI HANO, IBIRYO AVUZE UBYANDIKE AHAGENEWE “IBINDI BIRYO” NIBA HARI IBIRIBWA BYAKORESHEJWE MU KURYOSHYA IBIRYO NK’IBIRUNGO, UBISHYIRE AHAGENEWE ITSINDA RY’IBIRUNGO ONCE THE RESPONDENT FINISHES RECALLING FOODS EATEN, READ EACH FOOD GROUP WHERE ‘1’ WAS NOT CIRCLED, ASK THE FOLLOWING QUESTION AND CIRCLE ‘1’ IF RESPONDENT SAYS YES, ‘0’ IF NO AND ‘8’ IF DON’T KNOW: Yesterday during the day or night, did (NAME) drink/eat any (FOOD GROUP ITEMS)? ONCE THE RESPONDENT FINISHES RECALLING FOODS EATEN, READ EACH FOOD GROUP WHERE ‘1’ WAS NOT CIRCLED, ASK THE FOLLOWING QUESTION AND CIRCLE ‘1’ IF RESPONDENT SAYS YES, ‘0’ IF NO AND ‘8’ IF DON’T KNOW: Yesterday during the day or night, did (NAME) drink/eat any (FOOD GROUP ITEMS)? MU GIHE USUBIZA ARANGIJE KUVUGA IBIRYO BYOSE UMWANA YARIYE< SOMA BURI KICIRI CY’IBIRYO AHO UTIGEZE USHYIRA AKAZIGA KURI “1” , UBAZE IKIBAZO GIKURIKIRA HANYUMA USHIRE AKAZIGA KURI “1” NIBA ASHUBIJE YEGO, KURI “0” NIBA ASHUBIJE OYA, KURI “8” NIBA ASHUBIJE SIMBIZI: Ejo ku manywa cyangwa nijoro, ese (Kanaka) yaba yarariye cyangwa yaranyoye ibiryo biri muri ibi biryo ngiye kukubaza (IBIRYO MU BYICIRI)? OTHER FOODS: PLEASE WRITE DOWN OTHER FOODS IN THIS BOX THAT RESPONDENT Appendix: Original Protocol from April 2012 with minor updates A56 MENTIONED BUT ARE NOT IN THE LIST BELOW: IBINDI BIRIBWA: ANDIKA IBINDI BIRIBWA YAVUZE BITAGARAGARA KURUTONDE RWO HASI. NO. QUESTIONS AND FILTERS CODING CATEGORIES YES/YEGO NO/OYA DK/SINZI A Porridge, bread, rice, noodles, or other foods made from/ grains Igikoma,umugati,umuceri,amakaroni,cyangwa ibindi biribwa bikomoka ku binyameke A 1 0 8 B Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside/ Ibihaza,karoti,ibijumba by’ umuhondo cyangwa bya orange B 1 0 8 C White potatoes, white yams, manioc, cassava, or any other foods made from roots/ Ibirayi,ibikoro,imyumbati,isombe,cyangwa ibindi biribwa bikomoka ku binyabijumba. C 1 0 8 D Any dark or green leafy vegetables/ Imboga z’icyatsi kibisi cyane, Imboga rwatsi D 1 0 8 E Ripe mangoes, ripe papayas or (INSERT OTHER LOCAL VITAMIN A_RICH FRUITS)/ Imyembe ihishije,ipapayi ihishije, cyangwa (ONGERAMO IZINDI MBUTO ZIKUNGAHAYE KURI VITAMINE A) E 1 0 8 F Any other fruits or vegetables/ Izindi mbuto cyangwa imboga F 1 0 8 G Liver, kidney, heart or other organ meats/ Umwijima,impyiko,umutima, cyangwa izindi nyama zo munda G 1 0 8 H Any meat, such as beef, pork, lamb, goat, chicken or duck/Izindi nyama iz’inka,ingururube,intama,ihene,inkoko cyangwa imbata H 1 0 8 I Eggs/Amagi I 1 0 8 J Fresh or dried fish, shellfish or seafood/Amafi mabisi cyangwa yumye,isambaza J 1 0 8 K Any foods made from beans, peas, lentils, nuts or seeds/Ibindi biribwa k’ibishyimbo,amashaza,lantiye,ubunyobwa K 1 0 8 L Cheese, yogurt, or other milk products/foromage,yawurute,cyangwa andi mata L 1 0 8 M Any oil, fats or butter, or foods made with any of these Andi mavuta,ibinure cyangwa mayonese, cyangwa ibiribwa M 1 0 8 Appendix: Original Protocol from April 2012 with minor updates A57 bikomoka kwibyo tuvuze. N Any sugary foods such as chocolates, sweets, candies, pastries cakes or biscuits/Ibindi biribwa birimo isukari nka shokora,bombo,shikareti,gato cyangwa biswi N 1 0 8 O Condiments for flavor, such as chilies, spices, herbs or fish powder/ibiribwa by’ibirungo nk’urusenda, utundi twatsi, ifu y’indagara O 1 0 8 P Grubs, snails or insects/inswa ,isenane cyangwa utundi dusimba duto tuguruka P 1 0 8 Q Foods made with red palm oil, red palm nut or red palm nut pulp sauce/ibiribwa byatekeshejwe amamesa Q 1 0 8 Check categories A-Q/GENZURA IBYICIRO A-Q IF ALL ‘No’  GO TO 41/NIBA BYOSE ARI OYA JYA KURI 41 IF AT LEAST ONE “YES” or ALL “DK”:  GO TO 42/NIBA KIMWE MURI BYO ARI YEGO CYANGWA BYOSE ARI “SIMBIZI”: JYA KURI 42 42 Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night? Ese (Izina ry’umwana) yigeze arya ibiryo bikomeye cyangwa bidakomeye cyane cyangwa byoroshye ejo cyangwa ijoro ryashije? IF ‘YES’ PROBE: What kind of solid, semi-solid, or soft foods did (NAME) eat? NIBA ARI YEGO KOMEZA UBAZEUTI: Ni ubuhe bwoko bw’ ibiryo bikomeye cyangwa bidakomeye cyane cyangwa byoroshye yafashe? YES/ YEGO . . . . . . . . . . . 1 GO BACK TO Q41 AND RECORD FOODS EATEN THEN CONTINUE. Subira kukibazo cya 41 umusubiriremo bya bibazo nyuma ukomeze NO / OYA . . . . . . . . . . . ……. . .0 DON”T KNOW/ SIMBIZI……..….8  45  45 Appendix: Original Protocol from April 2012 with minor updates A58 43 How many times did (NAME) eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night?/ Ibiryo bikomeye cyangwa bidakomeye cyane cyangwa ibindi biryo byoroshye ariko bitari nk’amazi yabifashe inshuro zingahe ejo ku manywa cyangwa nijoro? ADAPT THIS QUESTION TO USE LOCAL WORDS FOR THE SEMI-SOLID FOODS THAT ARE GIVEN. INCLUDE MASHED OR PUREED FOOD, ALONG WITH PORRIDGES, PAPS, THICK GRUELS, STEWS, ETC. SOLID FOODS – E. G., FAMILY FOODS, BANANAS, MANGOES, POTATOES, BREAD – SHOULD ALSO BE INCLUDED./ GERAGEZA GUKORESHA AMAGAMBO ASANZWE AKORESHWA MURI AKO GACE KU MAZINA Y’IBIRYO BIDAKOMEYE CYANE BIHABWA UMWANA. UBARIREMO INOMBE,IBISEYE, IGIKOMA, IBIRYO BYOKEJWE, IBITETSE, N’IBINDI; URUGERO RW’IBIRYO BIKOMEYE: IBIRYO BY’UMULYANGO WOSE. IMINEKE, IMYEMBE, IBIJUMBA, UMUGATI BISHOBORA KUBARIRWAMO. WE WANT TO FIND OUT HOW MANY TIMES THE CHILD ATE ENOUGH TO BE FULL. SMALL SNACKS AND SMALL FEEDS SUCH AS ONE OR TWO BITES OF MOTHER’S OR SISTER’S FOOD SHOULD NOT BE COUNTED. / TURIFUZA KUMENYA UMUBARE W’INSHURO UMWANA AGABURIRWA KUGEZA AHAZE. NTUBARIREMO UTWO GUHUGENZA UMWANA N’UTUNDI TUNTU DUTO ASHOBORA GUHABWA NA NYINA CYANGWA BAKURU BE. LIQUIDS DO NOT COUNT FOR THIS QUESTION. DO NOT INCLUDE THIN SOUPS OR BROTH, WATERY GRUELS, OR ANY OTHER LIQUID./ IBINYOBWA NTIBIBARWA MURI IKI KIBAZO. NTUBARIREMO AMASUPU AMEZE NK’AMAZI N’IBINDIBIRYO BIMEZE NK’AMAZI CYANGWA BINYOBWA. KOMEZA UMUBAZE KUGIRA NGO UMUFASHE KWIBUKA INSHURO ZOSE UMWANA YAGABURIWE UMUNSI W’EJO. USE PROBING QUESTIONS TO HELP THE RESPONDENT REMEMBER ALL NUMBER OF TIMES / INSHURO .. ……..|___|___I DON’T KNOW/ SIMBIZI ……………….... 88 Appendix: Original Protocol from April 2012 with minor updates A59 AIF ‘YES’ PROBE: What kind of solid, semi￾solid or soft foods did (NAME) eat? / NIBA ARI “YEGO” MUBAZE UTI: Ni ibihe biribwa bikomeye, bidakomeye cyane cyangwa byoroshye kanaka(amazina y’umwana) yagaburiwe? GO BACK TO Q.38 TO RECORD FOOD EATEN YESTERDAY/ SUBIRA INYUMA KU KIBAZO CYA 38 KUGIRA NGO USHYIRE AKAZIGA KU BYO UMWANA YARIYE UMUNSI W’EJO. 44 (IF YES) At what age did (Name) begin solid, semi-solid, or soft foods?/(NIBA ARI YEGO)( kanaka) yanganaga iki mutangira kumuhaibiryo bikomeye cyangwa bidakomeye cyane cyangwa byoroshye? Age in months/ Imyaka mumezi DON'T KNOW/ SIMBIZI . . . . . . . . . .88 45 Are you or someone in your family helping (NAME) eat?Ujya ufasha Kanaka (IZINA RY’UMWANA MUTO) kurya cyangwa hari undi wo mumuryango umufasha? YES/ YEGO……..………………1 NO/ OYA……………….…………0 47 46 IF NO:At what age did (Name) start eating by himself/herself? / NIBA ARI OYA: nikuyahe mezi (izina ry’umwana muto ) yatangiye kwirisha ubwe ? Age in months/ Amezi . DON'T KNOW/ SIMBIZI . . . . . . . . . . . .88 47 Has (NAME) ever received a vitamin A dose (like this/any of these)? /Kanaka(IZINA RY’UMWANA MUTO) yigezahabwa ikinini cya VitaminiA? SHOW COMMON TYPES OF AMPULES/CAPSULES/SYRUPS/ MWEREKE IKININI CYA VITAMINI A GISANZWE GIKORESHWA YES/ YEGO ............................................1 NO/ OYA................................................. 0 DON’T KNOW/ SIMBIZI ......................... 8 49 49 Appendix: Original Protocol from April 2012 with minor updates A60 48 If Yes, did (NAME) receive a vitamin A dose within the last 6 months?/ Niba ari Yego kanaka( izina ry’umwana muto) hari ubwo yahawe akanini ka Vitamini A mu mezi atandatu ashize YES/ YEGO ............................................1 NO/ OYA................................................. 0 DON’T KNOW/ SIMBIZI ......................... 8 49 Has (NAME) taken any drug for intestinal worms in the past 6 months?/Kanaka (izina ry’umwana Muto)yaba hari utunini tw’inzoka zo munda yahawe mu mezi atandatu ashije? YES/ YEGO ............................................1 NO/ OYA................................................. 0 DON’T KNOW/ SIMBIZI ......................... 8 SECTION IV: IMCI B. DANGER SIGNS Appendix: Original Protocol from April 2012 with minor updates A61 50 Sometimes children get sick and need to receive careor treatment for illnesses. What are the signs ofillness that would indicate your child needs treatment? Rimwe na rimwe abana bajya barwara bagakenera ubufasha cyangwa kuvurwa, ni ibihe bimenyetso byakwereka ko umwana wawe urwaye akeneye kuvuzwa? RECORD ALL MENTIONED./ ANDIKA IBYO AKUBWIYE BYOSE. Don’t Know/ Simbizi …………………………..A Looks Unwell Or Not Playing Normally/ Kwigunga cg kudakina n’abandi ………..…...B Not Eating Or Drinking/ Ntabasha kurya/kunywa ……………..…………………………………….…C Lethargic Or Difficult To Wake/ Gucika intege bikabije……………………….…………………..D High Fever/ Umuriro mwinshi………………….E Fast Or Difficult Breathing/ Guhumeka insigane cg bimugoye……………………………………....F Vomits Everything/ Kuruka ibintu byose ………G Convulsions/ Kugagara………………………..H Gets worse despite home care/ Kurushaho kuremba ……………………………………….I Looks dehydrated (dry mouth or no tears)/ Amazi yamushizemo (iminywa yumye, cg nta turira)………………………………………………...J Other/ Ibindi K (Specify/ Sobanura) C. CONTROL OF MALARIA Appendix: Original Protocol from April 2012 with minor updates A62 51 Has (Name) been ill with fever at any time in the last 2 weeks?/ Kanaka ( izina ry’umwana muto ) yigeze agira umuriro mubyumweru bibiri bishize ? YES/ YEGO .............................................1 NO/ OYA................................................. 0 DON’T KNOW/ SIMBIZI ............................... 8 52 Did you seek advice or treatment for (NAME’S) fever?/ Waba waragiriwe inama cyangwa waravuje kanaka (izina ry’umwana muto) igihe yari afite umuriro? YES/ YEGO .............................................1 NO/ OYA................................................. 0 57 53 Where did you first go for advice or treatment for fever?1/ Nihe wabanje kujya kugisha inama cyangwa kumuvuza? Hospital/ Ku bitaro bikuru ……....01 Health Center/ Ku kigo nderabuzima ………02 Health Post/ Poste de Sante …..................03 Community Health Worker/ Umujyamana w’ubuzima binome……………………..…….04 Traditional Practitioner/ Umuvuzi wa gihanga…05 Shop/ Mu Isoko…………………………………..06 Pharmacy/ Farumasi…………………………..07 Friend/Relative/ Inshuti/Abavandimwe ……..08 Other/ Ahandi _______________________09__ (Specify/ Sobanura) 54 How long after you noticed (NAME’S) fever did you seektreatment?/Wamuvuje amaze igihe kingana iki afashwe n’umuriro? Same Day/ Uwo munsi .................. 0 Next Day/ Umunsi ukurikiyeho ...... 1 Two Days/ Nyuma y’iminsi 2 ......... 2 Three Or More Days/ Nnyuma y’iminsi 3 /irenga …………3 Don’t Know/ Simbizi…………………..8 Appendix: Original Protocol from April 2012 with minor updates A63 55 At any time during the illness, did (Name) take any drugs for the fever?/ Hari imiti y.umuriro Kanaka(Izina ry’umwana) yahawe mu gihe yari arwaye? YES/ YEGO .............................................1 NO/ OYA................................................. 0 DON’T KNOW/ SIMBIZI ............... …..8 57 57 Appendix: Original Protocol from April 2012 with minor updates A64 56 Which medicines were given to (NAME) for his/her fever?1/ Ni iyihe miti yahawe kubera impanvu z’umuriro? CIRCLE ALL MEDICINES THAT WERE GIVEN./ SHYIRA AKAZIGA KU MUTI WOSE AKUBWIYE KO YAHAWE IF MOTHER IS UNABLE TO RECALL DRUG NAME(S), ASK HER TO SHOW THE DRUG(S) TO YOU. IF SHE IS UNABLE TO SHOW YOU THEM, SHOW HER TYPICAL ANTI-MALARIALS AND HAVE HER IDENTIFY WHICH WERE GIVEN. NIBA UMUBYEYI ADASHOBOYE KUKUBWIRA IYO MITI, MUSABE AYIKWEREKE, NIBA ADASHOBOYE KUYIKWERERA MWEREKE IMITI YA MALARIYA ITANDUKANYE AKWEREKE IYO YAKORESHEJE. FOR EACH ANTI-MALARIAL MEDICINE ASK:/ KURI BURI MUTI WA MALARIYA, MUBAZE UTI: How long after the fever started did (NAME) start taking the medicine?/ Yatangiye kuwufata amaze igihe kingana iki afashwe n’umuriro? CIRCLE THE APPROPRIATE CODE/ SHYIRA AKAZIGA KU GISUBIZO AKUBWIYE . CODES/ KODE: SAME DAYUWO MUNSI= 0 NEXT DAY AFTER THE FEVER/ UMUNSI UKURIKIYEHO = 1 TWO DAYS AFTER THE FEVER/ NYUMA Y’IMINSI 2 = 2 THREE OR MORE DAYS AFTER THE FEVER / NYUMA Y’IMINSI 3 CYANGWA IRENGA = 3 DON’T KNOW/ SIMBIZI =8 ANTI-MALARIAL DRUGS A. Amodiaquine + Artesunate….0 1 2 3 8 B. Quinine………………………..0 1 2 3 8 Other Drugs/ Indi miti C. Paracetamol ………………….0 1 2 3 8 D. Unknown Drug/ Ntuzwi ………0 1 2 3 8 E. Other/ Undi___________ 0 1 2 3 8 (Specify/ Sobanura) Appendix: Original Protocol from April 2012 with minor updates A65 57 Does your household have any mosquito nets that can be used while sleeping?/ Murugo rwawe mufite inzitiramibu mukoresha YES/ YEGO ............................................. 1 NO/ OYA................................................. 0 62 58 Who slept under a bed net last night?/Ni bande baraye mu nzitiramibu iri joro ryakeye? RECORD ALL MENTIONED/ SHYIRA IKIMENYETSO KU BO AKUBWIYE IF ANYONE OTHER THAN THE CHILD OF INTEREST IS MENTIONED, CIRCLE “OTHER.”/ NIBA HARI ABANDI BAYIRAYEMO BATARI UWO MWANA, SHYIRA IKIMENYETSO KURI “ABANDI” No One/ Nta numwe……………………..…… 0 Child (Name)/ Umwana………………………..1 Other/ Undi………………………………………..2 59 Which brand of bed net did (Name) sleep under last night? / Ni ubuhe bwoko bw’inzitiramibu kanaka (amazina y’umwana) yarayemo iri joro ryakeye? SHOW PICTURES OF TYPICAL NET TYPES AND BRANDS/ MWEREKE AMAFOTO Y’AMOKO ATANDUKANYE Y’INZITIRAMIBU BRAND OPTIONS NEED TO MATCH WHAT IS LOCALLY AVAILABLE IN EACH CATEGORY. THE PURPOSE OF THIS QUESTION IS TO IDENTIFY WHAT TYPE OF NET IS BEING USED/ BURI BWOKO BWO KURI IYI LISTI BUGOMBA GUHUZWA N’UBWOKO BW’ INZITIRAMIBU BUBONEKA MURI AKO GACE. IMPAMVU Y’IKI KIBAZO NI UKUGIRA NGO TUMENYE NEZA UBWOKO BW’INZITIRAMIBU BUKORESHWA.. LONG LASTING NETS/ INZITIRA MIBU IKORANYWE UMUTI BRAND A…………….1 BRAND B……………..2 PRETREATED NETS/ INZITIRAMIBU IKARISHYWA BRAND C………………..3 BRAND D…………………4 OTHER NET (UNTREATED)/ IZINDI NZITIRAMIBU ZIDAKARISHIJE OTHER NET/ IZINDI………………5 DON’T KNOW BRAND/ BRAND NTIZWI……6 62 62 Appendix: Original Protocol from April 2012 with minor updates A66 60 Was the bed net that (Name) slept under last night ever soaked or dipped in a liquid treated to repel mosquitoes or bugs?/ Inzitiramibu kanaka (amazina y’umwana) yarayemo iri joro yigeze ikarishywa? YES/ YEGO ............................................. 1 NO/ OYA................................................. 0 DON’T KNOW/ SIMBIZI ................ …..8 62 62 61 How long ago was the net last soaked or dipped in a liquid treated to repel mosquitoes or bugs? Iyo nzitiramibu imaze igihe kingana iki ikarihijwe? IF LESS THAN ONE MONTH AGO, RECORD 00 MONTHS. NIBA IMAZE IGIHE KIRI MUNSI Y’UKWEZI KUMWE, ANDIKA AMEZI 00 IF LESS THAN 2 YEARS AGO, RECORD MONTHS AGO. PROBE FOR EXACT NUMBER OF MONTHS NIBA ICYO GIHE KIRI MUNSI Y’IMYAKA IBIRI, ANDIKA UMUBARE W’AMEZI ASHIZE. KOMEZA UMUBAZE UMENYE NEZA UMUBARE W’AMEZI ASHIZE MONTHS/ AMEZI I___I___I MORE THAN 2 YEARS AGO/ HEJURU Y’IMYAKA IBIRI …………………………………………………2 DON’T KNOW/ SIMBIZI……………………..8 D. PNEUMONIA MANAGEMENT 62 Has (Name) had an illness with a cough that comes from the chest at any time in the last two weeks? Kanaka (Amazina y’umwana) yaba yarigeze arwara inkorora no kubabara mu gatuza igihe icyo aricyo cyose mu byumweru bibiri bishize? YES/ YEGO ............................................. 1 NO/ OYA................................................. 0 DON’T KNOW/ SIMBIZI …..8 66 66 63 When (Name) had an illness with a cough, did s/he have trouble breathing or breath faster than usual with short, fast breath? Mu gihe kanaka (izina ry’umwana muto) yari arwaye inkorora, yahumekaga insigane cyangwa yahumekaga bimugoye? YES/ YEGO ............................................. 1 NO/ OYA................................................. 0 DON’T KNOW/ SIMBIZI ………………..8 66 66 Appendix: Original Protocol from April 2012 with minor updates A67 64 Did you seek advice or treatment for the cough/fast breathing?Wigeze usaba inama cyangwa ushaka umuti w’ inkorora, guhumeka insigane cyangwa guhumeka bimugoye? YES/ YEGO ............................................. 1 NO/ OYA................................................. 0 66 65 Who gave you advice or treatment? Anyone else? Record all mentioned. Ninde waba yarakugiriye inama cyangwa akaguha umuti? Ntawundi?ANDIKAABO AKUBWIYE BOSE. Doctor/ Dogiteri………………………………………….A Nurse/ Umuforomo……………………………….B Community Health Workerbinome/Umujyanama w’ubuzima binome…………………………………………………..C Other / Undi________________________________D E. CONTROL OF DIARRHEAL DISEASES 66 Has (NAME) had diarrhea in the last 2 weeks? (Add definition) Kanaka ( izina ry’umwana muto ) yigeze arwara impiswi mubyumweru bibiri bishize Definition of diarrhea: Bavugako umwana andwaye impiswi iyo agiye ku musarane inshuro zirenze 3 ku munsi kandi yituma umusarani w’amazi. YES/ YEGO ............................................. 1 NO/ OYA................................................. 0 DON’T KNOW/ SIMBIZI …………………...8 76 76 Appendix: Original Protocol from April 2012 with minor updates A68 67 What was given to treat the diarrhea? 2 Ni iki wamuhaye kugira ngo impiswi ihagarare ? Anything else?/Ntakindi ? If answer pill or syrup, show local packaging for zinc and ask if the child received this medicine/Niba ari ibinini cg imiti y’amazi, mwereke ibinini bya zinc noneho umubaze niba umwana yarahawe iyo miti RECORD ALL MENTIONED.ANDIKA IBO AVUZE BYOSE NOTHING/ NTACYO………………………………. A FLUID FROM ORS PACKET/ URUVANGE RW’IMYUNYU …………………………………….. B HOME-MADE FLUID/ IBYO KUNYWA BITEGURIWE IMUHIRA ……………………………………. C PILL OR SYRUP, ZINC/ IKININI,UMUTI W’AMAZI, ZINC...…..……………………………………………..D PILL OR SYRUP, NOT ZINC/ IBININI,UMUTI W’AMAZI NTA ZINC…………………………………E INJECTION/ URUSHINJE ……………………………….. F (IV) INTRAVENOUS/ SERUMU …………………….. G HOME REMEDIES/HERBAL MEDICINES/ IMITI Y’IBYATSI ………………………………………….H OTHER/ IBINDI__________________________ X (SPECIFY/ BISOBANURE) 68 If the child is exclusively breastfed (only taking breastmilk), ask only this question and then skip to Q 71Niba umwana yonka gusa baza gusa iki kibazo noneho uhite ujya ku kibazo cya 71 When (name of child) was sick, was s/he offered more breastmilk than usual, about the same amount, or less than usual? / Mu gihe Kanaka (izina ry’umwana muto) yari arwaye, yonkejwe inshuro nyinshi kuruta ubusanzwe, zingana cyangwa nkeya kubusanzwe? Less than usual Nkey k’ubusanzwe………………A Same amount/ Zingana …………………B More than usual/ Ziruta ubusanzwe ……………….C 71 71 71 Appendix: Original Protocol from April 2012 with minor updates A69 69 When (NAME) had diarrhea, was he/she offered less than usual to drink, about the same amount, or more than usual to drink?Mu gihe Kanaka (izina ry’umwana muto) yari arwaye impiswi, yahawe ibinyobwa bike cyangwa bingana cyangwa biruta ibyo yarasanzwe anywa? Less than usual/ Bike ku bisanzwe………………….A Same amount/ Bingana…………………………..…..B More than usual/ Biruta ibisanzwe…………………….C 70 When (name of child) was sick, was s/he offered more than usual to eat, about the same amount, or less than usual to eat? Mu gihe Kanaka (izina ry’umwana muto) yari arwaye impiswi, yahawe ibyo lurya bike cyangwa bingana cyangwa biruta ibyo yarasanzwe arya? Less than usual/ Bike ku bisanzwe………………….A Same amount/ Bingana…………………………..…..B More than usual/ Biruta ibisanzwe…………………….C 71 Was s/he given any of the following to drink at any time s/he started having diarrhea?Mugihe Kanaka yari atangiye kugira impiswi hari ibbo wamuhaye muri ibi binyobwa bikurikira: Read the choices to the mother and circle all mentioned:Bimusomere maze ushyire akaziga kubyo akubwiye byose A fluid made from a special packet called (local name for ORS packet) Uruvange rw’imyunyu (SRO)……………………………………………………...A Cereal based ORT (rice water, maize water)Amazi avura impiswi ( Amazi y’umuceri, amazi y’ibigori)…….B Other home available fluids/ Ibindi binyobwa byateguriwe imuhira …………………..…………………C 72 Did you seek advice or treatment from someone outside of the home for (NAME’S) diarrhea? Igihe Kanaka yari arwaye impiswi,wigeze ushaka inama cyangwa umuti hanze y’urugo? YES/ YEGO................................. 1 NO/ OYA...................................... 2 75 Appendix: Original Protocol from April 2012 with minor updates A70 73 Where did you first go for advice or treatment? 3 Washakiye inama cyangwa wamuvurije he bwa mbere? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE.NIBA AHO YAKUYE IMITI ARI KUBITARO,KU KIGO NDERABUZIMA CG MU IVURIRO RYIGENGA , ANDIKA IZINA RYAHO. __________________________________ _____________________ (NAME OF PLACE/ IZINA RY’AHO HANTU) HEALTH FACILITY/ AMAVURIRO HOSPITAL/ IBITARO BIKURU …………………………………… 01 HEALTH CENTER/ IKIGO NDERABUZIMA ……….………....02 HEALTH POST/ IVURIRO RYUNGIRIJE ……………………….03 COMMUNITY HEALTH WORKER/ UMUJYANAMA W’UBUZIMA ……………………………………………………………….06 OTHER HEALTH FACILITY/ IRINDI VURIRO ________________________________________ 07 (SPECIFY/RISOBANURE) OTHER SOURCE/ AHANDI YAKUYE IMITI TRADITIONAL PRACTITIONER/ UMUVUVUZI WA GIHANGA…………………………………………………………………..08 SHOP/ MU IDUKA………………………………………………………09 PHARMACY/ FARUMASI……………………………………..……..10 FRIEND/RELATIVE/ INSHUTI CG UMUVANDIMWE ……..12 OTHER/ ABANDI_________________________ 8 (SPECIFY/ BAVUGE) Appendix: Original Protocol from April 2012 with minor updates A71 74 Who decided that you should go there for (NAME’S) diarrhea?Ninde ufata icyemezo igihe ari ngombwa kuvuza umwana arwaye impiswi ? RECORD ALL MENTIONED./ ANDIKA IBYO AKUBWIYE BYOSE RESPONDENT/ USUBIZA ………………………………. A HUSBAND/PARTNER/ UMUGABO ………………………..B RESPONDENT’S MOTHER/ NYINA W’USUBIZA. ……C MOTHER-IN-LAW/ NYIRABUKWE W’USUBIZA ………..D FRIENDS/NEIGHBORS/ INSHUTI/ABATURANYI ……E OTHER/ABANDI_________________________ X (SPECIFY/ BASOBANURE) 75 Since (NAME) has been recovering from diarrhea, did you give him/her less than usual to eat, about the same to eat, or more than usual to eat?/ Mugihe umwana yorohewe,mumuha ibyo kurya bike ,bingana cg byinshi kuruta ibo yarasanzwe ahabwa ? LESS/ BIKE……………………………………………1 SAME/ BINGANA……………………………………..2 MORE/ BIRUTA………………………………………3 STILL HAS DIARRHEA/ ARACYAHITWA ……... 4 DON’T KNOW/ SIMBIZI.............. 8 SECTION V: WATER AND SANITATION 76 Do you treat your water in any way to make it safer for drinking? / Hari uburyo mukoresha mu gutunganya amazi yo kunywa? Yes/ Yego................................................. 1 No/ Oya .................................................... 0 78 Appendix: Original Protocol from April 2012 with minor updates A72 77 IF YES, what do you usually do to the water to make it safer to drink?Niba ari Yego, ubikora ute ngo wizere ko amazi ari meza yo kunyobwa? (ONLY CHECK MORE THAN ONE RESPONSE, IF SEVERAL METHODS ARE USUALLY USED TOGETHER, FOR EXAMPLE, CLOTH FILTRATION AND CHLORINE)/ SHYIRA IKIMENYETSO KU GISUBIZO KIRENZE KIMWE NIBA AKORESHA UBWO BURYO BWOSE ICYARIMWE, URUGERO: KUYAYUNGURURA UKORESHEJE CHLORINE CYANGWA AGATAMBARO. Let It Stand And Settle/Sedimentation/ kuyatereka akiyungurura …………………………………………….A Strain It Through Cloth/ kuyayunguruza agatambaro ….. B Boil/ kuyateka …………………………………………………………… C Add Bleach/Chlorine/ kuyashyiramo kilorine ……………….. D Water Filter (Ceramic, Sand, Composite)/ kuyayunguruza filitere(iya kizungu, amakara, umucanga ……………………. E Solar Disinfection/ kuyasukuza izuba …………………………. F Don’t Know/ simbizi ................................. G Other/ Ikindi _______________________ H (Specify/ Sobanura) 78 When do you wash your hands? Ni ryari ukaraba intoki? DO NOT PROMPT. CIRCLE ALL MENTIONED.NTUMUHAGARIKE, KOMEZA WUMVE IBYO AKUBWIRA USHYIRE AKAMENYETSO KU BYO AKUBWIRA Never/ nta narimwe ……………………………………….…A Before Food Preparation/ mbere yo gutegura amafunguro ……………………………………….…….…....B Before Feeding Child/ mbere yo konsa/ kugaburira umwana …………………………………………...C After Defecation/Visiting The Toilet/ nyuma yo kuva ku musarane …………………………..…………..….D After Attending To A Child Who Has Defecated/Soiled./ nyuma yo gutunganya/guhanagura umwana umaze kwituma ……………………………………………………………………...…E Other/ Ikindi gihe._____________________________ F (Specify/ Sobanura) 81 Appendix: Original Protocol from April 2012 with minor updates A73 79 Can you show me where you usually wash your hands and what you use to wash hands?/Mushobora kunyereka aho mukarabira intoki n’icyo mukoresha mukaraba intoki? ASK TO SEE AND OBSERVE/ MUSABE ABIKWEREKE NAWE WITEGEREZE. Inside/Near Toilet Facility/ mu musarane imbere cyangwa hafi yawo ………………………………………………………….1 Inside/Near Kitchen/Cooking Place/ mu gikoni, iruhande rwacyo/ aho batekera……………………………….. 2 Elsewhere In Yard/ ahantu aho ari ho hose mu rugo ……….3 Outside Yard/ inyuma y’urugo …………………………………. 4 No Specific Place/ nta mwanya wihariye uhari…………. 5 No Permission To See/ ntakwemereye kuhareba ……… 8 80 OBSERVATION ONLY: Is there soap or detergent or locally used cleansing agent? ITEGEREZE GUSA: Hari isabune cyangwa ibindi bikoreshwa mu gukaraba intoki? This item should be either in place or brought by the interviewee within one minute. If the item is not present within one minute check none, even if brought out later.Icyo gikoresho gishobora kuba gihari cyangwa kikazanwa n’umubyeyi mu gihe cy’umunota umwe gusa. niba kitabonetse mu munota umwe, kibarwa nk’ikidahari. Soap/ Isabune isanzwe………………….…………1 Detergent/ Isabune y’ifu nka omo………………..2 Ash/ Ivu..................................................... 3 Mud/Sand/ Icyondo/ Akabuye .................. 4 None/ Nta na kimwe................................. 5 Other/ Ikindi _____________________ 6 (Specify/ Sobanura 81 What kind of toilet facility do you have? Can I see it?Umusarani mukoresha umeze ute? Nshobora kuwureba ? No toilet facility/ Nta musarane ………………………….A Open latrine/ Umusarane udapfundikiye…………………B Closed latrine/ umusarane upfundikiye …………………..C Flush toilet/ umusarane wa kizungu ………………………D No permission to see/ ntiyakwemereye kureba …………..E Appendix: Original Protocol from April 2012 with minor updates A74 82 The last time (name of child) passed stools, where were the feces disposed of? Igihe cyashize kanaka(izina ry’umwana)amaze kwituma umwanda we wawushyize he? Probe to find the location.Komeza umubaze wumve aho yaba ashyira umwana w’umwana. Disposed into a latrine or toilet facility/ Yawushyize mu musarane ………………………………………………….A Disposed into a garbage/trash bin/ yawushyize mukintu kijyamo imyanda cyangwa ahagenewe imyanda……………………………………………………..…B Disposed of somewhere near the house/ Ahariho hose iruhande rw’inzu: Dug and buried?/ Yaracukuye arawutaba...........C1 Did not bury/ Ntiyawutabye………………………..C2 Disposed of somewhere far from the house/ yawushyize kure y’urugo: Dug and buried?/ Yaracukuye arawutaba..........D1 Did not bury/ Ntiyawutabye ……………………….D2 Don’t know/ Simbizi…………………………………………....E Other/ Ahandi____________________________________F SECTION VI: IMMUNIZATION 83 Did you receive a card or child health booklet where (name of child’s) vaccinations and Vitamin A doses can be written down? If so, can I see the card? Ese ufite igipande kanaka(izina ry’umwana) yakingiriweho, yanahereweho vitamine A?Niba gihari wakinyereka? Yes, interviewer sees the card/ Yego, ubaza abonye igipande ……………………………………………….A Yes, but card is missing or lost/ Yego, ariko igipande ntagihari …………………………………….B No, never had a card/ Oya, nta gipande afite.……..C Don’t know / Simbizi …………….…………………..…D 86 86 86 Appendix: Original Protocol from April 2012 with minor updates A75 84 Copy the following vaccinations dates from the card or booklet. If Vaccines are not recorded in the child health card or booklet, fill in 99/99/9999. Reba ku gipande wandikure amatariki yaboneyeho buri rukingo. niba bitanditse kugipande andika 99/99/9999. IF ALL VACCINES ARE RECORDED IN THE CHILD HEALTH CARD OR BOOKLET, GO TO Q.93/ NIBA INKINGO ZOSE ZANDITSE KUGIPANDE, JYA KUKIBAZO CYA 93. Date of Immunization/ Itariki y’ikingira DAY MONTH YEAR BCG/ IGITUNTU POLIO 0 / IMBASA 0 (POLIO GIVEN AT BIRTH OR BEFORE 2 WEEKS/ URUKINGO RW’IMBASA RUTANZWE UMWANA AKIVUKA CYANGWA MBERE Y’IBYUMWERU BIBIRI) POLIO 1 POLIO 2 POLIO 3 DTP 1 DTP 2 DTP 3 Measles/ Iseru Vitamin A (most recent dose/ Akanini aherutse kubona) Vitamin A (previous dose/ Akanini kabanjirije agaheruka) 85 Has (NAME) received any vaccinations that are not recorded on this card, including vaccinations given during immunization campaigns? Kanaka hari urundi rukingo yaba yarahawe rutari kugipande, ushyizemo n’izo yaherewe mu ikingira ry’ihururu? Yes/ Yego ......................................... 1 No/ Oya............................................. 0 Don’t Know/ Simbizi.......................... 8 93 93 Appendix: Original Protocol from April 2012 with minor updates A76 86 Please tell me if (NAME) received any of the following vaccinations:Ndabasaba kumbwira niba (KANAKA ) yarahawe izi nkingo zikurikira : BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar?/Urukingo rw’igituntu, rumwe bakingira umwana kukaboko cg ku rutugu rukamusigiraho inkovu? Yes/ Yego ......................................... 1 No/ Oya............................................. 0 Don’t Know/ Simbizi.......................... 8 87 Polio vaccine, that is, drops like these, in the mouth?Urukingo rw’imbasa Igitonyanga baha umwana mukanwa? SHOW THE EXAMPLE OF POLIO DROPS/ MWEREKE URUGERO RW’ IGITONYANGA. Yes/ Yego ......................................... 1 No/ Oya............................................. 0 Don’t Know/ Simbizi.......................... 8 90 90 88 When was the first polio vaccine received? [In the first two weeks after birth or later?Niryari umwana yahawe urkingo rwa mbere rw’imbasa?(Mu byumweru bibiri bya mbere amaze kuvuka cg nyuma yabyo) First Two Weeks After Birth/ Mubyumweru bibiri bya mbere avutse………………………………………………1 Later/ Nyuma yaho………………………………………………..2 Don’t Know/ Simbizi…………………………….……………………8 89 How many times was the polio vaccine received? Urukingo rw’imbasa yarubonye inshuro zingahe? Number Of Times/ Incuro zingahe Don’t Know/ Simbizi………………………………………8 90 DTP vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops?Urukingo batera ku kibero akenshi batangira rimwe n’urw’imbasa yararuhawe? Yes/ Yego ......................................... 1 No/ Oya............................................. 0 Don’t Know/ Simbizi.......................... 8 92 92 91 How many times?Yaruhawe inshuro zingahe? Number Of Times/ Incuro zingahe Don’t Know/ Simbizi………………………………………8 Appendix: Original Protocol from April 2012 with minor updates A77 92 Did (name of child) ever receive an injection in the arm to prevent Measles? Ese Kanaka (Izina ry’umwana muto) yaba yarakingiwe urukingo rw’iseru ? Yes/ Yego ......................................... 1 No/ Oya............................................. 0 Don’t Know/ Simbizi…………………..8 SECTION VII: ANTHROPOMETRICS 93 May I weigh (name of child)?/Nshobora gupima kanaka (izina ry’umwana muto) ibiro? Yes/ Yego …………..1 __ __ . __ Kilograms/ Ibiro No/ Oya…………….0 94 May I use MUAC Tape with (name of child)?/Nshobora gupima umuzenguruko w’ikizigira wa (izina ry’umwana muto)? Yes/ Yego …………..1 ______ mm/ mirimetero No/ Oya…………….0 95 May I measure length for (name of child)?Nshobora gupima uburebure bw’umwana ? Yes/ Yego…………..1 ______ cm/ santimetero No/ Oya…………….0 96 May I use MUAC Tape with you ?Nshobora gupima umuzenguruko w’ikizigira cy’akaboko kawe? Yes/ Yego…………..A ______ cm, santimetero No/ Oya…………….B SECTION VIII: BEHAVIOR CHANGE COMMUNICATION Appendix: Original Protocol from April 2012 with minor updates A78 97 Have you ever participated in a week-long training on child feeding and food preparation led by a CHW? / Waba warigeze witabira inyigisho zitangwa n’abajyanama b’ubuzima zimara icyumweru zijyanye no kugaburira umwana no gutegura amafunguro mumudugudu ? Yes/ Yego ......................................... 1 No/ Oya............................................. 0 Don’t Know/ Simbizi……………………………..8 101 98 (IF YES) How many times?/NIBA ARI YEGO , wazigiyemo inshuro zingahe ? Once/ Rimwe………………………………………………1 Twice/ Kabiri…………………………………….…………2 Three or more/ Gatatu cyangwa karenga………………3 99 When was the most recent time you participated in such a week-long training?Ni ryari uherutse gukurikirana izo nyigisho zimara icyumweru? Month/ Ukwezi ___ ___ Year/ Umwaka ___ ___ ___ ___ 100 How many of the days did you participate?Wazitabiriye iminsi ingahe? Number…………………………….....# Don’t know/ Simbizi……………………………8 No response/ Nta gisubizo ………………………….9 101 Did you receive a visit from your CHW in the past month?Waba warigeze usurwa n’umujyanama w’ubuzima muri uku kwezi gushize ? Yes/ Yego ......................................... 1 No/ Oya...................................... ……0 Don’t Know/ Simbizi………………….8 end end Appendix: Original Protocol from April 2012 with minor updates A79 102 If yes, what was the purpose of the visit?/Niba ari yego,niki cyamugenzaga ? O. FOLLOW UP ON SICK CHILD,/ GUKURIKIRANA UMWANA URWAYE P. PROVIDE HEALTH EDUCATION ON MALARIA PREVENTION/ GUTANGA INYIGISHO ZO KWIRINDA MALARIYA Q. PROVIDE HEALTH EDUCATION ON DIARRHEA PREVENTION/ GUTANGA INYIGISHO ZO KWIRINDA IMPISWI R. PROVIDE HEALTH EDUCATION ON PNEUMONIA/ GUTANGA INYIGISHO KUNDWARA Y’UMUSONGA. S. PROVIDE HEALTH EDUCATION ON NUTRITION/ GUTANGA INYIGISHO KU MIRIRE T. PROVIDE HEALTH EDUCATION ON IMMUNIZATION/ GUTANGA INYIGISHO KU IKINGIRA U. OTHER/ IKINDI: _____________________. Appendix: Original Protocol from April 2012 with minor updates A80 Annex G: Population Lists of Communities by Hospital Catchment Area Lists of communities for Kigeme hospital catchment area DISTRICT SECTOR HC CELL VILLAGE POPULATION 1 NYAMAGABE CYANIKA CYANIKA GITEGA BUTARE 441 2 NYAMAGABE CYANIKA CYANIKA GITEGA GASEKE 369 3 NYAMAGABE CYANIKA CYANIKA GITEGA GASHARU 541 4 NYAMAGABE CYANIKA CYANIKA GITEGA GITEGA 557 5 NYAMAGABE CYANIKA CYANIKA GITEGA KIGARAMA 408 6 NYAMAGABE CYANIKA CYANIKA GITEGA MIKO 415 7 NYAMAGABE CYANIKA CYANIKA GITEGA MUNYERERI 720 8 NYAMAGABE CYANIKA CYANIKA GITEGA MUSASA 432 9 NYAMAGABE CYANIKA CYANIKA GITEGA RWINGOMA 412 10 NYAMAGABE CYANIKA CYANIKA GITEGA RUSARASI 509 11 NYAMAGABE CYANIKA CYANIKA NYANZOGA MUGARI 683 12 NYAMAGABE CYANIKA CYANIKA NYANZOGA NYAMIRAMA 278 13 NYAMAGABE CYANIKA CYANIKA NYANZOGA KARUVENYA 396 14 NYAMAGABE CYANIKA CYANIKA NYANZOGA MBEHO 593 15 NYAMAGABE CYANIKA CYANIKA NYANZOGA BIGAZI 612 16 NYAMAGABE CYANIKA CYANIKA NYANZOGA GAFUHISHA 686 17 NYAMAGABE CYANIKA CYANIKA NYANZOGA RUSENYI 488 18 NYAMAGABE CYANIKA CYANIKA NYANZOGA KAGARAMA 431 19 NYAMAGABE CYANIKA CYANIKA NYANZA BUHIGA 898 20 NYAMAGABE CYANIKA CYANIKA NYANZA KIBINGO 990 21 NYAMAGABE CYANIKA CYANIKA NYANZA MUGOMBWA 708 22 NYAMAGABE CYANIKA CYANIKA NYANZA RUGARAGARA 700 23 NYAMAGABE CYANIKA CYANIKA NYANZA MIRAMA 670 24 NYAMAGABE CYANIKA CYANIKA NYANZA NYABISINDU 629 25 NYAMAGABE CYANIKA CYANIKA NGOMA KAVUMU 456 26 NYAMAGABE CYANIKA CYANIKA NGOMA KAMUHIRWA 598 27 NYAMAGABE CYANIKA CYANIKA NGOMA KINGA 345 28 NYAMAGABE CYANIKA CYANIKA NGOMA KABARERA 531 29 NYAMAGABE CYANIKA CYANIKA NGOMA NYAMIRAMBO 711 30 NYAMAGABE CYANIKA CYANIKA NGOMA MURAMA 440 31 NYAMAGABE CYANIKA CYANIKA KARAMA BIRAMBO 359 32 NYAMAGABE CYANIKA CYANIKA KARAMA KARABA 724 33 NYAMAGABE CYANIKA CYANIKA KARAMA KARAMA 528 34 NYAMAGABE CYANIKA CYANIKA KARAMA MUGAMBA 690 Appendix: Original Protocol from April 2012 with minor updates A81 35 NYAMAGABE CYANIKA CYANIKA KARAMA MUNYINYA 574 36 NYAMAGABE CYANIKA CYANIKA KARAMA NYAMISAVE 338 37 NYAMAGABE CYANIKA CYANIKA KARAMA NYANZA 1259 38 NYAMAGABE CYANIKA CYANIKA KARAMA RWAMAGANA 393 39 NYAMAGABE CYANIKA CYANIKA KIYUMBA GATARE 358 40 NYAMAGABE CYANIKA CYANIKA KIYUMBA GATENTWE 509 41 NYAMAGABE CYANIKA CYANIKA KIYUMBA GIKOMERO 452 42 NYAMAGABE CYANIKA CYANIKA KIYUMBA GISHIKE 386 43 NYAMAGABE CYANIKA CYANIKA KIYUMBA KAGARAMA 474 44 NYAMAGABE CYANIKA CYANIKA KIYUMBA NYARUCYAMU 544 45 NYAMAGABE CYANIKA CYANIKA KIYUMBA KAVIRI 448 46 NYAMAGABE KIBILIZI CYANIKA KARAMBO NYIRAKIRARO 589 47 NYAMAGABE KIBILIZI CYANIKA KARAMBO GITWA 469 48 NYAMAGABE KIBILIZI CYANIKA KARAMBO GISORO 448 49 NYAMAGABE KIBILIZI CYANIKA KARAMBO KAVUMU 769 50 NYAMAGABE KIBILIZI CYANIKA KARAMBO NYAMIRAMA 471 51 NYAMAGABE KITABI KITABI KAGANO BUSUSURUKE 1112 52 NYAMAGABE KITABI KITABI KAGANO UWARWUBATSI 609 53 NYAMAGABE KITABI KITABI KAGANO TURONZI 692 54 NYAMAGABE KITABI KITABI KAGANO UWINTYABIRE 896 55 NYAMAGABE KITABI KITABI KAGANO KINTOBO 1211 56 NYAMAGABE KITABI KITABI KAGANO UWABUMENYI 779 57 NYAMAGABE KITABI KITABI MUJUGA GAHANDE 942 58 NYAMAGABE KITABI KITABI MUJUGA GASASA 945 59 NYAMAGABE KITABI KITABI MUJUGA MUJUGA 639 60 NYAMAGABE KITABI KITABI MUJUGA MUKAKA 797 61 NYAMAGABE KITABI KITABI MUJUGA RWUFE 831 62 NYAMAGABE KITABI KITABI MUJUGA UWANYAKANYERI 835 63 NYAMAGABE KITABI KITABI MUJUGA UWINKA 842 64 NYAMAGABE KITABI KITABI MUKUNGU KARAMBI 856 65 NYAMAGABE KITABI KITABI MUKUNGU UWURUNAZI 450 66 NYAMAGABE KITABI KITABI MUKUNGU GAHIRA 558 67 NYAMAGABE KITABI KITABI MUKUNGU GATARE 728 68 NYAMAGABE KITABI KITABI MUKUNGU UWICURANGIRO 470 69 NYAMAGABE KITABI KITABI SHABA BITABA 807 70 NYAMAGABE KITABI KITABI SHABA GAKOKO 859 71 NYAMAGABE KITABI KITABI SHABA KUMUGANZA 1015 72 NYAMAGABE KITABI KITABI SHABA UWAKAGORO 783 73 NYAMAGABE KITABI KITABI SHABA UWINKA 859 74 NYAMAGABE KITABI KITABI SHABA MUYANGE 982 75 NYAMAGABE KITABI KITABI UWINGUGU GISARENDA 767 76 NYAMAGABE KITABI KITABI UWINGUGU KIGALI 999 Appendix: Original Protocol from April 2012 with minor updates A82 77 NYAMAGABE KITABI KITABI UWINGUGU RUBUYE 854 78 NYAMAGABE KITABI KITABI UWINGUGU RUHANGA 726 79 NYAMAGABE KITABI KITABI UWINGUGU UWIMISIGATI 1019 80 NYAMAGABE KITABI KITABI UWINGUGU UWURUNAZI 860 81 NYAMAGABE KAMEGELI NYARUSIZA KIREHE KIGARAMA 832 82 NYAMAGABE KAMEGELI NYARUSIZA KIREHE RYANYIRATABA 480 83 NYAMAGABE KAMEGELI NYARUSIZA KIREHE GASHARU 701 84 NYAMAGABE KAMEGELI NYARUSIZA KAMEGERI SOVU 520 85 NYAMAGABE KAMEGELI NYARUSIZA KAMEGERI KINYOVU 878 86 NYAMAGABE KAMEGELI NYARUSIZA KAMEGERI RWERU 585 87 NYAMAGABE KAMEGELI NYARUSIZA KAMEGERI NTARUKA 932 88 NYAMAGABE KAMEGELI NYARUSIZA KIZI GAKOMEYE 650 89 NYAMAGABE KAMEGELI NYARUSIZA KIZI KINYANA 538 90 NYAMAGABE KAMEGELI NYARUSIZA KIZI KAGARAMA 553 91 NYAMAGABE KAMEGELI NYARUSIZA BWAMA GITWA 895 92 NYAMAGABE KAMEGELI NYARUSIZA BWAMA KIGARAMA 654 93 NYAMAGABE KAMEGELI NYARUSIZA BWAMA KAMIRO 856 94 NYAMAGABE KAMEGELI NYARUSIZA RUSUSA MUHEMBE 776 95 NYAMAGABE KAMEGELI NYARUSIZA RUSUSA BAHINA 501 96 NYAMAGABE KAMEGELI NYARUSIZA RUSUSA BARO 415 97 NYAMAGABE KAMEGELI NYARUSIZA RUSUSA KIGARAMA 546 98 NYAMAGABE KAMEGELI NYARUSIZA NYARUSIZA NYARUSIZA 409 99 NYAMAGABE KAMEGELI NYARUSIZA NYARUSIZA RUTUNA 635 100 NYAMAGABE KAMEGELI NYARUSIZA NYARUSIZA BANDE 664 101 NYAMAGABE KAMEGELI NYARUSIZA NYARUSIZA NYARUSANGE 409 102 NYAMAGABE MBAZI NGARA MANWARI KIBUMBA 707 103 NYAMAGABE MBAZI NGARA MANWARI KIGARAMA 502 104 NYAMAGABE MBAZI NGARA MANWARI KARAMBI 704 105 NYAMAGABE MBAZI NGARA MANWARI MUHORORO 497 106 NYAMAGABE MBAZI NGARA MUTIWINGOMA GATWA 713 107 NYAMAGABE MBAZI NGARA MUTIWINGOMA KABERE 507 108 NYAMAGABE MBAZI NGARA MUTIWINGOMA KABUGA 635 109 NYAMAGABE MBAZI NGARA MUTIWINGOMA MUDUHA 426 110 NYAMAGABE MBAZI NGARA MUTIWINGOMA NYAMIRAMA 490 111 NYAMAGABE MBAZI NGARA NGAMBI GASEKE 231 112 NYAMAGABE MBAZI NGARA NGAMBI KABEZA 428 113 NYAMAGABE MBAZI NGARA NGAMBI KIVOMO 564 114 NYAMAGABE MBAZI NGARA NGAMBI MAHERESHO 922 115 NYAMAGABE MBAZI NGARA NGAMBI MUNANIRA 528 116 NYAMAGABE MBAZI NGARA NGARA BUTARE 786 117 NYAMAGABE MBAZI NGARA NGARA GASHARU 687 Appendix: Original Protocol from April 2012 with minor updates A83 118 NYAMAGABE MBAZI NGARA NGARA GISIZA 383 119 NYAMAGABE MBAZI NGARA NGARA GITUNTU 385 120 NYAMAGABE MBAZI NGARA NGARA NYAGISHUMBU 458 121 NYAMAGABE MBAZI NGARA NGARA RUSEKE 578 122 NYAMAGABE GASAKA KIGEME KIGEME MUNOMBE 1003 123 NYAMAGABE GASAKA KIGEME KIGEME NYENTANGA 953 124 NYAMAGABE GASAKA KIGEME KIGEME GITABA 832 125 NYAMAGABE GASAKA KIGEME KIGEME GAKOMA 1037 126 NYAMAGABE GASAKA KIGEME NZEGA NZEGA 774 127 NYAMAGABE GASAKA KIGEME NZEGA KADOMA 724 128 NYAMAGABE GASAKA KIGEME NZEGA GASAKA 950 129 NYAMAGABE GASAKA KIGEME NZEGA GITANTU 840 130 NYAMAGABE KIBILIZI KIGEME RUHUNGA GAKOMA 1103 131 NYAMAGABE KIBILIZI KIGEME RUHUNGA RUHURURA 660 132 NYAMAGABE KIBILIZI KIGEME RUHUNGA MUNOMBE 467 133 NYAMAGABE KIBILIZI KIGEME RUHUNGA NYAGISHUBI 825 134 NYAMAGABE KIBILIZI KIGEME RUHUNGA CYAMASHYA 770 135 NYAMAGABE KIBILIZI KIGEME RUHUNGA KABUGA 894 136 NYAMAGABE UWINKINGI UWINKINGI MUNYEGE BITABA 673 137 NYAMAGABE UWINKINGI UWINKINGI MUNYEGE NYARURAMBI 789 138 NYAMAGABE UWINKINGI UWINKINGI MUNYEGE KANYAMPONGO 695 139 NYAMAGABE UWINKINGI UWINKINGI MUNYEGE MUNYEGE 821 140 NYAMAGABE UWINKINGI UWINKINGI MUNYEGE GAHANGO 630 141 NYAMAGABE UWINKINGI UWINKINGI MUNYEGE KIMINA 690 142 NYAMAGABE UWINKINGI UWINKINGI GAHIRA KIBUGAZI 728 143 NYAMAGABE UWINKINGI UWINKINGI GAHIRA UWINKINGI 496 144 NYAMAGABE UWINKINGI UWINKINGI GAHIRA RUGEYO 716 145 NYAMAGABE UWINKINGI UWINKINGI GAHIRA GAHIRA 703 146 NYAMAGABE UWINKINGI UWINKINGI GAHIRA BUNYUNYU 689 147 NYAMAGABE UWINKINGI UWINKINGI GAHIRA GITITI 703 148 NYAMAGABE UWINKINGI UWINKINGI GAHIRA KUNYU 783 149 NYAMAGABE UWINKINGI UWINKINGI MUDASOMWA UWANJYOGORO 659 150 NYAMAGABE UWINKINGI UWINKINGI MUDASOMWA NSINDUKA 679 151 NYAMAGABE UWINKINGI UWINKINGI MUDASOMWA RUSHUBI 689 152 NYAMAGABE UWINKINGI UWINKINGI MUDASOMWA KARAMBO 796 153 NYAMAGABE UWINKINGI UWINKINGI MUDASOMWA GICACA 628 154 NYAMAGABE UWINKINGI UWINKINGI BIGUMIRA CYUMUGANZA 608 155 NYAMAGABE UWINKINGI UWINKINGI BIGUMIRA BIGUMIRA 578 156 NYAMAGABE UWINKINGI UWINKINGI BIGUMIRA GAKOKO 777 157 NYAMAGABE UWINKINGI UWINKINGI BIGUMIRA MAGUMIRA 705 158 NYAMAGABE UWINKINGI UWINKINGI KIBYAGIRA CYUMUGANZA 608 159 NYAMAGABE UWINKINGI UWINKINGI KIBYAGIRA KABUSEKURU 508 Appendix: Original Protocol from April 2012 with minor updates A84 160 NYAMAGABE UWINKINGI UWINKINGI KIBYAGIRA SEKERA 885 161 NYAMAGABE UWINKINGI UWINKINGI KIBYAGIRA KAGANO 663 162 NYAMAGABE UWINKINGI UWINKINGI KIBYAGIRA KABUGA 664 163 NYAMAGABE UWINKINGI UWINKINGI KIBYAGIRA BISHYA 898 164 NYAMAGABE UWINKINGI UWINKINGI KIBYAGIRA SABAKE 809 165 NYAMAGABE UWINKINGI UWINKINGI RUGOGWE MABENDE 574 166 NYAMAGABE UWINKINGI UWINKINGI RUGOGWE SUBUKINIRO 715 167 NYAMAGABE UWINKINGI UWINKINGI RUGOGWE MUNINI 641 168 NYAMAGABE UWINKINGI UWINKINGI RUGOGWE RUGETI 614 169 NYAMAGABE UWINKINGI UWINKINGI RUGOGWE NYAMUGARI 559 170 NYAMAGABE UWINKINGI UWINKINGI RUGOGWE MWISHOGWE 176 171 NYAMAGABE KIBILIZI MBUGA BUGARAMA KAMINA 570 172 NYAMAGABE KIBILIZI MBUGA BUGARAMA KARANDURA 546 173 NYAMAGABE KIBILIZI MBUGA BUGARAMA KIVUMU 545 174 NYAMAGABE KIBILIZI MBUGA BUGARAMA MUNAZI 469 175 NYAMAGABE KIBILIZI MBUGA BUGARAMA NYABUSOZI 516 176 NYAMAGABE KIBILIZI MBUGA BUGARAMA KABARERA 425 177 NYAMAGABE KIBILIZI MBUGA UWINDEKEZI KARUMBI 851 178 NYAMAGABE KIBILIZI MBUGA UWINDEKEZI BIREMBO 523 179 NYAMAGABE KIBILIZI MBUGA UWINDEKEZI KIGARAMA 483 180 NYAMAGABE KIBILIZI MBUGA UWINDEKEZI GATOVU 766 181 NYAMAGABE KIBILIZI MBUGA UWINDEKEZI UWAMATABA 737 182 NYAMAGABE KIBILIZI MBUGA UWINDEKEZI MUGOTE 707 183 NYAMAGABE TARE MBUGA NKUMBURE BIRARO 484 184 NYAMAGABE TARE MBUGA NKUMBURE BIREKA 570 185 NYAMAGABE TARE MBUGA NKUMBURE KIBWIJE 547 186 NYAMAGABE TARE MBUGA NKUMBURE GAHEMBE 389 187 NYAMAGABE TARE MBUGA NKUMBURE MUBEZI 464 188 NYAMAGABE TARE MBUGA NKUMBURE MUHUMO 599 189 NYAMAGABE TARE MBUGA NKUMBURE RUKEREKO 391 190 NYAMAGABE TARE MBUGA NKUMBURE RUGETI 517 191 NYAMAGABE TARE MBUGA NKUMBURE UWUMUGETI 382 192 NYAMAGABE TARE MBUGA NKUMBURE VUMWE 465 193 NYAMAGABE TARE MBUGA GATOVU GASENGE 497 194 NYAMAGABE TARE MBUGA GATOVU MUHATI 480 195 NYAMAGABE TARE MBUGA GATOVU KIGUSA 704 196 NYAMAGABE TARE MBUGA GATOVU KIMINA 735 197 NYAMAGABE TARE MBUGA GATOVU RUZIBA 368 198 NYAMAGABE TARE MBUGA NYAMIGINA NGORORERO 472 199 NYAMAGABE TARE MBUGA NYAMIGINA NKOMERO 392 200 NYAMAGABE TARE MBUGA NYAMIGINA NYARUGETI 408 201 NYAMAGABE TARE MBUGA NYAMIGINA RUKOKO 558 Appendix: Original Protocol from April 2012 with minor updates A85 202 NYAMAGABE TARE MBUGA NYAMIGINA GAKOMA 655 203 NYAMAGABE TARE MBUGA NYAMIGINA UWINYANA 340 204 NYAMAGABE TARE MBUGA NYAMIGINA MARYOHE 462 205 NYAMAGABE TARE MBUGA GASARENDA KAGARAMA 1195 206 NYAMAGABE TARE MBUGA GASARENDA KIMINAZI 521 207 NYAMAGABE TARE MBUGA GASARENDA KIVURUGA 618 208 NYAMAGABE TARE MBUGA GASARENDA MUSE 551 209 NYAMAGABE TARE MBUGA GASARENDA MWUFE 358 210 NYAMAGABE TARE MBUGA GASARENDA MURANGARA 771 211 NYAMAGABE TARE MBUGA GASARENDA UWINKOMO 351 212 NYAMAGABE TARE MBUGA BUHORO KIRWA 433 213 NYAMAGABE TARE MBUGA BUHORO NYABWOMA 409 214 NYAMAGABE TARE MBUGA BUHORO GISANZE 548 215 NYAMAGABE TARE MBUGA BUHORO RWUFE 383 216 NYAMAGABE TARE MBUGA BUHORO KANSEREGE 546 217 NYAMAGABE TARE MBUGA BUHORO RYARUBONDO 616 218 NYAMAGABE TARE MBUGA BUHORO GITOVU 740 219 NYAMAGABE TARE MBUGA KAGANZA BIVUMU 553 220 NYAMAGABE TARE MBUGA KAGANZA BUREMERA 638 221 NYAMAGABE TARE MBUGA KAGANZA RUGANZA 507 222 NYAMAGABE TARE MBUGA KAGANZA KANYIRANDORI 568 223 NYAMAGABE TARE MBUGA KAGANZA KIMICANGA 638 224 NYAMAGABE GASAKA NYAMAGABE NGIRYI KARAMBI 1506 225 NYAMAGABE GASAKA NYAMAGABE NGIRYI KITAZIGURWA 1280 226 NYAMAGABE GASAKA NYAMAGABE NGIRYI KIBANDA 573 227 NYAMAGABE GASAKA NYAMAGABE NGIRYI SUMBA 1803 228 NYAMAGABE GASAKA NYAMAGABE NGIRYI NGIRYI 484 229 NYAMAGABE GASAKA NYAMAGABE NGIRYI MUNYEGE 675 230 NYAMAGABE GASAKA NYAMAGABE REMERA GITWA 848 231 NYAMAGABE GASAKA NYAMAGABE REMERA NYAMIFUMBA 757 232 NYAMAGABE GASAKA NYAMAGABE REMERA MURIRO 613 233 NYAMAGABE GASAKA NYAMAGABE REMERA KABEZA 672 234 NYAMAGABE GASAKA NYAMAGABE REMERA MURAMBI 495 235 NYAMAGABE GASAKA NYAMAGABE NYABIVUMU GASHARU 265 236 NYAMAGABE GASAKA NYAMAGABE NYABIVUMU RARO 598 237 NYAMAGABE GASAKA NYAMAGABE NYABIVUMU DUSEGO 393 238 NYAMAGABE GASAKA NYAMAGABE NYABIVUMU NYABIVUMU 391 239 NYAMAGABE GASAKA NYAMAGABE NYAMUGALI NYAMUGARI 821 240 NYAMAGABE GASAKA NYAMAGABE NYAMUGALI KARAMA 1030 241 NYAMAGABE GASAKA NYAMAGABE NYAMUGALI KIGARAMA 892 242 NYAMAGABE GASAKA NYAMAGABE NYAMUGALI NYARUSANGE 1258 243 NYAMAGABE GASAKA NYAMAGABE NYAMUGALI KABACUZI 1460 Appendix: Original Protocol from April 2012 with minor updates A86 244 NYAMAGABE GASAKA NYAMAGABE NYAMUGALI KABAJOGO 1243 245 NYAMAGABE KIBILIZI NYAMAGABE BUGARURA MUYANGE 806 246 NYAMAGABE KIBILIZI NYAMAGABE BUGARURA UWINYANA 627 247 NYAMAGABE KIBILIZI NYAMAGABE BUGARURA NYAKIBYEYI 594 248 NYAMAGABE KIBILIZI NYAMAGABE BUGARURA KASEBUTURANYI 767 249 NYAMAGABE KIBILIZI NYAMAGABE BUGARURA KIRWA 574 250 NYAMAGABE KIBILIZI NYAMAGABE GASHIHA GASHARU 601 251 NYAMAGABE KIBILIZI NYAMAGABE GASHIHA MUDUHA 790 252 NYAMAGABE KIBILIZI NYAMAGABE GASHIHA RUKAMIRO 945 253 NYAMAGABE KIBILIZI NYAMAGABE GASHIHA NYABUBARE 894 254 NYAMAGABE KIBILIZI NYAMAGABE GASHIHA MUGANZA 873 166,581 Lists of communities for Kaduha hospital catchment area DISTRICT SECTOR HEALTH CENTER CELL VILLAGE POPULATION 1 NYAMAGABE KIBUMBWE KIBUMBWE BWENDA MUNYINYA 735 2 NYAMAGABE KIBUMBWE KIBUMBWE BWENDA MURAMBI 441 3 NYAMAGABE KIBUMBWE KIBUMBWE BWENDA MURWA 521 4 NYAMAGABE KIBUMBWE KIBUMBWE BWENDA NYAGATOVU 464 5 NYAMAGABE KIBUMBWE KIBUMBWE BWENDA NYAMIRAMA 582 6 NYAMAGABE KIBUMBWE KIBUMBWE GAKANKA CYERU 556 7 NYAMAGABE KIBUMBWE KIBUMBWE GAKANKA GIKOMERO 511 8 NYAMAGABE KIBUMBWE KIBUMBWE GAKANKA MUNINI 532 9 NYAMAGABE KIBUMBWE KIBUMBWE GAKANKA NKURUBUYE 785 10 NYAMAGABE KIBUMBWE KIBUMBWE GAKANKA NYARUBUYE 531 11 NYAMAGABE KIBUMBWE KIBUMBWE GAKANKA RAMBYA 532 12 NYAMAGABE KIBUMBWE KIBUMBWE KIBIBI GATANDAGANYA 512 13 NYAMAGABE KIBUMBWE KIBUMBWE KIBIBI KABERE 514 14 NYAMAGABE KIBUMBWE KIBUMBWE KIBIBI KANYEGE 478 15 NYAMAGABE KIBUMBWE KIBUMBWE KIBIBI KIRWA 642 16 NYAMAGABE KIBUMBWE KIBUMBWE KIBIBI RWEZAMENYO 796 17 NYAMAGABE KIBUMBWE KIBUMBWE KIBIBI RYINGARURA 351 18 NYAMAGABE KIBUMBWE KIBUMBWE NYAKIZA DUSENYI 596 19 NYAMAGABE KIBUMBWE KIBUMBWE NYAKIZA KARAMBO 463 Appendix: Original Protocol from April 2012 with minor updates A87 20 NYAMAGABE KIBUMBWE KIBUMBWE NYAKIZA KINYANA 357 21 NYAMAGABE KIBUMBWE KIBUMBWE NYAKIZA MURAMBI 529 22 NYAMAGABE KIBUMBWE KIBUMBWE NYAKIZA NYAKIZU 271 23 NYAMAGABE KIBUMBWE KIBUMBWE NYAKIZA ZIGATI 433 24 NYAMAGABE MUGANO MUGANO RUHINGA CYIBANDE 370 25 NYAMAGABE MUGANO MUGANO RUHINGA CYINZIRA 403 26 NYAMAGABE MUGANO MUGANO RUHINGA GITARAMA 579 27 NYAMAGABE MUGANO MUGANO RUHINGA KABUYE 658 28 NYAMAGABE MUGANO MUGANO RUHINGA KARAMBI 443 29 NYAMAGABE MUGANO MUGANO RUHINGA RUNYINYA 436 30 NYAMAGABE MUGANO MUGANO YONDE GISOVU 499 31 NYAMAGABE MUGANO MUGANO YONDE KANYEGENYEGE 661 32 NYAMAGABE MUGANO MUGANO YONDE NYARUSIZA 613 33 NYAMAGABE MUGANO MUGANO YONDE RUHAMIRA 1 395 34 NYAMAGABE MUGANO MUGANO YONDE RUHAMIRA 2 589 35 NYAMAGABE MUGANO MUGANO SUTI CYABUTE 446 36 NYAMAGABE MUGANO MUGANO SUTI GASIZA 296 37 NYAMAGABE MUGANO MUGANO SUTI MATYAZO 588 38 NYAMAGABE MUGANO MUGANO SUTI RWAMIKO 474 39 NYAMAGABE MUGANO MUGANO SUTI TURYANGO 672 40 NYAMAGABE MUGANO MUGANO SOVU KIGARAMA 913 41 NYAMAGABE MUGANO MUGANO SOVU NZIRANZIZA 751 42 NYAMAGABE MUGANO MUGANO SOVU RUGARAMA 1 637 43 NYAMAGABE MUGANO MUGANO SOVU RUGARAMA 2 982 44 NYAMAGABE MUGANO MUGANO SOVU RUHANGA 812 45 NYAMAGABE MUGANO MUGANO GITONDORERO GAKOMEYE 938 46 NYAMAGABE MUGANO MUGANO GITONDORERO GITONDORERO 936 47 NYAMAGABE MUGANO MUGANO GITONDORERO GITUNTU 888 48 NYAMAGABE MUGANO MUGANO GITONDORERO KARAMBI 534 49 NYAMAGABE MUGANO MUGANO GITONDORERO MASO 704 50 NYAMAGABE MUGANO MUGANO GITWA KABUHORO 738 51 NYAMAGABE MUGANO MUGANO GITWA KIRENZI 1 450 52 NYAMAGABE MUGANO MUGANO GITWA KIRENZI 2 307 53 NYAMAGABE MUGANO MUGANO GITWA NYAKIBINGO 358 54 NYAMAGABE MUGANO MUGANO GITWA RUTABO 611 55 NYAMAGABE MUGANO MUGANO GITWA RYAMIGABO 619 Appendix: Original Protocol from April 2012 with minor updates A88 56 NYAMAGABE MUSHUBI MUSHUBI GISHWATI BWERAMANA 563 57 NYAMAGABE MUSHUBI MUSHUBI CYOBE CYOBE 409 58 NYAMAGABE MUSHUBI MUSHUBI CYOBE GASEKE 523 59 NYAMAGABE MUSHUBI MUSHUBI GISHWATI GASHWATI 777 60 NYAMAGABE MUSHUBI MUSHUBI CYOBE GITIKIREMA 485 61 NYAMAGABE MUSHUBI MUSHUBI BUTETERI GORWE 517 62 NYAMAGABE MUSHUBI MUSHUBI BUTETERI KAGORWE 449 63 NYAMAGABE MUSHUBI MUSHUBI GISHWATI KIZANGANYA 514 64 NYAMAGABE MUSHUBI MUSHUBI BUTETERI MUGUNDA 385 65 NYAMAGABE MUSHUBI MUSHUBI GISHWATI MUHEMBE 673 66 NYAMAGABE MUSHUBI MUSHUBI GISHWATI MUKO 336 67 NYAMAGABE MUSHUBI MUSHUBI BUTETERI MURAMBI 589 68 NYAMAGABE MUSHUBI MUSHUBI GISHWATI MUSHUBI 770 69 NYAMAGABE MUSHUBI MUSHUBI BUTETERI NGOMA 483 70 NYAMAGABE MUSHUBI MUSHUBI CYOBE NYAGISUMO 498 71 NYAMAGABE MUSHUBI MUSHUBI CYOBE NYAKABINGO 688 72 NYAMAGABE MUSHUBI MUSHUBI BUTETERI NYAKIBANDE 529 73 NYAMAGABE MUSHUBI MUSHUBI CYOBE NYAKIRAMBO 426 74 NYAMAGABE MUSHUBI MUSHUBI CYOBE NYARUSHIKE 639 75 NYAMAGABE MUSHUBI MUSHUBI BUTETERI REMERA 462 76 NYAMAGABE MUSHUBI MUSHUBI GISHWATI RUCUNDO 673 77 NYAMAGABE MUSHUBI MUSHUBI GISHWATI RUHINGA 324 78 NYAMAGABE MUSHUBI MUSHUBI BUTETERI RUSOYO 459 79 NYAMAGABE MUSHUBI MUSHUBI CYOBE RUTOYI 536 80 NYAMAGABE MUSHUBI MUSHUBI BUTETERI RWAMIKO 532 81 NYAMAGABE NKOMANE NYARWUNGO NKOMANE BANDA 682 82 NYAMAGABE NKOMANE NYARWUNGO NKOMANE RUHINGA 686 83 NYAMAGABE NKOMANE NYARWUNGO NKOMANE KAGANO 680 84 NYAMAGABE NKOMANE NYARWUNGO NKOMANE MUTARAMA 685 85 NYAMAGABE NKOMANE NYARWUNGO NKOMANE MUGALI 682 86 NYAMAGABE NKOMANE NYARWUNGO NYARWUNGO BUKERO 403 87 NYAMAGABE NKOMANE NYARWUNGO NYARWUNGO NYARWUNGO 237 88 NYAMAGABE NKOMANE NYARWUNGO NYARWUNGO NYARUHONDO 248 89 NYAMAGABE NKOMANE NYARWUNGO NYARWUNGO MARAMBO 431 90 NYAMAGABE NKOMANE NYARWUNGO NYARWUNGO RUTOYI 681 91 NYAMAGABE NKOMANE NYARWUNGO NYARWUNGO RANGI 585 Appendix: Original Protocol from April 2012 with minor updates A89 92 NYAMAGABE NKOMANE NYARWUNGO NYARWUNGO BISHARARA 438 93 NYAMAGABE NKOMANE NYARWUNGO MUSARABA GATOROVE 421 94 NYAMAGABE NKOMANE NYARWUNGO MUSARABA MUSARABA 422 95 NYAMAGABE NKOMANE NYARWUNGO MUSARABA ROSOYO 378 96 NYAMAGABE NKOMANE NYARWUNGO MUSARABA RWIMPIRI 431 97 NYAMAGABE NKOMANE NYARWUNGO MUSARABA KIMBOGO 399 98 NYAMAGABE NKOMANE NYARWUNGO MUSARABA RUTARE 426 99 NYAMAGABE NKOMANE NYARWUNGO MUSARABA GIHUNGA 626 100 NYAMAGABE NKOMANE NYARWUNGO MUTENGERI KAVUMU 380 101 NYAMAGABE NKOMANE NYARWUNGO MUTENGERI TUBUYE 560 102 NYAMAGABE NKOMANE NYARWUNGO MUTENGERI MUTENGERI 373 103 NYAMAGABE NKOMANE NYARWUNGO MUTENGERI CYURWUFE 384 104 NYAMAGABE NKOMANE NYARWUNGO MUTENGERI KIVUMU 467 105 NYAMAGABE NKOMANE NYARWUNGO MUTENGERI GIHWAHWA 357 106 NYAMAGABE NKOMANE NYARWUNGO TWIYA KIBUGA 433 107 NYAMAGABE NKOMANE NYARWUNGO TWIYA TWIYA 479 108 NYAMAGABE NKOMANE NYARWUNGO TWIYA GISHENGE 415 109 NYAMAGABE NKOMANE NYARWUNGO TWIYA GAKOMEYE 375 110 NYAMAGABE NKOMANE NYARWUNGO TWIYA KARUKOMA 495 111 NYAMAGABE NKOMANE NYARWUNGO BITANDARA MUYANGE 416 112 NYAMAGABE NKOMANE NYARWUNGO BITANDARA MUNANIRA 496 113 NYAMAGABE NKOMANE NYARWUNGO BITANDARA BITANDARA 693 114 NYAMAGABE NKOMANE NYARWUNGO BITANDARA RUGEYO 606 115 NYAMAGABE NKOMANE NYARWUNGO BITANDARA BUHANZI 637 116 NYAMAGABE MUSANGE JENDA MASANGANO NYAKABUYE 548 117 NYAMAGABE MUSANGE JENDA MASANGANO GASAGARA 591 118 NYAMAGABE MUSANGE JENDA MASANGANO RUTUNTU 576 119 NYAMAGABE MUSANGE JENDA MASANGANO KIBUMBA 585 120 NYAMAGABE MUSANGE JENDA MASANGANO MUBUGA 593 121 NYAMAGABE MUSANGE JENDA MASIZI MUREHE 633 122 NYAMAGABE MUSANGE JENDA MASIZI KARAMA 563 123 NYAMAGABE MUSANGE JENDA MASIZI MUNINI 602 124 NYAMAGABE MUSANGE JENDA MASIZI RWINA 607 125 NYAMAGABE MUSANGE JENDA MASIZI RWANKANGO 621 126 NYAMAGABE MUSANGE JENDA NYAGISOZI KIBAGA 464 127 NYAMAGABE MUSANGE JENDA NYAGISOZI UWABARASHI 438 Appendix: Original Protocol from April 2012 with minor updates A90 128 NYAMAGABE MUSANGE JENDA NYAGISOZI DUSENYI 522 129 NYAMAGABE MUSANGE JENDA NYAGISOZI RUHUGA 508 130 NYAMAGABE MUSANGE JENDA NYAGISOZI REMERA 493 131 NYAMAGABE MUSANGE JENDA GASAVE MURAMBI 532 132 NYAMAGABE MUSANGE JENDA GASAVE GASURA 564 133 NYAMAGABE MUSANGE JENDA GASAVE KABINGO 538 134 NYAMAGABE MUSANGE JENDA GASAVE NYAKABUYE 526 135 NYAMAGABE MUSANGE JENDA GASAVE NYABIVUMU 481 136 NYAMAGABE MUSANGE JENDA GASAGARA GITUNTU 463 137 NYAMAGABE MUSANGE JENDA GASAGARA MUHORORO 478 138 NYAMAGABE MUSANGE JENDA GASAGARA MUTAKARA 548 139 NYAMAGABE MUSANGE JENDA GASAGARA MUTUNTU 510 140 NYAMAGABE MUSANGE JENDA GASAGARA CYARUVUNGE 620 141 NYAMAGABE MUSANGE JENDA GASAGARA NYAGIHIMA 580 142 NYAMAGABE MUSANGE JENDA GASAGARA CYABASANA 441 143 NYAMAGABE MUSANGE JENDA JENDA KAYOGORO 979 144 NYAMAGABE MUSANGE JENDA JENDA KAVUMU 620 145 NYAMAGABE MUSANGE JENDA JENDA NYAKIRAMBI 601 146 NYAMAGABE MUSANGE JENDA JENDA NYAKIBUNGO 617 147 NYAMAGABE MUSANGE JENDA JENDA KABAKANNYI 906 148 NYAMAGABE MUSANGE JENDA JENDA CYABUGOMBA 512 149 NYAMAGABE KADUHA KADUHA NYABISINDU KABAZIRO 616 150 NYAMAGABE KADUHA KADUHA NYABISINDU KIREHE 539 151 NYAMAGABE KADUHA KADUHA NYABISINDU KIVUMU 700 152 NYAMAGABE KADUHA KADUHA NYABISINDU MUKONGORO 450 153 NYAMAGABE KADUHA KADUHA NYABISINDU MUDUHA 493 154 NYAMAGABE KADUHA KADUHA NYABISINDU NYABISINDU 638 155 NYAMAGABE KADUHA KADUHA NYABISINDU GITABAGE 473 156 NYAMAGABE KADUHA KADUHA MURAMBI NYARURYANGO 670 157 NYAMAGABE KADUHA KADUHA MURAMBI KIBIRARO 556 158 NYAMAGABE KADUHA KADUHA MURAMBI REBERO 719 159 NYAMAGABE KADUHA KADUHA MURAMBI KASEMANYANA 595 160 NYAMAGABE KADUHA KADUHA NYAMIYAGA GASHIRU 304 161 NYAMAGABE KADUHA KADUHA NYAMIYAGA NKOMERO 569 162 NYAMAGABE KADUHA KADUHA NYAMIYAGA RUHUHA 465 163 NYAMAGABE KADUHA KADUHA NYAMIYAGA CYUGARO 568 Appendix: Original Protocol from April 2012 with minor updates A91 164 NYAMAGABE KADUHA KADUHA NYAMIYAGA RUKERI 508 165 NYAMAGABE KADUHA KADUHA NYAMIYAGA NYAKABINGO 661 166 NYAMAGABE KADUHA KADUHA KAVUMU BIZIGURO 570 167 NYAMAGABE KADUHA KADUHA KAVUMU KAREHE 1041 168 NYAMAGABE KADUHA KADUHA KAVUMU GATABA 539 169 NYAMAGABE KADUHA KADUHA KAVUMU KABUGA 510 170 NYAMAGABE KADUHA KADUHA KAVUMU BAMBA 546 171 NYAMAGABE KADUHA KADUHA KAVUMU JOMA 364 172 NYAMAGABE KADUHA KADUHA KAVUMU KAVUMU 641 173 NYAMAGABE KADUHA KADUHA KAVUMU GAHAMA 648 174 NYAMAGABE KADUHA KADUHA MUSENYI MUNINI 510 175 NYAMAGABE KADUHA KADUHA MUSENYI NYAKIRAMBI 684 176 NYAMAGABE KADUHA KADUHA MUSENYI KIRWA 486 177 NYAMAGABE KADUHA KADUHA MUSENYI BURENGO 628 178 NYAMAGABE KADUHA KADUHA MUSENYI RUGANDA 594 179 NYAMAGABE KADUHA KADUHA MUSENYI NGANZO 596 180 NYAMAGABE KADUHA KADUHA MUSENYI GATOKE 742 181 NYAMAGABE GATARE RUGEGE BAKOPFU KALAMBO 809 182 NYAMAGABE GATARE RUGEGE BAKOPFU MUHINGO 850 183 NYAMAGABE GATARE RUGEGE BAKOPFU TWIYA 580 184 NYAMAGABE GATARE RUGEGE BAKOPFU KALUMBI 663 185 NYAMAGABE GATARE RUGEGE MUKONGORO KAGEYO 479 186 NYAMAGABE GATARE RUGEGE MUKONGORO NYAKABUYE 580 187 NYAMAGABE GATARE RUGEGE MUKONGORO KAGANO 636 188 NYAMAGABE GATARE RUGEGE MUKONGORO RUKEREKO 677 189 NYAMAGABE GATARE RUGEGE MUKONGORO GIKUNGU 501 190 NYAMAGABE GATARE RUGEGE MUNINI MAGUMIRA 555 191 NYAMAGABE GATARE RUGEGE MUNINI KINYONZA 544 192 NYAMAGABE GATARE RUGEGE MUNINI RUKWANDU 660 193 NYAMAGABE GATARE RUGEGE MUNINI MATSINDA 640 194 NYAMAGABE GATARE RUGEGE MUNINI UWINZOVU 718 195 NYAMAGABE GATARE RUGEGE MUNINI GITOVU 704 196 NYAMAGABE GATARE RUGEGE MUNINI MUNINI 701 197 NYAMAGABE GATARE RUGEGE SHYERU BAZIRO 981 198 NYAMAGABE GATARE RUGEGE SHYERU RUHANGA 627 199 NYAMAGABE GATARE RUGEGE SHYERU BIMBA 662 Appendix: Original Protocol from April 2012 with minor updates A92 200 NYAMAGABE GATARE RUGEGE SHYERU KAGUSA 507 201 NYAMAGABE GATARE RUGEGE SHYERU RUSHYARARA 602 202 NYAMAGABE GATARE RUGEGE RUGANDA GITUNTU 506 203 NYAMAGABE GATARE RUGEGE RUGANDA RUNABA 580 204 NYAMAGABE GATARE RUGEGE RUGANDA RWANGAMBIBI 705 205 NYAMAGABE GATARE RUGEGE RUGANDA GASHARU 455 206 NYAMAGABE GATARE RUGEGE RUGANDA MASANGANO 546 207 NYAMAGABE GATARE RUGEGE RUGANDA GITUNTU 506 208 NYAMAGABE GATARE RUGEGE RUGANDA KAMAMARA 492 209 NYAMAGABE GATARE RUGEGE GATARE UWISULI 950 210 NYAMAGABE GATARE RUGEGE GATARE RWAMAKARA 1149 211 NYAMAGABE GATARE RUGEGE GATARE GASHASHA 390 212 NYAMAGABE GATARE RUGEGE GATARE MUREMBO 401 213 NYAMAGABE GATARE RUGEGE GATARE KIYOVU 966 214 NYAMAGABE Buruhukiro MUSEBEYA BUSHIGISHIGI BUSHIGISHIGI 455 215 NYAMAGABE Buruhukiro MUSEBEYA BUSHIGISHIGI GIHARAYUMBU 513 216 NYAMAGABE Buruhukiro MUSEBEYA BUSHIGISHIGI MUGOTE 588 217 NYAMAGABE Buruhukiro MUSEBEYA BUSHIGISHIGI RUSEKERA 424 218 NYAMAGABE Buruhukiro MUSEBEYA BYIMANA BISHYIGA 501 219 NYAMAGABE Buruhukiro MUSEBEYA BYIMANA BUHORO 455 220 NYAMAGABE Buruhukiro MUSEBEYA BYIMANA GAKANGAGA 583 221 NYAMAGABE Buruhukiro MUSEBEYA BYIMANA GIHUMO 837 222 NYAMAGABE Buruhukiro MUSEBEYA BYIMANA RUKELI 500 223 NYAMAGABE Buruhukiro MUSEBEYA GIFURWE BITABA 668 224 NYAMAGABE Buruhukiro MUSEBEYA GIFURWE GIFURWE 329 225 NYAMAGABE Buruhukiro MUSEBEYA GIFURWE NGANZO 432 226 NYAMAGABE Buruhukiro MUSEBEYA GIFURWE NYAMABERE 662 227 NYAMAGABE Buruhukiro MUSEBEYA GIFURWE RURONZI 596 228 NYAMAGABE Buruhukiro MUSEBEYA GIFURWE UWANKIRIYE 511 229 NYAMAGABE Buruhukiro MUSEBEYA KIZIMYAMURIRO GIKUNGU 597 230 NYAMAGABE Buruhukiro MUSEBEYA KIZIMYAMURIRO GISHWATI 589 231 NYAMAGABE Buruhukiro MUSEBEYA KIZIMYAMURIRO KAGANO 607 232 NYAMAGABE Buruhukiro MUSEBEYA KIZIMYAMURIRO KINABA 753 233 NYAMAGABE Buruhukiro MUSEBEYA KIZIMYAMURIRO MINAGA 364 234 NYAMAGABE Buruhukiro MUSEBEYA KIZIMYAMURIRO MUJERENGE 793 235 NYAMAGABE Buruhukiro MUSEBEYA KIZIMYAMURIRO TANTAMARA 807 Appendix: Original Protocol from April 2012 with minor updates A93 236 NYAMAGABE Buruhukiro MUSEBEYA KIZIMYAMURIRO UWINZIRA 1017 237 NYAMAGABE Buruhukiro MUSEBEYA RAMBYA BURUHUKIRO 423 238 NYAMAGABE Buruhukiro MUSEBEYA RAMBYA KIBUBURO 533 239 NYAMAGABE Buruhukiro MUSEBEYA RAMBYA MPANGA 439 240 NYAMAGABE Buruhukiro MUSEBEYA RAMBYA NKAMBA 803 241 NYAMAGABE Buruhukiro MUSEBEYA RAMBYA RUSEKE 408 242 NYAMAGABE Musebeya MUSEBEYA GATOVU BISEREGANYA 370 243 NYAMAGABE Musebeya MUSEBEYA GATOVU GATOVU 590 244 NYAMAGABE Musebeya MUSEBEYA GATOVU GITOVU 495 245 NYAMAGABE Musebeya MUSEBEYA GATOVU KANYIRANZOGA 967 246 NYAMAGABE Musebeya MUSEBEYA GATOVU NYARUBANDE 719 247 NYAMAGABE Musebeya MUSEBEYA GATOVU RYANYAKAYAGA 874 248 NYAMAGABE Musebeya MUSEBEYA NYARURAMBI CYABWIMBA 545 249 NYAMAGABE Musebeya MUSEBEYA NYARURAMBI CYARWA 585 250 NYAMAGABE Musebeya MUSEBEYA NYARURAMBI GATITI 826 251 NYAMAGABE Musebeya MUSEBEYA NYARURAMBI GIHETA 864 252 NYAMAGABE Musebeya MUSEBEYA NYARURAMBI KABERE 403 253 NYAMAGABE Musebeya MUSEBEYA NYARURAMBI MUJYEJURU 387 254 NYAMAGABE Musebeya MUSEBEYA NYARURAMBI NYARURAMBI 763 255 NYAMAGABE Musebeya MUSEBEYA NYARURAMBI RWABIGEYO 370 256 NYAMAGABE Musebeya MUSEBEYA RUGANO BUGARAMA 837 257 NYAMAGABE Musebeya MUSEBEYA RUGANO Busanza 757 258 NYAMAGABE Musebeya MUSEBEYA RUGANO GISIZA 462 259 NYAMAGABE Musebeya MUSEBEYA RUGANO KIBANDIRWA 409 260 NYAMAGABE Musebeya MUSEBEYA RUGANO RUGANO 654 261 NYAMAGABE Musebeya MUSEBEYA RUGANO RUKUNGU 336 262 NYAMAGABE Musebeya MUSEBEYA RUNEGE BIGUGU 489 263 NYAMAGABE Musebeya MUSEBEYA RUNEGE BITABA 743 264 NYAMAGABE Musebeya MUSEBEYA RUNEGE GACUNDURA 501 265 NYAMAGABE Musebeya MUSEBEYA RUNEGE GAKEREKO 613 266 NYAMAGABE Musebeya MUSEBEYA RUNEGE NDOGONDWE 669 267 NYAMAGABE Musebeya MUSEBEYA RUNEGE RUGANZA 525 268 NYAMAGABE Musebeya MUSEBEYA RUNEGE RUKARANKA 697 269 NYAMAGABE Musebeya MUSEBEYA RUSEKERA KARAMBO 570 270 NYAMAGABE Musebeya MUSEBEYA RUSEKERA NGOMA 347 271 NYAMAGABE Musebeya MUSEBEYA RUSEKERA REBERO 506 Appendix: Original Protocol from April 2012 with minor updates A94 272 NYAMAGABE Musebeya MUSEBEYA RUSEKERA SHAKI 703 273 NYAMAGABE Musebeya MUSEBEYA RUSEKERA UWIMITUZA 384 274 NYAMAGABE Musebeya MUSEBEYA SEKERA MASINDE 373 275 NYAMAGABE Musebeya MUSEBEYA SEKERA MUGANO 462 276 NYAMAGABE Musebeya MUSEBEYA SEKERA Nkomero 1027 277 NYAMAGABE Musebeya MUSEBEYA SEKERA NYARUHURA 458 278 NYAMAGABE Musebeya MUSEBEYA SEKERA RUBUMBURI 563 279 NYAMAGABE Musebeya MUSEBEYA SEKERA RUGAZI 582 159,195 Annex H: Baseline Characteristics of Study Arms Characteristics Intervention Area Comparison Area A. Demographic Population Population of <5 year olds Number of Homes Sex ratio Birth rate Infant Mortality Rate Under Five Mortality Rate Number of Persons Living with HIV/AIDS B. Health Services Number of hospitals Number of health centers Number of CHWs C. Socioeconomic Literacy Rate (M/F) Very poor Poor Averagely well to do Rich Very rich Appendix: Original Protocol from April 2012 with minor updates A95 Appendix: Original Protocol from April 2012 with minor updates A96 Annex I.Standard KPC Survey Methodology The 30-cluster KPC survey is an industry standard for USAID child survival projects measuring the knowledge, practices and coverage of the common child survival indicators in a population. The project has already noted in the Evaluative Research section above how sampling will be adjusted to meet both the needs of the standard KPC to measure project objectives and to collect data for the operations research. The most notable adjustment, described above, is that of increasing the total number of interviews in each cluster to 12, with 3 from children 0-5 months and 9 from children 6-23 months, in order to achieve minimum samples by age group of 75 and 265, respectively. This will be followed in both arms of the study, for a sample size of 360 per arm. The 30-cluster KPC Survey Methodology The 30-cluster KPC survey is an industry standard for measuring the knowledge, practices and coverage of common child survival indicators in a population as compared to the project’s targets. The survey will be pre-tested in two villages from within the project area that are not going to be randomly selected to be a part of the sample. These villages are culturally, economically, and geographically similar to the rest of the project area. Survey staff will conduct 2 interviews each and then came back to discuss any problems with asking questions or coding responses; the survey instrument will be then adapted based on their experiences and the discussion. The questionnaire contains 99 questions that cover the topics listed in table 10. Sampling Design for the 30-cluster KPC Surveys Two stage random sampling will be used for the KPC surveys completed in each district. The survey team will use a standard 30-cluster sampling methodology with 10 households per cluster. The populations of all villages for both Hospital catchment areas has been listed by the District; 30 villages were randomly selected and then 10 households from each village will be randomly selected to participate in the survey. The total sample of 300 is large enough to provide adequate denominators for calculating indicators for subgroups (such as sick children or children within a particular age group). Children surveyed will also be weighed and measured, and, although this sample size (300 households) is not enough to measure a reduction in stunting, we will be able to weigh and measure children as part of the program’s regular monitoring activities, and we will measure proxy indicators for stunting (such as feeding quality and quantity). Sample Size Calculation for the 30-cluster KPC survey Sample size was calculated using the following formula: n=z2 (pq)d2 Where n = sample size; z = statistical certainty chosen; p = estimated prevalence/coverage rate; q = 1 - p; and d = degree of precision. Appendix: Original Protocol from April 2012 with minor updates A97 The p value was defined by the coverage rate that requires the largest sample size (p = 0.5). The margin of error or d value was set at 0.1. The statistical certainty chosen was 95% (z = 1.96). The resulting sample size needed (n) was determined to be: n = (1.96 X 1.96) (.5 X .5) / (.1 X .1) n = (3.84) (.25) /.01 n = 96 In order to compensate for bias which enters the survey from interviewing persons in clusters (rather than randomly selecting 96 persons), the sample size of 96 should be doubled. However, experience has shown that a minimum sample of 210 (7 per cluster) should be used with the given values of p, d and z. To further eliminate bias and to take into account possible non-respondents, the sample size of 300 was chosen (10 per cluster). Confidence limits will be calculated using the following formula, assuming a conservative design effect of 2: P = p + z √(pq/n′), where n′ = the effective sample size of the sample or sub sample. Effective Sample Size (n′) = n/e, where: n = size of survey sample or sub-sample e = design effect. The design effect is a value corresponding to how much the cluster survey departs from the assumptions of a simple random sample. The design effect is used to correct the value of n used to calculate the confidence limit of a cluster survey. Household Selection for the 30-cluster KPC Surveys The starting point for each cluster will be determined in the following manner: the survey team will ask village leaders to identify the center of the village. From that central point, a random direction will be selected by spinning a bottle. Surveyors then will walk in a straight line in the randomly chosen direction until they will reach a house with a child under 24 months, which became the first mother interviewed. The second and subsequent households will be selected by continuing in the same direction in a straight line, until a second house with a child under 24 months, then a third house, and so forth. In each cluster, 10 mothers will be interviewed. In cases where the mother is not available at the time the interviewer arrived at the home, the interviewer will return to the same house later in the day. If the mother will still not available by the end of the day, then the house is skipped. In the case where there will be two children under 24 months, the child will be randomlyselected. In the case of twins, the second born of the two will be selected. Mothers will be interviewed alone unless the husband will object in which case he will be allowed to be present as well. Appendix: Original Protocol from April 2012 with minor updates A98 Interviewer Recruitment for the 30-cluster KPC surveys The approximately 30 interviewers will be HC staff in charge of community health activities, Sector staff in charge of social affairs, and WR Rwanda CSP staff. All surveyors will match the CSP job qualifications and have completed secondary school as well as some level of higher technical education. The interviewers will be between 20 and 40 years of age. All interviewers will be fluent in the local language. The surveyors will come from a wide range of professional backgrounds; some surveyors may even be experienced nurses with experience working in the community. Interviewer and Supervisor Training for the 30-cluster KPC surveys The WRR staff and some HC Community Health Supervisors were already trained from EIP and got refresher training in Year one on how to conduct a KPC survey, and Melene Kabadege, WR Regional Technical Advisor, will be overseeing the survey. WRR will hold refresher training for the Interviewers, covering the objectives of the KPC survey, the process and rationale of 30 cluster methodology, basic survey interview techniques and an in-depth review of the survey content. In pairs, surveyors will practice reading the questionnaire and coding responses accurately. In addition, supervisors will receive training on how to monitor interviewers and check for accurate coding on survey questionnaires. Pre-testing of the questionnaire will take place in neighboring village, and will provide interviewers with an additional opportunity to practice conducting the survey and coding responses on the survey form. It also allows the supervisors to practice using the supervisor forms, to take note of potential problems that may be encountered in the field, and to strategize ways to overcome the identified challenges. An additional half day of training will be conducted after pre-testing to review the revised questionnaire form and to discuss problems that were observed in the field or in the coding of the questionnaires. Data Collection and Analysis for the 30-cluster KPC surveys Interviews required approximately 40 minutes per household to complete. A minimum of ten days will be needed to complete all the data collection for 600 households. (See the Timeline in annex H.) The five supervisors will review each completed KPC survey in the field before leaving the village in which data had been collected, in order to ensure the completeness and accuracy of the survey forms. In the event of missed data, interviewers will return to the households to gather the necessary information. The data entry and analysis team consists of the WR Rwanda, WR Home Office technical unit staff (CSP Specialists) and students from Inatek. Basic statistical analyses, primarily frequencies and ranges, will be conducted to identify any inconsistencies, so that the data could be cleaned accordingly. The Rapid Catch 2008 indicators and other project indicators will be then calculated. Appendix: Original Protocol from April 2012 with minor updates A99 Annex J: Letters of Support Appendix: Original Protocol from April 2012 with minor updates A100 Appendix: Original Protocol from April 2012 with minor updates A101 Annex K: Changes to 2013 & 2014 versions of Protocol 2013 Cover page • Addition of UBC logo • Repositioning of logos • Notation of revision Acronyms and Abbreviations(Protocol, p. 5) • Removal of ICG – “Integrated Care Group” in favor of “modified Care Groups” so as not to confuse with alternate use of the term “integrated care group” being used in Burundi by another organization. Contact Persons • Updated World Relief Home Office contacts in Baltimore, MD, USA (Protocol, p.7) o Removed Melanie Morrow, Monisha Jayakumar and Olga Wollinka, who are not currently employed by World Relief Synopsis(Protocol, p.8) • Frequency of Nutrition Weeks increased from twice to thrice per year, per recommendation of Nutrition Working Group (Protocol p.8 and elsewhere) • Reference to 33-cluster surveys corrected to 30-cluster (Protocol p. 8 and elsewhere) Overall Project Strategy (Protocol, p.13) • Changed term from “Integrated Care Groups” to “modified Care Groups” (Protocol, p.13) Formative Research • Table 4: Market Survey Findings (Protocol, p. 21): Combined headings for fat and carbohydrate into one column labeled “energy”. • Exit interviews with mother participants in Nutrition Weeks (Protocol. 25); timing of follow up interview changed from four weeks post-intervention to “at least” four weeks post intervention. • Please see below for additional qualitative methods that will be used to assess implementation and continue to shape design of the Nutrition Weeks and other interventions. Evaluation Methods – KPC Sampling (Protocol p. 29-30) • For monitoring surveys in years two and three, the sample was adjusted to two, 30x10 cluster samples in each arm (from 30 x 12 used at baseline), without parallel sampling. This was deemed sufficient for monitoring purposes and a better use of limited resources. Appendix: Original Protocol from April 2012 with minor updates A102 Logistics (Protocol, p.33) • Table 7. Roles and Responsibilities (Protocol, p.33): updated to reflect changing individuals and responsibilities. Changes highlighted in yellow (2013) and green (2014). • Table 4: FY 2,3 and 4 Timeline as of Year 1.(Protocol, p. 36) o Please see addendum for a more detailed, updated table for May-December 2013 • Budget (Protocol, p. 37) o Please see addendum for the Year 2 Budget. Annex A: CVs for Principal Investigators and Co-Investigators (Protocol, p. 38) o CVs for Principal Investigators Dr. Judy McLean and Dr. Fidele Ngabo, and for Co￾Investigator Ms. Melene Kabadege were already included in Annex A. o Please see addendum for the CV for Co-Investigator Ms. Alphonsine Nyirahabineza Annex B. Project Indicators Table • Table 5: Proposed Project and OR Indicators to be measured by KPC Surveys (p.45) Pleasesee below for a revised indicator table that re-orders the indicators, adds an additional process indicator related to home visits, and shifts timing of measurement of some indicators from Y2 to Y3. Annex E. KPC Survey Draft Questionnaire • The KPC Survey Draft Questionnaire included in the original protocol (p.60) was for the baseline survey. For monitoring purposes in Year 2, an abridged version of the survey will be used that focuses on the operations research indicators (nutrition and control of diarrheal disease). • The Year 2 KPC Monitoring Survey is included with the additions below; it will use the same consent form that was already approved for the baseline KPC in Year 1 (p.59) Annex I. Standard KPC Survey Methodology(Protocol, p. 117) • The KPC Monitoring Survey will largely follow the “standard” KPC 30 clusters x 10 households methodology as described in the original Annex I. Minor changes include the following: o In households with more than one child 0-23 months-old, instead of systematically selecting the younger child (to favor data collection on exclusive breastfeeding), the child to be included will be randomly selected by flipping a coin or drawing straws (in the rare event of three children 0-23 months). o The number of interviewers (Protocol, p. 118) will be 32 o The anticipated time for completing the questionnaire (Protocol, p. 119) will be 40 minutes. Additional data collection plans and instruments are included as an amendment to this protocol, including the draft year two monitoring survey. Appendix: Original Protocol from April 2012 with minor updates A103 2014 1. Contact Persons: Updated World Relief Home Office contacts in Baltimore, MD, USA. Removed Melanie Morrow, who is not currently employed by World Relief, and added Rachel Hower, Health Advisor at World Relief Home Office in Baltimore. 2. Roles and Responsibilities: updated to reflect changing individuals and responsibilities. Changes made in 2014 highlighted in green. Rwanda ICSP Final Evaluation Report September 2015 Page 823 ANNEX XIV. STAKEHOLDER DEBRIEF POWERPOINT PRESENTATION Rwanda ICSP Final Evaluation Report September 2015 Page 824 Rwanda ICSP Final Evaluation Report September 2015 Page 825 Rwanda ICSP Final Evaluation Report September 2015 Page 826 Rwanda ICSP Final Evaluation Report September 2015 Page 827 Rwanda ICSP Final Evaluation Report September 2015 Page 828 Rwanda ICSP Final Evaluation Report September 2015 Page 829 Rwanda ICSP Final Evaluation Report September 2015 Page 830 Rwanda ICSP Final Evaluation Report September 2015 Page 831 Rwanda ICSP Final Evaluation Report September 2015 Page 832 Rwanda ICSP Final Evaluation Report September 2015 Page 833 Rwanda ICSP Final Evaluation Report September 2015 Page 834 ANNEX XV. PROJECT DATA FORM Child Survival and Health Grants Program Project Summary Feb-03-2016 World Relief Corporation (Rwanda) General Project Information Cooperative Agreement Number: AID-OAA-A-11-00056 WRC Headquarters Technical Backstop: Melanie Morrow WRC Headquarters Technical Backstop Backup: Rachel Hower Field Program Manager: Carmen Umutoni Midterm Evaluator: Final Evaluator: Headquarter Financial Contact: Rachel Hower Project Dates: 10/1/2011 - 9/30/2015 (FY2011) Project Type: Innovation USAID Mission Contact: Patrick M. Condo Project Web Site: Field Program Manager Name: Carmen Umutoni Address: Rwanda Phone: Rwanda ICSP Final Evaluation Report September 2015 Page 835 Fax: E-mail: cumutoni@wr.org Skype Name: Alternate Field Contact Name: Melene Kabadege (MCH Regional Technical Advisor) Address: Box 6052 Kigali Rwanda Phone: 250.(0)78.830.6586 Fax: E-mail: mkabadege@wr.org Skype Name: melene571 Grant Funding Information USAID Funding: $1,750,000 PVO Match: $583,333 General Project Description World Relief is implementing a child survival project in Nyamagabe District, Rwanda. The project goal is to reduce morbidity, mortality and underlying malnutrition of children under five and pregnant women. Project resources will build the capacity of Minitry of Health (MOH) staff to train and supervise government-sanctioned community health workers (CHWs) in the implementation of their community-based packages. Integration of interventions at community level and local problem solving will be enhanced by forming the CHWs into Modified Care Groups with additional members drawn from local and religious leaders and members of the Hygiene Club executive committees. CHWs will retain their specialized responsibilities, as defined by the MOH, yet they will work together with the additional CG members to more effectively mobilize the communities for behavior change and appropriate care seeking by dividing up the village geographically amongst themselves to facilitate more regular home visits. Rwanda ICSP Final Evaluation Report September 2015 Page 836 The project’s Strategic Objective is “improved capacity of MOH staff and CHWs to implement high impact maternal, newborn and child health interventions at the community level.” The project’s intermediate results are: IR 1) Improved geographic access to and demand for high quality MNCH services; IR 2) Improved coordination of and impact of community health activities; and IR 3) Innovation tested to improve the effectiveness of the Community Based Nutrition Program. Project Location Latitude: -2.45 Longitude: 29.26 Project Location Types: Rural Levels of Intervention: Health Center Health Post Level Home Community District Hospital Other: National MOH Province(s): Southern Province District(s): Nyamagabe District Sub-District(s): Kaduha Hospital Catchment area Kigeme Hospital Catchment area Operations Research Information OR Project Title: Nutrition Weeks addition to Rwanda MOH CBNP Program for malnutrition prevention in first 1000 days. Cost of OR Activities: $175,917 Rwanda ICSP Final Evaluation Report September 2015 Page 837 Research Partner(s): PI Dr. Judy McLean, PhD, Assistant Professor, Univ of British Columbia, Vancouver; Co-PI:Dr. Fidele Ngabo, MD, MSc, PhD Candidate, Director of MCH Unit; Co-Investigator and author of Nutrition Weeks: Melene Kabadeghe, WR Regional Technical Advisor;Co-I: Alphonsine Nyirahabineza, MOH Nutrition Head OR Project Description: Given the high prevalence of undernutrition and stunting in Rwanda, this operational research study aims toidentify the most feasible way to reduce and prevent undernutrition in the first 1000 days of life of children in Nyamagabe District, Rwanda through formative research, and then to test the innovated intervention, namely,“Nutrition Weeks” to evaluate if the intervention is more effective than the standard Community-based Nutrition Program which uses education and cooking demonstrations. "Nutrition Weeks" are a hybrid of PD/Hearth and Care Groups, with a focus on preventing malnutrition through three-times per year Hearth￾like community-based learning sessions led by trained (CHWs), and supervised by MOH and WR. The assessment will include an evaluation of the effects through anthropometry and KPCs, CHW interviews to assess additional cost, effort and time involved, changes in health practices and child growth outcomes through maternal exit interviews, and feasibility of scale-up. Partners Ministry of Health (Collaborating Partner) $0 District of Nyamagabe (Collaborating Partner) $0 Strategies Social and Behavioral Change Strategies: Community Mobilization Group interventions Interpersonal Communication Rwanda ICSP Final Evaluation Report September 2015 Page 838 Health Services Access Strategies: Addressing social barriers (i.e. gender, socio-cultural, etc) Community-based health insurance scheme/Community financing mechanisms Implementation with a sub-population that the government has identified as poor and underserved Implementation in a geographic area that the government has identified as poor and underserved Health Systems Strengthening: Quality Assurance Conducting capacity assessment of local partners Supportive Supervision Task Shifting Developing/Helping to develop clinical protocols, procedures, case management guidelines Developing/Helping to develop job aids Referral-counterreferral system development for CHWs Community role in supervision of CHWs Community role in recruitment of CHWs Coordinating existing HMIS with community level data Performance-based incentives or contracts for health facility workers Strategies for Enabling Environment: Create/Update national guidelines/protocols Advocacy for revisions to national guidelines/protocols Stakeholder engagement and policy dialogue (local/state or national) Advocacy for policy change or resource mobilization Building capacity of communities/CBOs to advocate to leaders for health Tools/Methodologies: Community-based Monitoring of Vital Events Mobile Devices for Data Collection Capacity Building Local Partners: National Ministry of Health (MOH) Dist. Health System Health Facility Staff Government sanctioned CHWs Faith-Based Organizations (FBOs) Rwanda ICSP Final Evaluation Report September 2015 Page 839 Interventions & Components Control of Diarrheal Diseases (15%) - Water/Sanitation - Hand Washing - ORS/Home Fluids - Feeding/Breastfeeding - Care Seeking - Case Management/Counseling - POU Treatment of water - Zinc - Community Case Management with Zinc (Implementation) - Community Case Management with ORS (Implementation) IMCI Integration CHW Training HF Training Infant & Young Child Feeding - ENA - Gardens - Comp. Feed. from 6 mos. - Cont. BF up to 24 mos. - Growth Monitoring - Maternal Nutrition - Promote Excl. BF to 6 Months IMCI Integration CHW Training HF Training Maternal & Newborn Care (35%) - Recognition of Danger signs - Newborn Care - Post partum Care - Child Spacing - Integation. with Iron & Folic Acid - Normal Delivery Care - Birth Plans - Emergency Transport IMCI Integration CHW Training HF Training Pneumonia Case Management (10%) - Case Management Counseling - Recognition of Pneumonia Danger Signs - Community Case Management with Antibiotics (Implementation) IMCI Integration CHW Training HF Training Operational Plan Indicators Number of People Trained in Maternal/Newborn Health Rwanda ICSP Final Evaluation Report September 2015 Page 840 Gender Year Target Actual Female 2012 1608 Female 2012 554 Male 2012 10 Male 2012 1608 Female 2013 2144 Female 2013 2740 Male 2013 2374 Male 2013 1608 Female 2015 2740 Female 2015 2740 Male 2015 2374 Male 2015 2374 Number of People Trained in Child Health & Nutrition Gender Year Target Actual Female 2012 1608 Female 2012 2500 Male 2012 2832 Male 2012 1608 Female 2013 1608 Female 2013 2740 Rwanda ICSP Final Evaluation Report September 2015 Page 841 Male 2013 2374 Male 2013 1608 Female 2015 2740 Female 2015 2740 Male 2015 2374 Male 2015 2374 Number of People Trained in Malaria Treatment or Prevention Gender Year Target Actual Female 2012 0 Female 2012 0 Male 2012 0 Male 2012 0 Female 2013 0 Female 2013 0 Male 2013 0 Male 2013 0 Female 2015 0 Female 2015 0 Male 2015 0 Male 2015 0 Rwanda ICSP Final Evaluation Report September 2015 Page 842 Locations & Sub-Areas Kaduha Hopsital catchment area of Nyamagabe District 159,195 Kigeme Hospital Catchment area of Nyamagabe District 166,581 Total Population: 325,776 Target Beneficiaries Kaduha Hopsital catchment area of Nyamagabe District Kigeme Hospital Catchment area of Nyamagabe District Total Children 0-59 months 20,218 21,096 41,314 Women 15-49 years 54,531 56,900 111,431 Beneficiaries Total 74,749 77,996 152,745 Rapid Catch Indicators: DIP Submission Sample Type: 30 Cluster Antenatal Care Description -- Percentage of mothers of children age 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child Numerator: Enter the number of mothers with children age 0-23 months who had at least four antenatal visits while pregnant with their youngest child Denominator: Enter the total number of mothers of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 163 358 45.5% 7.3 Kigeme Hospital Catchment area of Nyamagabe District 176 360 48.9% 7.3 Rwanda ICSP Final Evaluation Report September 2015 Page 843 Maternal TT Vaccination Description -- Percentage of mothers with children age 0-23 months who received at least two Tetanus toxoid vaccinations before the birth of their youngest child Numerator: Enter the number of mothers with children age 0-23 months who received at least two tetanus toxoid vaccinations before the birth of their youngest child Denominator: Enter the total number of mothers of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 245 358 68.4% 6.8 Kigeme Hospital Catchment area of Nyamagabe District 246 360 68.3% 6.8 Skilled Birth Attendant Description -- Percentage of children age 0-23 months whose births were attended by skilled personnel Numerator: Enter the number of children age 0-23 months whose birth was attended by a doctor, nurse, midwife, auxiliary midwife, or other personnel with midwifery skills Denominator: Enter the total number of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 297 358 83.0% 5.5 Kigeme Hospital Catchment area of Nyamagabe District 330 360 91.7% 4.0 Current Contraceptive Use Among Mothers of Young Children Rwanda ICSP Final Evaluation Report September 2015 Page 844 Description -- Percentage of mothers of children age 0-23 months who are using a modern contraceptive method Numerator: Enter the number of mothers with children age 0-23 months who are using a modern contraceptive method Denominator: Enter the total number of mothers of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 205 358 57.3% 7.2 Kigeme Hospital Catchment area of Nyamagabe District 225 360 62.5% 7.1 Post-Natal Visit to Check on Newborn Within the First 2 Days After Birth Description -- Percentage of children age 0-23 months who received a post-natal visit from an appropriately trained health worker within two days after birth Numerator: Enter the number of children age 0-23 months who received a post-natal visit within two days after birth by an appropriate health worker Denominator: Enter the total number of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 135 358 37.7% 7.1 Kigeme Hospital Catchment area of Nyamagabe District 159 360 44.2% 7.3 Exclusive Breastfeeding Description -- Percentage of children age 0-5 months who were exclusively breastfed during the last 24 hours Numerator: Enter the number of children age 0-5 months who drank breast milk in the previous 24 Rwanda ICSP Final Evaluation Report September 2015 Page 845 hours AND did not drink any other liquids in the previous 24 hours AND was not given any other foods or liquids in the previous 24 hours Denominator: Enter the total number of children age 0-5 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 82 90 91.1% 8.3 Kigeme Hospital Catchment area of Nyamagabe District 89 90 98.9% 3.1 Infant and Young Child Feeding Description -- Percentage of infants and young children age 6-23 months fed according to a minimum of appropriate feeding practices Numerator: Enter the number infants and young children age 6-23 months fed according to a minimum of appropriate feeding practices Denominator: Enter the total number of children age 6-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 8 270 3.0% 2.9 Kigeme Hospital Catchment area of Nyamagabe District 9 270 3.3% 3.0 Vitamin A Supplementation in the Last 6 Months Description -- Percentage of children age 6-23 months who received a dose of Vitamin A in the last 6 months: card verified or mother’s recall Numerator: Enter the number of children age 6-23 months who received a dose of Vitamin A in the last 6 months (mother’s recall or card verified) Rwanda ICSP Final Evaluation Report September 2015 Page 846 Denominator: Enter the total number of children age 6-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 190 270 70.4% 7.7 Kigeme Hospital Catchment area of Nyamagabe District 208 270 77.0% 7.1 Measles Vaccination Description -- Percentage of children age 12-23 months who received a measles vaccination Numerator: Enter the number of children age 12-23 months who received a measles vaccination by the time of the interview as seen on the card or recalled by the mother Denominator: Enter the total number of children age 12-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 139 159 87.4% 7.3 Kigeme Hospital Catchment area of Nyamagabe District 121 145 83.4% 8.6 Access to Immunization Services Description -- Percentage of children age 12-23 months who received DTP1 according to the vaccination card or mother’s recall by the time of the survey Numerator: Enter the number of children age 12-23 months who received a DTP1 at the time of the survey according to the vaccination card/child health booklet or mother’s recall Denominator: Enter the total number of children age 12-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Rwanda ICSP Final Evaluation Report September 2015 Page 847 Kaduha Hopsital catchment area of Nyamagabe District 142 159 89.3% 6.8 Kigeme Hospital Catchment area of Nyamagabe District 126 145 86.9% 7.8 Health System Performance Regarding Immunization Services Description -- Percentage of children age 12-23 months who received DTP3 according to the vaccination card or mother’s recall by the time of the survey Numerator: Enter the number of children age 12-23 months who received DTP3 at the time of the survey according to the vaccination card/child health booklet or mother’s recall Denominator: Enter the total number of children age 12-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 134 159 84.3% 8.0 Kigeme Hospital Catchment area of Nyamagabe District 122 145 84.1% 8.4 Treatment of Fever in Malarious Zones Description -- 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 Numerator: Enter the number of children age 0-23 months with a febrile episode in the last two weeks AND whose mother/caretaker sought treatment for the child within 24 hours AND who were treated with an appropriate anti-malarial drug Denominator: Enter the total number of children age 0-23 months with a febrile episode in the last two weeks Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment 11 75 14.7% 11.3 Rwanda ICSP Final Evaluation Report September 2015 Page 848 area of Nyamagabe District Kigeme Hospital Catchment area of Nyamagabe District 1 86 1.2% 3.2 ORT Use Description -- 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 Numerator: Enter the number of children age 0-23 months with diarrhea in the last two weeks AND who received oral rehydration solution (ORS) and/or recommended home fluids Denominator: Enter the total number of children age 0-23 months who had diarrhea in the last two weeks Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 15 65 23.1% 14.5 Kigeme Hospital Catchment area of Nyamagabe District 16 70 22.9% 13.9 Appropriate Care Seeking for Pneumonia Description -- Percentage of children age 0-23 months with chest-related cough and fast and/or difficult breathing in the last two weeks who were taken to an appropriate health provider Numerator: Enter the number of children age 0-23 months with chest-related cough and fast and/or difficult breathing in the last two weeks who were taken to an appropriate health provider Denominator: Enter the total number of children with chest-related cough and fast and /or difficult breathing in the last two weeks Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 38 86 44.2% 14.8 Rwanda ICSP Final Evaluation Report September 2015 Page 849 Kigeme Hospital Catchment area of Nyamagabe District 51 113 45.1% 13.0 Point of Use (POU) Description -- Percentage of households of children age 0-23 months that treat water effectively Numerator: Enter the number of households of mothers of children 0-23 months that treat water effectively Denominator: Enter the total number of households of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 180 360 50.0% 7.3 Kigeme Hospital Catchment area of Nyamagabe District 203 360 56.4% 7.2 Appropriate Hand Washing Practices Description -- Percentage of mothers of children age 0-23 months who live in households with soap at the place for hand washing Numerator: Enter the number of mothers with children age 0-23 months who live in households with soap at the place for hand washing Denominator: Enter the total number of mothers of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 139 360 38.6% 7.1 Kigeme Hospital Catchment area of Nyamagabe District 158 360 43.9% 7.2 Rwanda ICSP Final Evaluation Report September 2015 Page 850 Child Sleeps Under an Insecticide-Treated Bednet Description -- Percentage of children age 0-23 months who slept under an insecticide-treated bednet (in malaria risk areas, where bednet use is effective) the previous night Numerator: Enter the number of children age 0-23 months who slept under an insecticide-treated bednet the previous night Denominator: Enter the total number of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 241 360 66.9% 6.9 Kigeme Hospital Catchment area of Nyamagabe District 241 360 66.9% 6.9 Underweight Description -- Percentage of children 0-23 months who are underweight (-2 SD for the median weight for age, according to the WHO/NCHS reference population) Numerator: Enter the number of children 0-23 months with weight/age -2 SD for the median weight for age, according to the WHO/NCHS reference population Denominator: Enter the total number of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 64 359 17.8% 5.6 Kigeme Hospital Catchment area of Nyamagabe District 32 359 8.9% 4.2 Rapid Catch Indicators: Mid-term Sample Type: 30 Cluster Rwanda ICSP Final Evaluation Report September 2015 Page 851 Antenatal Care Description -- Percentage of mothers of children age 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child Numerator: Enter the number of mothers with children age 0-23 months who had at least four antenatal visits while pregnant with their youngest child Denominator: Enter the total number of mothers of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District % Kigeme Hospital Catchment area of Nyamagabe District % Maternal TT Vaccination Description -- Percentage of mothers with children age 0-23 months who received at least two Tetanus toxoid vaccinations before the birth of their youngest child Numerator: Enter the number of mothers with children age 0-23 months who received at least two tetanus toxoid vaccinations before the birth of their youngest child Denominator: Enter the total number of mothers of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District % Kigeme Hospital Catchment area of Nyamagabe District % Skilled Birth Attendant Description -- Percentage of children age 0-23 months whose births were attended by skilled personnel Rwanda ICSP Final Evaluation Report September 2015 Page 852 Numerator: Enter the number of children age 0-23 months whose birth was attended by a doctor, nurse, midwife, auxiliary midwife, or other personnel with midwifery skills Denominator: Enter the total number of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District % Kigeme Hospital Catchment area of Nyamagabe District % Current Contraceptive Use Among Mothers of Young Children Description -- Percentage of mothers of children age 0-23 months who are using a modern contraceptive method Numerator: Enter the number of mothers with children age 0-23 months who are using a modern contraceptive method Denominator: Enter the total number of mothers of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District % Kigeme Hospital Catchment area of Nyamagabe District % Post-Natal Visit to Check on Newborn Within the First 2 Days After Birth Description -- Percentage of children age 0-23 months who received a post-natal visit from an appropriately trained health worker within two days after birth Numerator: Enter the number of children age 0-23 months who received a post-natal visit within two days after birth by an appropriate health worker Rwanda ICSP Final Evaluation Report September 2015 Page 853 Denominator: Enter the total number of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District % Kigeme Hospital Catchment area of Nyamagabe District % Exclusive Breastfeeding Description -- Percentage of children age 0-5 months who were exclusively breastfed during the last 24 hours Numerator: Enter the number of children age 0-5 months who drank breast milk in the previous 24 hours AND did not drink any other liquids in the previous 24 hours AND was not given any other foods or liquids in the previous 24 hours Denominator: Enter the total number of children age 0-5 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 78 84 92.9% 7.8 Kigeme Hospital Catchment area of Nyamagabe District 66 70 94.3% 7.7 Infant and Young Child Feeding Description -- Percentage of infants and young children age 6-23 months fed according to a minimum of appropriate feeding practices Numerator: Enter the number infants and young children age 6-23 months fed according to a minimum of appropriate feeding practices Denominator: Enter the total number of children age 6-23 months in the survey Rwanda ICSP Final Evaluation Report September 2015 Page 854 Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 73 189 38.6% 9.8 Kigeme Hospital Catchment area of Nyamagabe District 51 208 24.5% 8.3 Vitamin A Supplementation in the Last 6 Months Description -- Percentage of children age 6-23 months who received a dose of Vitamin A in the last 6 months: card verified or mother’s recall Numerator: Enter the number of children age 6-23 months who received a dose of Vitamin A in the last 6 months (mother’s recall or card verified) Denominator: Enter the total number of children age 6-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District % Kigeme Hospital Catchment area of Nyamagabe District % Measles Vaccination Description -- Percentage of children age 12-23 months who received a measles vaccination Numerator: Enter the number of children age 12-23 months who received a measles vaccination by the time of the interview as seen on the card or recalled by the mother Denominator: Enter the total number of children age 12-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment % Rwanda ICSP Final Evaluation Report September 2015 Page 855 area of Nyamagabe District Kigeme Hospital Catchment area of Nyamagabe District % Access to Immunization Services Description -- Percentage of children age 12-23 months who received DTP1 according to the vaccination card or mother’s recall by the time of the survey Numerator: Enter the number of children age 12-23 months who received a DTP1 at the time of the survey according to the vaccination card/child health booklet or mother’s recall Denominator: Enter the total number of children age 12-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District % Kigeme Hospital Catchment area of Nyamagabe District % Health System Performance Regarding Immunization Services Description -- Percentage of children age 12-23 months who received DTP3 according to the vaccination card or mother’s recall by the time of the survey Numerator: Enter the number of children age 12-23 months who received DTP3 at the time of the survey according to the vaccination card/child health booklet or mother’s recall Denominator: Enter the total number of children age 12-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District % Kigeme Hospital Catchment % Rwanda ICSP Final Evaluation Report September 2015 Page 856 area of Nyamagabe District Treatment of Fever in Malarious Zones Description -- 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 Numerator: Enter the number of children age 0-23 months with a febrile episode in the last two weeks AND whose mother/caretaker sought treatment for the child within 24 hours AND who were treated with an appropriate anti-malarial drug Denominator: Enter the total number of children age 0-23 months with a febrile episode in the last two weeks Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District % Kigeme Hospital Catchment area of Nyamagabe District % ORT Use Description -- 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 Numerator: Enter the number of children age 0-23 months with diarrhea in the last two weeks AND who received oral rehydration solution (ORS) and/or recommended home fluids Denominator: Enter the total number of children age 0-23 months who had diarrhea in the last two weeks Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District % Kigeme Hospital Catchment % Rwanda ICSP Final Evaluation Report September 2015 Page 857 area of Nyamagabe District Appropriate Care Seeking for Pneumonia Description -- Percentage of children age 0-23 months with chest-related cough and fast and/or difficult breathing in the last two weeks who were taken to an appropriate health provider Numerator: Enter the number of children age 0-23 months with chest-related cough and fast and/or difficult breathing in the last two weeks who were taken to an appropriate health provider Denominator: Enter the total number of children with chest-related cough and fast and /or difficult breathing in the last two weeks Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District % Kigeme Hospital Catchment area of Nyamagabe District % Point of Use (POU) Description -- Percentage of households of children age 0-23 months that treat water effectively Numerator: Enter the number of households of mothers of children 0-23 months that treat water effectively Denominator: Enter the total number of households of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 227 300 75.7% 6.9 Kigeme Hospital Catchment area of Nyamagabe District 171 300 57.0% 7.9 Rwanda ICSP Final Evaluation Report September 2015 Page 858 Appropriate Hand Washing Practices Description -- Percentage of mothers of children age 0-23 months who live in households with soap at the place for hand washing Numerator: Enter the number of mothers with children age 0-23 months who live in households with soap at the place for hand washing Denominator: Enter the total number of mothers of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 221 300 73.7% 7.0 Kigeme Hospital Catchment area of Nyamagabe District 219 300 73.0% 7.1 Child Sleeps Under an Insecticide-Treated Bednet Description -- Percentage of children age 0-23 months who slept under an insecticide-treated bednet (in malaria risk areas, where bednet use is effective) the previous night Numerator: Enter the number of children age 0-23 months who slept under an insecticide-treated bednet the previous night Denominator: Enter the total number of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District % Kigeme Hospital Catchment area of Nyamagabe District % Underweight Description -- Percentage of children 0-23 months who are underweight (-2 SD for the median weight for age, according to the WHO/NCHS reference population) Rwanda ICSP Final Evaluation Report September 2015 Page 859 Numerator: Enter the number of children 0-23 months with weight/age -2 SD for the median weight for age, according to the WHO/NCHS reference population Denominator: Enter the total number of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 20 185 10.8% 6.3 Kigeme Hospital Catchment area of Nyamagabe District 33 188 17.6% 7.7 Rapid Catch Indicators: Final Evaluation Sample Type: 30 Cluster Antenatal Care Description -- Percentage of mothers of children age 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child Numerator: Enter the number of mothers with children age 0-23 months who had at least four antenatal visits while pregnant with their youngest child Denominator: Enter the total number of mothers of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 212 357 59.4% 7.2 Kigeme Hospital Catchment area of Nyamagabe District 217 360 60.3% 7.1 Maternal TT Vaccination Description -- Percentage of mothers with children age 0-23 months who received at least two Tetanus toxoid vaccinations before the birth of their youngest child Rwanda ICSP Final Evaluation Report September 2015 Page 860 Numerator: Enter the number of mothers with children age 0-23 months who received at least two tetanus toxoid vaccinations before the birth of their youngest child Denominator: Enter the total number of mothers of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 276 357 77.3% 6.1 Kigeme Hospital Catchment area of Nyamagabe District 288 360 80.0% 5.8 Skilled Birth Attendant Description -- Percentage of children age 0-23 months whose births were attended by skilled personnel Numerator: Enter the number of children age 0-23 months whose birth was attended by a doctor, nurse, midwife, auxiliary midwife, or other personnel with midwifery skills Denominator: Enter the total number of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 332 357 93.0% 3.7 Kigeme Hospital Catchment area of Nyamagabe District 351 360 97.5% 2.3 Current Contraceptive Use Among Mothers of Young Children Description -- Percentage of mothers of children age 0-23 months who are using a modern contraceptive method Numerator: Enter the number of mothers with children age 0-23 months who are using a modern contraceptive method Rwanda ICSP Final Evaluation Report September 2015 Page 861 Denominator: Enter the total number of mothers of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 261 357 73.1% 6.5 Kigeme Hospital Catchment area of Nyamagabe District 284 360 78.9% 6.0 Post-Natal Visit to Check on Newborn Within the First 2 Days After Birth Description -- Percentage of children age 0-23 months who received a post-natal visit from an appropriately trained health worker within two days after birth Numerator: Enter the number of children age 0-23 months who received a post-natal visit within two days after birth by an appropriate health worker Denominator: Enter the total number of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 351 360 97.5% 2.3 Kigeme Hospital Catchment area of Nyamagabe District 359 360 99.7% 0.8 Exclusive Breastfeeding Description -- Percentage of children age 0-5 months who were exclusively breastfed during the last 24 hours Numerator: Enter the number of children age 0-5 months who drank breast milk in the previous 24 hours AND did not drink any other liquids in the previous 24 hours AND was not given any other foods or liquids in the previous 24 hours Denominator: Enter the total number of children age 0-5 months in the survey Rwanda ICSP Final Evaluation Report September 2015 Page 862 Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 87 90 96.7% 5.2 Kigeme Hospital Catchment area of Nyamagabe District 80 90 88.9% 9.2 Infant and Young Child Feeding Description -- Percentage of infants and young children age 6-23 months fed according to a minimum of appropriate feeding practices Numerator: Enter the number infants and young children age 6-23 months fed according to a minimum of appropriate feeding practices Denominator: Enter the total number of children age 6-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 109 270 40.4% 8.3 Kigeme Hospital Catchment area of Nyamagabe District 51 270 18.9% 6.6 Vitamin A Supplementation in the Last 6 Months Description -- Percentage of children age 6-23 months who received a dose of Vitamin A in the last 6 months: card verified or mother’s recall Numerator: Enter the number of children age 6-23 months who received a dose of Vitamin A in the last 6 months (mother’s recall or card verified) Denominator: Enter the total number of children age 6-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Rwanda ICSP Final Evaluation Report September 2015 Page 863 Kaduha Hopsital catchment area of Nyamagabe District 179 270 66.3% 8.0 Kigeme Hospital Catchment area of Nyamagabe District 164 270 60.7% 8.2 Measles Vaccination Description -- Percentage of children age 12-23 months who received a measles vaccination Numerator: Enter the number of children age 12-23 months who received a measles vaccination by the time of the interview as seen on the card or recalled by the mother Denominator: Enter the total number of children age 12-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 135 157 86.0% 7.7 Kigeme Hospital Catchment area of Nyamagabe District 132 147 89.8% 6.9 Access to Immunization Services Description -- Percentage of children age 12-23 months who received DTP1 according to the vaccination card or mother’s recall by the time of the survey Numerator: Enter the number of children age 12-23 months who received a DTP1 at the time of the survey according to the vaccination card/child health booklet or mother’s recall Denominator: Enter the total number of children age 12-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 142 157 90.4% 6.5 Kigeme Hospital Catchment 142 147 96.6% 4.1 Rwanda ICSP Final Evaluation Report September 2015 Page 864 area of Nyamagabe District Health System Performance Regarding Immunization Services Description -- Percentage of children age 12-23 months who received DTP3 according to the vaccination card or mother’s recall by the time of the survey Numerator: Enter the number of children age 12-23 months who received DTP3 at the time of the survey according to the vaccination card/child health booklet or mother’s recall Denominator: Enter the total number of children age 12-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 140 157 89.2% 6.9 Kigeme Hospital Catchment area of Nyamagabe District 138 147 93.9% 5.5 Treatment of Fever in Malarious Zones Description -- 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 Numerator: Enter the number of children age 0-23 months with a febrile episode in the last two weeks AND whose mother/caretaker sought treatment for the child within 24 hours AND who were treated with an appropriate anti-malarial drug Denominator: Enter the total number of children age 0-23 months with a febrile episode in the last two weeks Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 40 88 45.5% 14.7 Kigeme Hospital Catchment area of Nyamagabe District 48 104 46.2% 13.5 Rwanda ICSP Final Evaluation Report September 2015 Page 865 ORT Use Description -- 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 Numerator: Enter the number of children age 0-23 months with diarrhea in the last two weeks AND who received oral rehydration solution (ORS) and/or recommended home fluids Denominator: Enter the total number of children age 0-23 months who had diarrhea in the last two weeks Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 16 40 40.0% 21.5 Kigeme Hospital Catchment area of Nyamagabe District 26 72 36.1% 15.7 Appropriate Care Seeking for Pneumonia Description -- Percentage of children age 0-23 months with chest-related cough and fast and/or difficult breathing in the last two weeks who were taken to an appropriate health provider Numerator: Enter the number of children age 0-23 months with chest-related cough and fast and/or difficult breathing in the last two weeks who were taken to an appropriate health provider Denominator: Enter the total number of children with chest-related cough and fast and /or difficult breathing in the last two weeks Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 43 68 63.2% 16.2 Kigeme Hospital Catchment area of Nyamagabe District 75 113 66.4% 12.3 Rwanda ICSP Final Evaluation Report September 2015 Page 866 Point of Use (POU) Description -- Percentage of households of children age 0-23 months that treat water effectively Numerator: Enter the number of households of mothers of children 0-23 months that treat water effectively Denominator: Enter the total number of households of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 284 360 78.9% 6.0 Kigeme Hospital Catchment area of Nyamagabe District 240 360 66.7% 6.9 Appropriate Hand Washing Practices Description -- Percentage of mothers of children age 0-23 months who live in households with soap at the place for hand washing Numerator: Enter the number of mothers with children age 0-23 months who live in households with soap at the place for hand washing Denominator: Enter the total number of mothers of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 307 360 85.3% 5.2 Kigeme Hospital Catchment area of Nyamagabe District 277 360 76.9% 6.2 Child Sleeps Under an Insecticide-Treated Bednet Description -- Percentage of children age 0-23 months who slept under an insecticide-treated bednet (in malaria risk areas, where bednet use is effective) the previous night Numerator: Enter the number of children age 0-23 months who slept under an insecticide-treated Rwanda ICSP Final Evaluation Report September 2015 Page 867 bednet the previous night Denominator: Enter the total number of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 181 360 50.3% 7.3 Kigeme Hospital Catchment area of Nyamagabe District 178 360 49.4% 7.3 Underweight Description -- Percentage of children 0-23 months who are underweight (-2 SD for the median weight for age, according to the WHO/NCHS reference population) Numerator: Enter the number of children 0-23 months with weight/age -2 SD for the median weight for age, according to the WHO/NCHS reference population Denominator: Enter the total number of children age 0-23 months in the survey Sub Area Name Numerator Denominator Percent(calculate) Confidence Limits Kaduha Hopsital catchment area of Nyamagabe District 39 360 10.8% 4.5 Kigeme Hospital Catchment area of Nyamagabe District 31 360 8.6% 4.1 Rapid Catch Indicator Comments The Rapid CATCH indictor for malaria treatment is defined as children with fever who received an antimalarial drug within 24 hours. According to this definition, just 15% of sick children in Kaduha and 1% of sick children in Kigeme met the criteria (compared to 8% in the DHS 2010) as shown in Graph 24. However, it is important to note that this indicator does not take into account rapid diagnostic testing. Now that Rwanda is testing all suspected cases prior to treatment, it would not be expected that all sick children with fever should receive a drug – only those with a positive test. Because rates of malaria are low in Nyamagabe the MOH did not introduce community treatment for malaria until rapid Rwanda ICSP Final Evaluation Report September 2015 Page 868 diagnostic testing became available. Consequently, you would only expect a small fraction of fevers to require treatment with a malaria drug. Minimum Appropriate Feeding Practices were calculated by the WHO definition of Minimum Acceptable Diet. According to the WHO: The composite indicator of a minimum acceptable diet is calculated from the proportion of breastfed children aged 6-23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day AND the proportion of non-breastfed children aged 6-23 months who received at least two milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day. Dietary diversity is present when the diet contained four or more of the following food groups: grains, roots and tubers; legumes and nuts; dairy products (milk, yogurt, cheese); flesh foods (meat, fish, poultry, liver or other organs); eggs; vitamin A￾rich fruits and vegetables; and other fruits and vegetables. The minimum daily meal frequency is defined as twice for breastfed infants aged 6-8 months, three times for breastfed children aged 9-23 months and four times for non-breastfed children aged 6-23 months. Midterm data for underweight was calculated only for children 6-23 months old. Rwanda ICSP Year 3 KPC Report Page 869 ANNEX XVI. YEAR 3 KPC REPORT World Relief Rwanda Innovation Child Survival Project Nyamagabe District, Rwanda October 2011-September 2015 Year 3 Abridged Knowledge Practices and Coverage (KPC) Survey Report Data collected: July 2014 USAID/CSHGP Cooperative Agreement Award No. AID-OAA-A-11-00056 Authors Allison Flynn, World Relief Rachel Hower, World Relief Melene Kabadege, World Relief 2 Acknowledgements The authors would like to acknowledge the many individuals who made this report possible through contributions ranging from development of the survey instrument to guidance on study design and sampling, technical support for electronic data collection using smart phones, data collection and supervision, data cleaning, analysis and interpretation of results. Please see Annex 5 for a list of all contributors. 3 Contents Acknowledgements.......................................................................................................................... 2 Acronyms......................................................................................................................................... 5 Executive Summary.......................................................................................................................... 7 Background ...................................................................................................................................... 9 Project location................................................................................................................... 9 Characteristics of target beneficiary population ................................................................ 9 Health, Social and Economic Conditions in Nyamagabe District........................................ 9 Community Health Workers and Community Mobilization ............................................. 11 National Standards and Policies Regarding Maternal and Child Health........................... 14 Nutrition Policy ................................................................................................................ 15 CSP Goals .......................................................................................................................... 16 CSP Objectives .................................................................................................................. 16 Technical Package............................................................................................................. 17 Tangiraneza I-CSP Intervention Activities...................................................................................... 17 Innovation – Nutrition Weeks ......................................................................................... 20 Objectives of the KPC survey ............................................................................................ 20 Process and Partnership Building .................................................................................................. 20 Methods of identifying and engaging local partners/stakeholders in the KPC ................ 20 Specific roles of local partners and stakeholders in the KPC survey ................................ 21 Constraints in making the KPC process more participatory ............................................. 21 Methods......................................................................................................................................... 21 Questionnaire ................................................................................................................... 21 KPC Indicators................................................................................................................... 22 Sampling design ................................................................... 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Training ............................................................................................................................. 25 Rwanda ICSP Year 3 KPC Report Page 4 Data Collection ................................................................................................................. 25 Data Analysis..................................................................................................................... 26 Results .............................................................................................................................26 Discussion ...................................................................................................................................... 39 External Comparisons....................................................................................................... 39 Programmatic Implications of Findings ............................................................................ 40 Community Feedback and Dissemination of Findings...................................................... 41 Annex 1. Raw Data for Each Survey Question ............................................................................... 42 Annex 2. Monitoring and Evaluation Tables.................................................................................. 99 Annex 3. Population Data Used to Select Clusters...................................................................... 112 Annex 4. Year 3 KPC Survey Questionnaire ................................................................................. 114 Annex 5. Survey Enumerators and Participants .......................................................................... 135 Annex 6. Training schedule for supervisors and interviewers..................................................... 138 Annex 7. Project Resource Requirements of the Survey ............................................................. 985 5 Acronyms ANC ARI ASM BCC BF Ante -Natal Care Acute Respiratory Infection Agente de Santé Maternelle (Maternal Health Agent) Behavior Change Communication Breastfeeding BMI Body Mass Index (method for calculating underweight) CATCH CBNP CCM Core Assessment Tool on Child Health Community -Based Nutrition Program Community Case Management CHW Community Health Worker C-IMCI Community-Integrated Management of Childhood Illness CORE CMAM Child Survival Collaborations and Resources Group Community Management of Acute Malnutrition CSHGP Child Survival and Health Grants Program CSP CFSVA Child Survival Project Comprehensive Food Security and Vulnerability Analysis DDP District Development Plan DIP Detailed Implementation Plan DHS EBF Demographic and Health Survey Exclusive Breast Feeding EIP Expanded Impact Child Survival Project FP FY GDP GMP GoR Family Planning Fiscal Year Gross Domestic Product Growth Monitoring and Promotion Government of Rwanda HBM Home -Based Management (of fever) HC HF Health Center In -Home Fortification HFA Health Facility Assessment HMIS HQ HSSPII IFA IGA Health Management Information System Headquarters Health Sector Strategic Plan II Iron -Folic Acid Income -generating activities ICG Integrated Care Group IMCI IMU Integrated Management of Childhood Illness Inpatient Malnutrition Unit IR ITN Intermediate Result Insecticide Treated Bed Net IYCF Infant and Young Child Feeding LLIN Long Lasting Insecticide Treated Bed Nets LOE KPC Level of Effort Knowledge, Practice and Coverage MAM Moderate Acute Malnutrition MCH Maternal and Child Health Rwanda ICSP Year 3 KPC Report Page 6 MCHIP MDG MINAGRI MINALOC MNC MNCH Maternal and Child Health Integrated Program Millennium Development Goals Ministry of Agriculture Ministry of Local Government Maternal and Newborn Care Maternal, Newborn and Child Health M&E Monitoring and Evaluation MOH Rwandan Ministry of Health MOU Memorandum of Understanding MUAC Mid-Upper Arm Circumference OR ORS ORT PBF PD/Hearth Operations Research Oral Rehydration Solution Oral Rehydration Therapy Performance Based Financing Positive Deviance/Hearth model PDA PI Personal Data Assistant Principal Investigator POU PVO Point-of-use US Private Voluntary Organization RDHS RFA RIDHS RUTF RWF Rwanda Demographic & Health Survey Request for Applications Rwanda Interim DHS Ready to Use Therapeutic Food (Plumpy Nut) Rwandan Francs SBC SAM SMS Social and Behavior Change Severe Acute Malnutrition Short Message Service (text message) TBA Traditional Birth Attendant TOT TT Training of Trainers Tetanus Toxoid TWG UBC Technical Working Group University of British Columbia UNICEF USAID VAS United Nations Children’s Fund United States Agency for International Development Vitamin A Supplement WHO World Health Organization WR WRR World Relief World Relief Rwanda WRA Women of Reproductive Age 7 Executive Summary Project Background: In October 2011, World Relief (WR) was awarded a four-year Innovation grant from the United States Agency for International Development (USAID) Child Survival and Health Grants Program. The overall goal of the Tangiraneza “Start Well” Innovation Child Survival Project (ICSP) is to reduce morbidity, mortality, and undernutition of children under five and pregnant women in Nyamagabe District, Southern Province, Rwanda. The targeted number of women beneficiaries is 111,431 and total number of children under five years of age is 41,314 children (12.5% of total population in 2011). The project established Modified Care Groups throughout Nyamagabe District in both Kaduha and Kigeme hospital zones. Tangiraneza is implementing a package of high impact interventions across both zones, including the standard Rwanda MOH Community Based Nutrition Protocol. In addition, the project is implementing an innovative intervention called “Nutrition Weeks” in Kaduha only, with the Kigeme hospital zone as a comparison area. Nutrition Weeks use a supportive group education technique heavily based on aspects of the PD/Hearth approach, but targets all children in the first 1,000 days of life, rather than just malnourished children. Objectives of the KPC survey: In Year 3, the project carried out an abridged Knowledge, Practices and Coverage (KPC) survey with a focus on nutrition and hygiene, for monitoring purposes. The primary objectives of the survey were: 1) To monitor indicators related to the project’s nutrition interventions, including USAID Key Indicators; 2) To collect monitoring values for USAID Rapid CATCH indicators related to nutrition (some of which overlap with the project indicators); and 3) To collect monitoring data for indicators related to the project’s operations research (OR) on the Nutrition Weeks innovation. Methods: This survey used 30-cluster methodology to collect information from mothers of children 0-23 months in July 2014. Two separate 30x10 cluster samples were selected using Probability Proportional to Size (PPS) in each of two hospital zones that comprise Nyamagabe District. The combined sample included 600 households. Key Findings of Abridged KPC Survey: The survey findings show that there have been significant improvements from three years of programming and intervention in the district, notably on complementary feeding practices, early breastfeeding initiation and hand washing. Minimum Dietary Diversity increased to 49% (21%BL, 38% Yr2) in Kaduha and decreased from 38% to 31% in Kigeme. Minimum Meal frequency increased to 70% (7%BL, 67%Yr2) in Kaduha and 61% (7%BL, 56%Yr2) in Kigeme. Minimum Acceptable Diet increased to 38.6% (3%BL, 32.5%Yr2) in Kaduha and 24.5% (3%BL, 23%Yr2) in Kigeme. Responsive feeding remained high at 97% (96%BL, 96% yr 2) in Kaduha, and 95% (79% BL, 92% yr2) in Kigeme. Age-appropriate introduction of semi-solid foods remained consistent at 79% (52%BL, 81% yr2) in Kaduha and 75% (58%BL, 79% Yr2) in Kigeme. Rwanda ICSP Year 3 KPC Report Page 8 Immediate Breastfeeding increased to 82% (48%BL, 71%Yr2) in Kaduha, and increased to 79% (51%BL, 72%Yr2) in Kigeme. Pre-lacteal feeds decreased to 4% (11%BL, 6%Yr2) Kaduha and decreased to 2% (11%BL, 9%Yr2) Kigeme. Exclusive breastfeeding until 6 months also increased in both districts (90% to 93% in Kaduha; 84% to 94% in Kigeme). Due partly to increasing stability of HC stock, the portion of pregnant women with iron pills increased back to 81% (80%BL, 64% Yr2) in Kaduha and 84% (82%BL, 71% Yr2) in Kigeme; Average number of days iron pills consumed increased to 42 days in both Kaduha (35 BL, 40 Yr2) and Kigeme (33 BL, 33 yr2). The percent of mothers who washed their hands with soap at the four key times improved from 21% to 30% in Kaduha and from 10% to 15% in Kigeme, though the percentage of households having washing stations with soap decreased from 78% to 74% in Kaduha and from 89% to 73% in Kigeme, a significant change from its year 2 value. Decreases in the percent of households that treat water effectively occurred in both zones, likely due to the fact that Sur Eau, a chlorine treatment, more than doubled in cost (Kaduha yr2 98%, yr3 76%; Kigeme yr2 98%, yr3 57%). Due to mixed results in hygiene indicators, the project will re-focus on hygiene and boiling water in the messaging given to mothers. The survey findings show improvements in the district regarding hygiene and child feeding practices, though underweight was only decreased in the Kaduha zone. The percent of underweight children increased from 16.0% (95% CI 11.4 – 22.1) to 17.6% (95% CI 12.0–24.9) in Kigeme, but decreased significantly from 21.7% (95% CI 17.0 – 27.2) to 10.8% (95% CI 7.1-16.1) in Kaduha. The confidence intervals overlap for Kigeme, meaning the increase was not significant. Stunting increased slightly in Kaduha, from 33.3% (95% CI 26.1 – 41.3) in year 2 to 34.1% (95% CI 27.6-41.1) at year 3, though the confidence intervals overlap. Stunting levels remained consistent in Kigeme (34% at Year 2 and 33% at Year 3). Acute malnutrition measured by MUAC decreased significantly in Kaduha while increasing slightly in Kigeme (9.6% to 0.5% in Kaduha and 4.0% to 5.3% in Kigeme). 9 Background Project location Rwanda is a small, mountainous and densely populated country. The population is over 80% rural and most people rely on agriculture to meet their basic needs.1 The under-five mortality rate in Rwanda has been decreasing steadily: the 2005 DHS found that for every 1,000 live births, 152 children died before their first birthday; by 2010 that number had dropped to 76.2 Malaria, anemia, pneumonia and diarrhea are major causes of mortality in children under age five and malnutrition is a contributing factor in over half of all child deaths. Child morbidity is very high throughout the country, although it too has been reduced, particularly between the last two Demographic and Health Surveys. This District is subdivided into two hospital zones: Kigeme and Kaduha, the targeted areas for the comparison and intervention groups of the Operational Research project. It is further divided into 17 administrative sectors, 92 cells and 536 villages. World Relief (WR) is partnering with National and district-level Ministry of Health (MOH) staff to implement project activities via MOH structures. Dr. Fidele Ngabo, head of the MOH Maternal and Child Health Unit, and Alphonsine Nyirahabineza, the Head of Nutrition Desk for the MOH are both involved with ICSP’s Operations Research component along with Melene Kabadege, WR Maternal & Child Health Regional Technical Advisor for Burundi, Congo & Rwanda. Together with the Project Manager, Carmen Grace Umutoni, the Nutrition Technical Working Group is kept fully appraised of the program data, goals and activities. Characteristics of target beneficiary population The World Relief Rwanda Innovation Child Survival Project serves all of Nyamagabe District in Southern Rwanda, which has a population of 330,510, according to Nyamagabe District Statistics 2011. The total number of women beneficiaries is 111,431 and total number of children under five years of age beneficiaries is 41,314 children (12.5% of total population in 2011)3 . The beneficiary population was derived from applying corresponding percentages related to women of reproductive age and children under five from the 2007 Census to the total population from Nyamagabe District Statistics 2011. Health, Social and Economic Conditions in Nyamagabe District The most recent (2010) DHS Survey Final Report reveals that Nyamagabe District has some of the highest rates of malnutrition, anemia and stunting nationwide4 . The District’s leading causes of child mortality are: neonatal complications, pneumonia, diarrhea and malnutrition. An EIP survey by World 1 US Department of State Background Note. Accessed November 14, 2011. http://www.state.gov/r/pa/ei/bgn/2861.htm 2 National Institute of Statistics of Rwanda. 2011. Rwanda Demographic Health Survey 2010; Preliminary Results. 3 For more information on calculations refer to Annex 3: Populations Estimate and Calculations. 4 2010 DHS Survey Final Report, published in February 2012 Rwanda ICSP Year 3 KPC Report Page 10 Relief and other NGOs prior to baseline found stunting in Nyamagabe and Nyaruguru to be 49% with 17% severely stunted5 . Most income-generating activities in Nyamagabe are agricultural. The crops grown, in order of importance, are: beans, Irish potatoes, sweet potatoes, wheat, bananas, sorghum, cassava, passion fruits, peas, maize and soy.6 The two primary cash crops are tea, grown in eastern Nyamagabe near Nyungwe National Park, and coffee, which is grown throughout the district. The 2010 Nyamagabe District Development Plan explains that “very poor soil conditions, degradation by erosion, fragmentation and over-exploitation linked to lack of fallow land and poor agricultural practice due to lack of inputs has led to acute impoverishment of available land.” Moreover, the land available per family is quite limited. These factors contribute to 28% of the population living below the poverty line, and the constant threat of food insecurity.7 Challenges to proper nutrition in Rwanda include shortage of land, poor soil, lack of animals (for fertilizer) and lack of enough animal protein or fat in the diet. At baseline, mothers also lacked knowledge about ideal breastfeeding practices, the proper times to introduce complementary foods, and proper fat content for diets of young children. Meal frequency and dietary diversity indicators were traditionally poor. At baseline, even health workers had erroneous beliefs about breastfeeding, complementary feeding and nutrient content of foods (thinking tree tomatoes have iron, for example). Formative research for Tangiraneza found that children were given a very watery porridge, so nutrient density was poor, and the porridge itself was not enriched with any source of protein such as small amounts of fish or animal protein or even added oil (as they believed oil is bad for children’s liver). Frequent bouts of diarrhea were a significant problem, and since it is so common, mothers did not have a strong enough perception of the severity, and they did not seek treatment, nor do enough give continued fluids and foods for catch-up growth. Nyamagabe District has sufficient water sources, yet many people still use streams, dams, swamps and valleys8 . Over 23% of the people travel nearly 3.5 km to the nearest clean water source; which is 3km further than the recommended national norm. Instead of the local government being in charge of management of the water infrastructure, maintenance and repair has been a responsibility of the general population. Due to poor management, existing infrastructure has been neglected, and left in a state of disrepair9 . The Nyamagabe district health services were strengthened by WR through the CSHGP –funded Expanded Impact Project (EIP) that was implemented in six districts of southern and eastern Rwanda 5 Expanded Impact Project, Nutrition Component Endline Survey, 2010 6 DDP, p. 10 7 ibid 8 Ibid, p. 15 9 Ibid, p. 15 Rwanda ICSP Year 3 KPC Report Page 11 prior to ICSP (funding ended in 2011). WR was responsible for Nyamagabe District and for overall training in Care Group methodology. The focus of EIP was to help the MOH roll out Community Case Management (CCM) for pneumonia and diarrhea through modified Care Groups (CGs) that used MOH CHWs (1 per 2-3 villages). Nyamagabe is not endemic for malaria, although the government added CCM for malaria in the district in conjunction with national use of rapid diagnostic testing for malaria. The program did not address nutrition or maternal and newborn care, which are both key areas for the present Innovation CSP. There are 2 District hospitals, 16 health centers, and 1,608 CHWs (binome and ASM) across 536 villages in Nyamagabe. The national plan, Vision 2020, calls for one health center in each of the 17 sectors to improve the number of people living within 10 km of a health facility (planned for completion in late 2014). According to the district development plan, there is only one physician for every 33,655 people (9 total), though the 2012 goal was for 15 doctors.10 Due to the USAID supported system-strengthening for logistics and procurement as well as direct support of various donors, there are fairly reliable supplies of essential medicines. Clients pay for health services in Rwanda. In 2003, the MOH instituted a health insurance scheme known as mutuelle de santé. The 2014 Tangiraneza KPC survey found that 69.7% and 83.3% (Kigeme and Kaduha, respectively) of families with children under two surveyed in the district are enrolled. Enrolled individuals make a small co-payment to receive all primary care services and medications. Many hospital services are also covered. For families who are not yet enrolled, the cost of services is a major barrier to appropriate care-seeking, however, there are various NGO and government programs to assist poor families to enroll. Community Health Workers and Community Mobilization Nyamagabe District has two district hospitals, 16 health centers, and 1,608 Community Health Workers in 536 villages. Community Health Workers in Rwanda Rwanda has a system of community health workers such that every village (umudugudu) has each of the following: 1) One male and one female pair of CHWs (binome) in charge of community case management (malaria, pneumonia and diarrhea) and nutrition; and 2) one maternal health agent (ASM), a female responsible for maternal and newborn health. The binome and ASM have indefinite terms of service once elected and trained. Not technically a CHW, but responsible for behavior change under the Ministry of Local Government (MINALOC), is the in-charge for Social Affairs at village level. This individual used to be included in the CHW Cooperative but was removed in April 2012; at the same time the MOH announced elimination of two CHWs per village who had been responsible for palliative care. 10 Ibid, p. 17 Rwanda ICSP Year 3 KPC Report Page 12 CHW incentives: The binome and ASM CHWs receive financial incentives via performance based financing. A small individual payment is made to each CHW in addition to a collective stipend that is paid into the CHW cooperative at health center level. The Social Affairs in-charge at village level is not part of the CHW Cooperatives, although their responsibility for behavior change under MINALOC remains the same. They receive a small annual incentive provided by Tangiraneza ICSP, along with other members of the modified Care Groups (described below). CHW training and supervision: Each type of CHW is trained with others of the same role according to a standard protocol for each component of their responsibilities (e.g. 2 days for growth monitoring; 5 days for MIYCF). Additionally, they attend monthly meetings en masse at the health center. However, as these meetings tend to focus on the income generation function of the CHW Cooperative, there is a separate monthly meeting specifically for CCM reporting and re-stocking of drug supplies. Supervision of CHWs occurs at two levels using standardized supervision tools. The health center in￾charge for community health is responsible for supervising all CHWs in the field once every three months. Additionally, peer supervision is to take place monthly via the CHW Cell-Coordinator, a competent (unpaid) peer elected to supervise the other CHWs (about 20) in his or her cell. CHW workload: Theoretically, all CHWs are responsible for conducting home visits in their village related to their area of expertise. However, they naturally focus their time most heavily on curative rather than preventive services with behavior change communication mostly done in the context of large community gatherings. In the March 2011 draft report of a 2010 c-IMCI evaluation of CHWs in Rwanda (Community Health Desk, Rwanda MOH, p. 14), analysis of CHW workload reported on “the basic elements of their work: seeing a sick child, completing the monthly report and traveling to the health center.” The study found that on average, CHW binomes spent about 9 hours per month on the combined tasks. Notably, BCC was not even included in the assessment, indicative of its ancillary role. Current status of CHW training in Nyamagabe: Tangiraneza has supported the MOH in rolling out training on maternal and newborn care for ASMs. Training related to nutrition has been comprehensive, centered on the focused primarily on the maternal, infant and young child feeding curriculum from the MOH (for binomes) and growth monitoring and screening for referral to the health center for rehabilitation. In addition to national protocols for CHW trainings, each district is mandated to do what it can towards the government’s goal to eliminate malnutrition. Modified Care Groups The overall strategy of Tangiraneza CSP is to train MOH staff, CHWs and local leaders in Modified Care Groups for BCC in nutrition, MNC, diarrhea and pneumonia. For Tangiraneza CSP, WR modified the Care Group model to better engage local leaders with community health, incorporating the elected village leader (usually male), other village-level leaders Rwanda ICSP Year 3 KPC Report Page 13 most closely associated with behavior change (including a representative of the village hygiene club), the village Social Affairs in-charge and the Women's Group Leader) and a religious leader. The groups will continue to include the two CHW binomes (one male and one female responsible for CCM and nutrition), the ASM CHW (responsible for maternal and newborn care) and the Social Affairs in-charge at village level (under MINALOC). All members of the Village Committee for Eliminating Malnutrition are also among the aforementioned members of the modified Care Group. Care Group members allocate all the households in their village amongst themselves for home visits and hold community meetings for BCC. Although CHWs retain their specialized MOH roles, uniting them into a CG helps them work together, and, with the additional CG members, they can more effectively mobilize the community to adopt key family health practices. The ICSP supports MOH policy for vital events data collection: ASM CHWs to report births and pregnancies and Binomes report under-five deaths. Other CG members support them to collect data when they do home visits. Roles and Responsibilities related to Care Groups and Nutrition Weeks The modified Care Groups in each village are supervised by the in-charge of Social Affairs at cell level (a paid position) and the CHW Cell Coordinator. Cells with a large number of Modified Care Groups are divided up for supervision by the CHW Cell Coordinator and the Cell in-charge for Social Affairs. (The maximum number of villages in a cell in Nyamagabe—and therefore CGs in a cell—is ten.) The Social Affairs in-charge at cell level is a Nutrition Weeks Trainer for CHWs, in addition to supporting the CHW Cell Coordinator in BCC and community mobilization. The CHWs Cell Coordinator and sector level in-charge for Social Affairs are each responsible for supervising two to three Modified Care Groups in each Cell. The CHW Cell Coordinator is a CHW chosen to supervise his or her peers (one for each cell), per MOH strategy. This extends the reach of the health center-level community health in-charge, who can only do quarterly supervision of CHWS. Multi-Sectoral Committees for the Elimination of Malnutrition The Community Based Nutrition Program protocol calls for Multi-Sectoral Committees for the Elimination of Malnutrition. These are to exist at multiple administrative levels, including sector, cell and village levels. Sector Level Multi-Sector Committee for Eliminating Malnutrition coordinates activities related to CBNP at sector level; analyzes reports from the cells and define priorities of intervention in matters related to eliminating malnutrition at cell level; advocates for nutrition and mobilizes resources; and are an intermediary between cells and the district. These committees exist but are not yet functional. They have a budget for activities that the CSP attempts to influence to promote strategic use of the resource. CSP staff can also introduce BCC and engage the members on community mobilization in this existing committee as well. Rwanda ICSP Year 3 KPC Report Page 14 Members include: Executive Secretary, Sector Head of HC, Chair of CHW cooperative, CHW trainer (HC in-charge of community health), National Women’s Committee rep, National Youth Committee rep, Agriculture Officer, Veterinary Officer, Chair of Parent Teacher Association, Cooperative Representatives, and Civil Society Representative. Cell-level Nutrition Committees exist in MOH plans but were non-functional in Nyamagabe at baseline. After three years of implementation, Tangiraneza has helped develop these committees, bolstered by the fact that all members are part to the village Modified Care Group. Mobilizing Faith Communities Religious leaders are highly regarded by their followers in Rwandan society and the vast majority of people identify themselves as Christian. A poll conducted by the Pew Forum on Religion and Public Life in 2010 reported that 93% of respondents were Christian, 5% Muslim, and 2% other, similar to data reported by the Rwanda government in 2006. Ninety eight percent polled said that religion was “very important” (90%) or “important” (8%) in their life. Weekly attendance at religious services was reported by 76% of respondents and an additional 12% participated monthly or yearly.11 These findings underscore the importance of engaging religious leaders and faith communities as part of community mobilization. The project engages with parish leaders from all denominations on a quarterly basis at sector level. Initially, the members helped to identify which church leaders should participate in the modified Care Group at cell level. They also have been charged with making plans with the congregations under their leadership for reinforcing key health messages and helping the most vulnerable families in their communities with the support needed to follow recommended behaviors. For example, during rollout of messages on hand washing, congregations could be challenged to identify and support families for whom building a tippy tap might otherwise be out of reach—with the expectation that assistance be based on need regardless of religious affiliation. National Standards and Policies Regarding Maternal and Child Health National standards and policies regarding MCH and Nutrition are developed based on internationally￾accepted guidelines and programs. This Innovation CSP is designed to help the government of Rwanda achieve goals related to maternal and child health, and particularly for the elimination of malnutrition. The Rwanda MOH Strategic Plan for 2008-2012 noted that “the most influential International commitments providing direction to the HSSP-II are the MDGs, the African Health Strategy 2007-2015, the Paris Declaration, Accra Accord and Abuja Declaration. The GoR has committed itself to achieving the MDGs by 2015. Four MDGs are related to health: • Goal 1: Eradicate extreme poverty and hunger (malnutrition) 11 http://features.pewforum.org/africa/country.php?c=182 Rwanda ICSP Year 3 KPC Report Page 15 • Goal 4: Reduce child mortality • Goal 5: Improve maternal health • Goal 6: Combat AIDS, malaria and other diseases The HSSP-II includes many strategies and interventions that are oriented towards speeding up the achievement of health-related MDGs. While great strides have been made to meet these goals, Goal 5, to improve maternal mortality, is proving the most difficult to achieve. This plan outlines the additional interventions required to accelerate progress towards realizing this MDG. The HSSP-II is also guided by the Africa Health Strategy 2007-2015, which provides strategic direction to Africa’s efforts in creating better health for all along with an overarching framework to enable coherence within and between countries, civil society and the international community. The Strategy emphasizes the need to strengthen health systems, provide the poor with services and thereby contribute to equity. It focuses on the health of women and children, where great challenges remain. It suggests that apart from the necessary attention for AIDS, malaria and TB, the substantial disease burden posed by other communicable and non-communicable diseases should not be overlooked. It also encourages sector-wide approaches to guarantee alignment of donor funding with nationally￾determined plans and priorities. Rwanda has signed up to the Abuja Declaration committing 15% of disposable GDP to its health sector. Furthermore, donor commitment to the Paris Declaration for aid harmonization (2005) and Accra Accord for aid effectiveness (2008) has resulted in improved donor co-ordination.12 Nutrition Policy The Second National Nutrition Summit held in Kigali in November, 2011 had the theme of “Supporting Progress in Rwanda’s Efforts to Eliminate Malnutrition”.13 Over 200 Rwandan and international participants and experts met to discuss progress on the consensus statement from the 2009 Nutrition Summit, which was “to prevent acute and chronic malnutrition (stunting), through a multi-sectoral approach featuring multiple well-proven and evidence-based interventions with a focus on community based nutrition programmes.” After two years of implementing District Plans to Eliminate Malnutrition (DPEM), participants described the following challenges and issues: “lack of commitment and participation from local leaders at the district level, and the amount of work expected of community health workers (CHWs) despite the fact that they are voluntary workers. “All Summit participants agreed with the potential communication power of the concept of 1,000 Precious Days. This slogan should be adopted as a theme of the DPEMs in order to add a highly human, 12 The Rwanda Ministry of Health Strategic Plan for 2008-2012 can be found online at: 13 Second National Nutrition Summit, report can be found online: www.nns2rwanda.org Rwanda ICSP Year 3 KPC Report Page 16 easy to understand concept and should be promoted in a major way at all levels with the objective of having all families take new interest and pride in this period and provide the special nutrition actions and protection needed to have the child reach the age of two years with their full potential intact for growth and development. The concept of “Agakono K’ umwana”, meaning a special pot for the child, should also be considered as a communication vehicle to drive the much needed high quality complementary feeding component of the 1,000 Precious Days.” CSP Goals The overall goal of the World Relief Innovation Child Survival Project is to reduce morbidity, mortality, and undernutrition of children under five and pregnant women in the Nyamagabe District of Rwanda. The aim of the operation research component of the project is to identify a feasible way for the Ministry of Health in Rwanda to use existing staff and CHWs to reduce and prevent undernutrition in children who are in their first 1,000 days of life in Nyamagabe District. The results of the project will yield valuable data relevant to scaling up the approach in Rwanda and contribute to the international body of knowledge on feasible approaches to prevent under-nutrition. To facilitate this, Dr. Fidele Ngabo, MD, MSc, PhD Candidate, who is the Director of the Maternal and Child Health Unit for the Ministry of Health is the Principal Investigator, along with Dr. Judy Mclean of the University of British Columbia. The Head of Nutrition Desk for the Ministry of Health, Alphonsine Nyiransabimana, is a Co-Investigator, along with Melene Kabadege, WR Maternal & Child Health Regional Technical Advisor for Burundi, Congo & Rwanda, who had the idea for Nutrition Weeks. CSP Objectives The project’s Strategic Objective is to improve the capacity of MOH staff and CHWs to implement high impact maternal, newborn and child health intervention at the community level. The main objective of the operational research (OR) component is to identify and test the effectiveness and feasibility of the Nutrition Weeks innovation when added to the standard CBNP. This intervention is expected to improve the nutritional status of infants and young children aged 6-23months from baseline to the end of study in the intervention area (Kaduha hospital zone) compared to that of the comparison area (Kigeme hospital zone), as a result of improved Infant and Yong Child Feeding (IYCF) practices. Proxy indicators will be used assess improvements made. Rwanda ICSP Year 3 KPC Report Page 17 Technical Package The project’s results framework is as follows: Project Goal: To reduce morbidity, mortality and undernutrition of children under five and pregnant women in Nyamagabe District of Rwanda. Strategic Objective: Improve capacity of MOH staff and CHWs to implement high impact maternal, newborn and child health interventions at the community level. IR 1. Improved geographic access to and demand for high-quality MNCH services IR 2. Improved coordination and impact of community health activities IR 3. Develop Nutrition Weeks Innovation and conduct OR to test effectiveness Activities: Activities: Activities: 1) Build capacity of Community Health Supervisor and Hygienists from all 16 Health Centers as TOT trainers who will train Care Groups in all CSP interventions. 2) Train Cell-Coordinators and Cell Social Affairs in-charges to supervise modified Care Groups comprised of CHWs, village and religious leaders. (3-10 modified CGs per cell) 3) Train Binome leaders of modified Care Groups to train their peers in BCC for all interventions: Nutrition, MNC, Diarrhea and Pneumonia. The Social Affairs in￾charge at the cell level will train CHWs for Nutrition Weeks, and support the CHW Coordinator in BCC/ community mobilization. 4) Train Kaduha area CBN Village Committees with the ‘Nutrition Week’ innovation. 5) Train 536 maternal health CHWs (ASM) in MNC package. 1) CHWs, religious leaders and community representatives (approximately ten members total including Village Head, Village Nutrition committee members, Village Social Affairs, Hygiene Committee representative, etc.) meet monthly in modified CG to: -Make action plans based on data reported by CHWs -Cross-train in BCC for key family practices based on barrier analysis and BCC strategy -Coordinate regular home visits -Improve referral to appropriate CHW and/or health facility. 2) Build capacity of Sector and Cell level In-Charge of Social Affairs to support BCC. 3) Mobilize churches to assist vulnerable households with kitchen gardens & tippy taps. 1) Conduct Operations Research comparing standard CBNP activities vs. CBNP plus ‘Nutrition Weeks’ intervention. Evaluate impact with regard to cost and feasibility for scale-up. 2) Participate in Nutrition Technical Working Group; solicit input and share findings. 3) Improve CHWs records and reporting system for nutrition. Tangiraneza I-CSP Intervention Activities The estimated Level of Effort per intervention is: Nutrition 40%, Maternal Newborn Care 35%, Diarrhea 15%, and Pneumonia 10%. The following table shows key indicators for each intervention. Key Activities for the Selected High Impact Technical Interventions Nutrition – 40% Level of Effort (LOE) Rwanda ICSP Year 3 KPC Report Page 18  Community-Based Growth Monitoring held every month with quality counseling based on weight for age growth plots  Underweight children screened with MUAC and severely underweight or SAM cases referred to health centers  Pregnant women screened with MUAC and referred for supplemental food if under 18.5 cm (will be held during Nutrition Week in Kaduha area)  Children enrolled in OTP and those discharged from the Inpatient Malnutrition Unit will get a referral card from Facility to Community and will be followed up by CHWs.  Integrated Care Groups use the Triple A process (per MOH protocol) to seek and implement solutions to malnutrition in community  Results of growth monitoring shared with churches to elicit specific support for families with malnourished children  Nutrition Weeks held in each community 3 times per year  De-worming and Vitamin A distribution provided twice a year during MCH week  Promotion of Kitchen Gardens as recommended by the MINAGRI (responsible for Kitchen Gardens) and with technical assistance from government agronomists or NGOs in the district working in agriculture  Provision of rabbits for community breeding to improve access to animal-source foods in Kaduha zone (paid by matching funds)  Plan and follow up the implementation of the District Plan to eliminate malnutrition in Kaduha and Kigeme hospital zones  Provide technical support to the implementation and supervision of PNBC Package (GM, cooking demonstration, IGA, etc.) Maternal Newborn Care – 35% LOE • Support the MOH to train the maternal health CHWs (ASM) to identify and register WRA and pregnant women, promote ANC, birth preparedness, institutional deliveries, use of family planning, attend postnatal checks for mothers and newborns and refer women and newborns with danger signs to health facilities. • Orient the Integrated Care Groups to key MNC messages they will promote to women and men including: - Attending ANC, value of institutional deliveries - Recognition of danger signs in pregnancy, delivery, post-partum, in the newborn Rwanda ICSP Year 3 KPC Report Page 19 - Maternal nutrition and decreased work load during pregnancy - Consumption of Iron-folic acid (IFA) and acquisition of Vitamin A supplements post-partum - Child spacing - ASMs help families make a birth plan and promote savings for the related costs or mutuelle enrollment - Integrated Care Groups develop emergency transport plan and community savings for medical emergencies. - Advocate for Facility Training and quality improvement on Post Natal Care - Provide Technical Support to Integrated Supervisions at community level Diarrhea – 15% LOE  Coordinate refresher training for CHWs in CCM with emphasis on use of zinc and continued fluids and feeding during illness.  Reinforce CHW’s Counseling and communication skills  Integrated Care Groups promote point of use water purification, Community-Led-Total Sanitation, and treatment-seeking for diarrhea to improve utilization rates for zinc in addition to oral rehydration solution (ORS).  Collaboration with Hygiene Clubs when they are started in Nyamagabe (district was not included in recent choice), through participation of Executive Committee member in Integrated Care Group.  Hygiene promotion through churches Pneumonia – 10% LOE  Coordinate refresher training for CHWs in CCM with emphasis on use of amoxicillin and increased fluids and feeding during illness.  Collaboration with Ministry of Infrastructure and on-going projects to promote improved stoves to reduce indoor smoke  Hygiene promotion to prevent transmission of respiratory infections  Integrated Care Groups promote recognition of danger signs and prompt care-seeking based on C-IMCI package. Rwanda ICSP Year 3 KPC Report Page 20 Innovation – Nutrition Weeks The Nutrition Weeks innovation was developed by World Relief in collaboration with national MOH and District MOH staff, based on findings from the formative research phase of the OR. This intervention went through pre-testing, revisions and pilot-testing prior to implementation, and was revised based on data from its first full year of implementation. Nutrition Weeks was introduced into the CBNP in the intervention area, Kaduha hospital zone, in October 2012. CHWs receive training and a step-by-step guide to implement Nutrition Weeks, which are scheduled three times a year. The Nutrition Week includes all women with children under two and pregnant women, who spend two hours a day in small groups of ten to twelve, participating in a nutrition education session modeled after PD/Hearth. The goal of Nutrition Weeks is for mothers to learn about foods, feeding practices, and other behaviors that will prevent undernutrition. They engage mothers in active learning to build self-efficacy and empower the trained CHWs to more effectively promote behavior change. It will do this by giving the mothers an opportunity to practice behaviors, ask questions, and see for themselves the efficacy of the new feeding practices, instead of passively hearing messages. Objectives of the KPC survey This KPC Survey was multi-purpose: a. To measure values for indicators related to the project’s interventions, including USAID Key Indicators. b. To collect values for USAID Rapid CATCH indicators (some of which overlap with the project indicators). c. To collect data for indicators related to the project’s operations research on the Nutrition Weeks innovation. Process and Partnership Building Methods of identifying and engaging local partners/stakeholders in the KPC Most (53 out of 57 interviewers) were experienced and trained from previous KPCs. Most were also MOH staff. World Relief employed a minimum number of staff for the project as a whole relative to the size of the population and number of CHWs being trained. WR’s role was more one of facilitation and capacity-building instead of direct implementation, which is the responsibility of MOH and local government. The Project Manager and Officers participated in National-level Technical Working Groups corresponding with their areas of focus and facilitated MOH capacity-building at the district, sector and community levels. Local officials, MOH staff, volunteers, and civic leaders were involved in every phase of the project, including the KPC and all evaluations. KPC Participants included: Rwanda ICSP Year 3 KPC Report Page 21 • 15 Health Center staff in-charge of Nutrition • 2 Hospital staff in charge of M&E • 27 sector staff in charge of socio-economic development at cell level • 4 UBC Students • 9 ICSP staff Additionally, 2 WR Technical Advisors participated: one, as the coordinator of the survey and the other as additional support for the enumerators. The refresher trainings were organized for one day including piloting the questionnaire. The interviewers were between 20 and 40 years of age, fluent in Kinyarwanda and had completed both secondary school and some level of higher technical education. The enumerators received refresher training on how to use the PDA tablets, as well as how to properly collect anthropometric measurements. Each enumerator had the opportunity to practice data collection in the field in Kabajogo, Nyamugali and Nyarusange villages, Gasaka sector. During the data collection the new enumerators were together with the experienced ones, in order to get more support from the stronger enumerators and to ensure good quality of data collection and proper use of PDA tablets. Specific roles of local partners and stakeholders in the KPC survey As described above, except for fewer than a dozen WR staff and University of British Columbia students, the entire KPC was conducted by MOH staff. Constraints in making the KPC process more participatory There were no constraints to making the KPC process more participatory. Methods Questionnaire In Year 3, an abridged version of the KPC Survey Questionnaire from the baseline survey was used for monitoring purposes. The questionnaire, conducted in Kinyarwanda, contained 102 questions and focused on the operations research indicators including nutrition and child feeding, hygiene, control of diarrheal disease, and interaction with CHWs and Care Group members. The same consent form approved for the KPC in the first two years of the project was also used. In addition to the questionnaire, the survey also required anthropometric measurements to be taken on one child in each household surveyed (600 children 0-23 months old total, 300 in each study area). The child’s weight, height and MUAC were measured, in addition to the mother’s MUAC. Participants’ confidentiality and privacy was assured through the use of a unique identifier number on all questionnaires. Soft copies of the data were kept in a password encrypted file and hard copies of questionnaires in a locked filing cabinet in the offices of World Relief in Kigali. Rwanda ICSP Year 3 KPC Report Page 22 KPC Indicators The project collected data on fewer indicators than it did at baseline for this monitoring mid-line survey, as seen in Table 1 below. Table 1. Indicators for Year 3 KPC Breastfeeding and Nutrition (LOE 40%) Immediate breastfeeding of newborns Percent of children 0-23 months who were put to the breast within one hour of birth. (Key indicator MNC) (OR) Prelacteal feeding Percent of children 0-23 months given liquids prior to the initiation of breastfeeding. Exclusive breastfeeding Percent of children age 0-5 months who were exclusively breastfed during the last 24 hours. (RC) Continued breastfeeding at 1 year Percent of children 12-15 months who are still breastfeeding. Continued breastfeeding at 2 years Percent of children 20-23 months who are still breastfeeding. Minimum Dietary Diversity % infants and young children age 6-23 months fed according to the Minimum Dietary Diversity (OR) Minimum Meal Frequency % infants and young children age 6-23 months fed according to the Minimum Meal Frequency (OR) Minimum Acceptable Diet % infants and young children age 6-23 months fed according to the Minimum Acceptable Diet *WHO 2008 definition (OR, RC*) Consumption of iron-rich foods % infants 6–23 months of age who consumed food rich in iron. (Include micronutrient powders if/when program expands to Nyamagabe) Age appropriate introduction of semi-solid foods Proportion of infants 6–8 months of age who receive solid, semi-solid or soft foods. Responsive feeding Percent of Caregivers who assist child when eating (of children who consume soft, semi-solid or solid foods). This indicator will get revised at next survey; will reference HF project data for baseline at that time. Self- Feeding Percent of children who consume soft, semi-solid or solid foods) who are self-feeding Anthropometry Underweight for Age Percent of children 0-23 months who are underweight (-2 SD for the median weight for age, according to WHO reference population). Disaggregate underweight by moderate (≤-2SD and >-3SD) and severe (≤ - 3SD) (RC) Acute Malnutrition / Wasting % children 0-23 months who are underweight for height (-2SD for the median height for age, according to WH0 reference population). Disaggregate wasting by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) (OR) Acute Malnutrition – MUAC Percent of children 6-23 months acutely malnourished as measured by MUAC Rwanda ICSP Year 3 KPC Report Page 23 Disaggregate by ‘at risk’, moderate and severe acute malnutrition Stunting – Height for Age Percentage of children 0-23 months who are under height/length for age (- 2SD for the median height for age, according to WHO reference population) Disaggregate stunting by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) Maternal Newborn Care (LOE 35%) Increase iron-folic acid supplementation during pregnancy. Percentage of mothers who received tablets; average number of days consumed of those who received pills. (OR) Control of Diarrheal Disease (LOE 15%) Prevention Point of Use water treatment Percentage of households of children age 0-23 months that treat water effectively. (RC15, OR) Improve appropriate hand washing practices Percentage of mothers of children age 0-23 months who live in households with soap at the place for hand washing. (RC16, OR) Hand washing at appropriate times Percentage of mothers of children age 0-23 months who wash hands with soap at all four key times Latrine/toilet in good condition Percentage of households of children age 0-23 months that have a toilet facility in appropriate condition Safe feces disposal Percentage of mothers of children 0-23 months who disposed of the youngest child’s feces safely the last time a stool passed. (Key Indicator) Process Indicators – CHWs and Nutrition Weeks CHW Home Visits Percent of households with children 0-23 months that received a visit from a CHW in the past month, according to reported purpose Participation in Nutrition Weeks Percentage of mothers with children 0-23 months who participated in “Nutrition Week” intervention at least once in the past 6 months for 4 or more days. Sampling design The KPC Monitoring Survey largely followed the “standard” KPC 30 cluster methodology. A double 30- cluster (30x10) sampling method was used with OR questions and anthropometric measurements in both Intervention and comparison areas. Parallel sampling was not used. Two separate 30x10 cluster samples were selected in each of two hospital zones that comprise Nyamagabe District. 30 clusters were selected in each zone using PPS. Ten households from each cluster were selected using the “spin-the-bottle” method. The total sample of 300 is large enough to provide adequate denominators for calculating indicators for subgroups (such as sick children or children within a particular age group). The combined sample included 600 households. The starting point for each cluster was determined in the following manner: the survey team asked village leaders to identify the center of the village. From that central point, a random direction was selected by spinning a bottle. Surveyors then walked in a straight line in the randomly chosen direction Rwanda ICSP Year 3 KPC Report Page 24 until they reached a house with a child under 24 months, which became the first mother interviewed. The second and subsequent households were selected by continuing in the same direction in a straight line, until a second house with a child under 24 months, then a third house, and so forth. In each cluster, 10 mothers were interviewed. In households with more than one child 0-23 months-old, the younger child was selected in order to favor data collection on exclusive breastfeeding. Sample Size Calculations n = D [(Zα + Zβ)2 * (P1 (1 - P1) + P2 (1 - P2)) / (P2 - P1)2 ] Where, D= 2; Zα =1.645; Zβ = 0.84; α= 0.05; β= 0.80 Table 2: Sample Size Calculations based on Primary Outcome Indicator (M.A.D.) Proportion of infants and young children of ages 6m￾23m fed according to minimum appropriate feeding practices** in sample 1. p1 Proportion of infants and young children of ages 6m￾23m fed according to minimum appropriate feeding practices in sample 2 p2 ∆ n1 = n2 N  0.37** 0.47  0.10 596 1191 0.37 0.52  0.15 265 530 0.37 0.57  0.20 148 295 0.37 0.67  0.30 62 125 0.37 0.77  0.40 32 63 0.37 0.87  0.50 17 34 *At the time of sample size calculation, ‘minimum appropriate feeding practices’ was the closest indicator to minimum acceptable diet available. The final 2010 DHS report with calculation of MAD was not available until later. ** Source: Addendum to the 2005 Rwanda DHS (IYCF). http://www.measuredhs.com/pubs/pdf/FR183/Rwanda_IYCF_KM-2005.pdf From the above calculation, in order to detect a 15% or greater difference in the proportion of infants and young children of ages 6m-23m fed according to the minimum acceptable diet between baseline and end of study in the intervention area and in the comparison area, with α =0.05 and 80% power, we would need a total of 530 infants and young children of ages 6m-23m, with a minimum of 265 in each arm. In order to have a consistent number of children 6-23m in each of 30 clusters, 265 was rounded up to 270 per arm yielding 9 children 6-23m per cluster. Rwanda ICSP Year 3 KPC Report Page 25 In order to measure indicators like exclusive breastfeeding, limited to infants 0-5 months, a minimum sample of 75 infants was recommended by MCHIP at baseline. That number was increased for the baseline and endline surveys to 90 in order to be evenly divisible by 30, so as to have the same number in each cluster. For the abridged monitoring surveys in years 2 and 3, this was reduced to 30 in order to have a simplified 30x10 cluster sample. In summary, the sample in each hospital zone totaled 300 mothers; 30 with children 0-5 months and 270 with children 6-23 months. The two 30x10 cluster samples combined totaled 600 interviews. Training For this survey, 44 interviewers were recruited from Health Center staff in charge of community health services and sector staff in charge of social affairs. Additionally, WR ICSP Rwanda staff, 2 WR headquarters staff and 4 UBC students participated as enumerators. Most enumerators participated in data collection in surveys for prior project years and were familiar with survey methodology. Interviewers were both men and women between 20 and 40 years of age, fluent in Kinyarwanda and had completed both secondary school and some level of higher technical education. The enumerators were trained by WR’s Regional Technical Advisor on how to administer the survey and use the PDA tablets the week before the survey was conducted. They went to a Health Center to receive training on anthropometric measurements, and conducted practice interviews in the field in Huye district one week before the survey was conducted. Data Collection The interviews took approximately 45 minutes per household to complete. The completion of the data collection for the 600 households took four days, starting on July 28, 2014 and ending on July 31, 2014. For four days, the teams simultaneously collected data in both the Kaduha and Kigeme zones. Data collection for the OR study was nested within the KPC due to limited resources. Supervisors reviewed completed questionnaires before leaving the village in which data had been collected to ensure completeness and accuracy of the forms. In the event of missed data, interviewers returned to the households to gather the missing information. The data was collected using electronic tablets and transferred into Excel on the WR-ISCP’s monitoring and evaluation staff’s computer. This removed the need for the manual transfer of data from questionnaires to an electronic database. The feasibility of doing electronic data collection was successfully pre-tested on the devices prior to data collection. Paper questionnaires were used if problems with the tablets were experienced. Rwanda ICSP Year 3 KPC Report Page 26 Data entry was completed by the WR Rwanda team and one UBC student with the entry of each questionnaire being double-checked for accuracy. Data cleaning was done by both the M&E Officers and MCH Regional Technical Advisor. The non-response rate in KPC surveys is typically negligible, as household selection happens at the time of the interview, which is non-invasive and well explained. If the mother was not available, an appointment was made to make another visit to the house later in the day. For the monitoring survey in year 3, the sample was the same as year two, with two 30x10 cluster samples in each arm (from 30 x 12 used at baseline), without parallel sampling. This was deemed sufficient for monitoring purposes and a better use of limited resources. There were no other major constraints or challenges with the survey. Data Analysis The data entry and analysis team consisted of WR Rwanda, WR Home Office Health technical unit staff and an outside consultant to perform data analysis on the nutrition indicators. Basic statistical analyses, primarily frequencies and ranges were conducted to identify any inconsistencies, so that the data could be cleaned accordingly. The Rapid Catch 2008 indicators and other project indicators were then calculated. All data was collected through electronic tablets by WR staff and fellow enumerators. This raw data was then synched with a main database and exported into Excel. This data was then transferred into PASW statistics 20 (formerly SPSS), STATA 10 or Epi Info. The data set was cleaned and checked for errors and inconsistencies. Exploratory analysis and descriptive analysis were performed. Project indicators were calculated using Excel and Epi Info for simple calculations, STATA for more complicated indicators and SMART) for anthropometry. Results See tables 3-5 below for detailed results on each indicator. Table 3. Demographic Information Demographic Information Kigeme Kaduha Mother’s Age Mean Median 28.96 28 28.85 28 Mother’s Education None/ Did not complete primary: 58.0% Primary: 37.67% Secondary: 4.33% Past Secondary: 0% None/ Did not complete primary: 57.67% Primary: 36.33% Secondary: 5% Past Secondary: 0.33% Household Size Mean 5.02 4.66 Rwanda ICSP Year 3 KPC Report Page 27 Median 5 4 Poverty Level (Ubudehe) 1. 4.67% 2. 19.67% 3. 70.0% 4. 5.33% 5. 0.33% 1. 4.33% 2. 26.0% 3. 66.0% 4. 3.67% 5. 0% Health Insurance (Mutuelle) Percent Yes (ConfInt) Percent No (ConfInt) 69.67% (58.9-80.3) 30.33% (19.6-41.1) 83.3% (77.4-89.2) 16.6% (10.8-22.6) Health Insurance Card Percent Yes (ConfInt) Percent No (ConfInt) 89.95% (79.8-100.0) 10.04% (0-20.1) 94.4% (90.6-98.2) 5.6% (1.8-9.4) Table 4. Indicator Results Indicator Location Numerator Denominator Year 3 KPC Value Confidence Limits I. Nutrition 1) Early initiation of breastfeeding: Percentage of children 0-23 months who were put to the breast within one hour of birth. (OR, Key Indicator MNC) Kaduha 247 300 82.3% 76.6-88.0 95% CI Kigeme 236 300 78.7% 72.9-84.4 95% CI 2) Prelacteal feeds: Percentage of children 0-23 months given liquids prior to the initiation of breastfeeding. Kaduha 11 300 3.7% 0.8-6.5 95% CI Kigeme 6 300 2.0% 0.5-3.5 95% CI 3) Exclusive breastfeeding: Percentage of children age 0-5 months who were exclusively breastfed during the last 24 hours. (RC6, OR) EBF disaggregation by age groups (recommended by WHO, if sufficient sample size) Kaduha 78 84 92.9% By age: 0-1 m: 91.4% 2-3 m: 94.3% 4-5 m: 84.0% 0-3 m: 93.1% 85.1-97.3 95% CI Kigeme 66 70 94.3% By age: 0-1 m: 96.0% 2-3 m: 96.8% 4-5 m: 80.0% 0-3 m: 95.7% 86.0-98.4 95% CI Indicator Location Numerator Denominator Year 3 KPC Value Confidence Limits Continued breastfeeding at 1 year (WHO core IYCF indicator, 2008) Kaduha 40 43 93.0% 85.2-100.0 95% CI Kigeme 49 50 98.0% 93.9-100.0 95% CI Rwanda ICSP Year 3 KPC Report Page 28 Continued breastfeeding at 2 years (WHO Optional IYCF indicator, 2008) Kaduha 29 33 87.9% 75.8-99.9 95% CI Kigeme 28 30 93.3% 83.9-100.0 95% CI Infant and Young Child Feeding Percent of infants and young children age 6-23 months fed according to: 4a) Minimum Dietary Diversity (OR) Kaduha 91 184 49.4% By age: 6-11m: 41.0% 12-17m: 54.9% 18-23m: 54.8% 42.0-56.9 95% CI Kigeme 81 206 39.3% By age: 6-11m: 36.3% 12-17m: 41.9% 18-23m : 38.5% 32.6-46.3 95% CI 4b) Minimum Meal Frequency (OR) Kaduha 133 189 70.4% 63.3-77.8 95% CI Kigeme 126 208 60.6% 53.6-67.3 95% CI 4c) Minimum Acceptable Diet Proportion of children 6-23 months who receive a minimum acceptable diet (apart from breast milk). (OR, RC adapted to WHO definition) Kaduha 73 189 38.6% 31.6-46.0 95%CI Kigeme 51 208 24.5% 18.8-30.9 95% CI 5) Consumption of iron-rich foods Kaduha 48 189 25.4% 17.2-33.6 95% CI Kigeme 25 208 12.0% 6.3-17.7 95% CI 6) Age appropriate introduction of semi-solid foods Proportion of infants 6–8 months of age who receive solid, semi-solid or soft foods (OR) Kaduha 15 19 78.9% 55.3-100.0 95% CI Kigeme 18 24 75.0% 57.5-92.5 95% CI 7) Responsive feeding: Percent of Caregivers who assist child when eating (of children who consume soft, semi-solid or solid foods) (OR) Kaduha 178 184 96.7% 93.8-99.6 95% CI Kigeme 190 200 95.0% 89.9-100.0 95% CI Indicator Location Numerator Denominator Year 3 KPC Value Confidence Limits 8) Underweight: Percentage of children 0-23 months who are underweight (-2 SD for the median weight for age, Kaduha 20 185 10.8% 7.1 – 16.1 95% CI Kigeme 33 188 17.6% 12.0-24.9 95% CI Rwanda ICSP Year 3 KPC Report Page 29 according to WHO reference population). (RC 18, OR) Disaggregate underweight by moderate (≤ -2SD and > -3SD) and severe (≤ -3SD) Yr 3 indicators calculated for 6 - 23 mos Kaduha Severe: Moderate: 6 14 185 185 3.2% 7.6% 1.5 -6.9% 95% CI 4.6 -12.3 95% CI Kigeme Severe: Moderate: 4 29 188 188 2.1% 15.4% 0.8 -5.5 95% CI 10.5 -22.2 95% CI 9) Wasted: Percentage of children 0 -23 months who are underweight for height ( -2SD for the median height for age, according to WH0 reference population) (OR) Kaduha 12 185 6.5% 3.5 -11.0 95% CI Kigeme 11 188 5.9% 2.8 -11.9 95% CI Disaggregate by moderate and severe wasting Yr 3 indicators calculated for 6 - 23 mos Kaduha Severe: Moderate: 2 10 185 185 1.1% 5.4% 0.3 -3.9 95% CI 3.0 -9.7 95% CI Kigeme Severe: Moderate: 1 10 188 188 0.5% 5.3% 0.1 -3.9 95% CI 2.6 -10.4 95% CI 10) Stunted: Percentage of children 0 -23 months who are under height/length for age ( - 2SD for the median height for age, according to WHO reference population) (OR) Kaduha 63 185 34.1% 27.6 - 41.1 95% CI Kigeme 62 188 33.0% 26.2 -40.5 95% CI Disaggregate stunting by moderate (≤ -2SD and > -3SD) and severe (≤ -3SD) Yr 3 indicators calculated for 6 - 23 mos Kaduha Severe: Moderate: 24 39 185 185 13.0% 21.1% 8.9 -18.6 95% CI 15.8 -27.5 95% CI Kigeme Severe: Moderate: 25 37 188 188 13.3% 19.7% 8.4 -20.4 95% CI 14.5 -26.2 95% CI Rwanda ICSP Year 3 KPC Report Page 30 11) Acute Malnutrition Children: Percent of children 6- 23 months as measured by MUAC (OR) References for children 6-23 m: SAM: <115mm MAM: ≥115 mm and < 125 mm Kaduha 1 185 0.5% 0.1-3.5 95% CI Kigeme 10 188 5.3% 2.8-9.8 95% CI Disaggregate by at risk, moderate and severe acute malnutrition Kaduha Severe: Moderate: 0 1 185 185 0.0% 0.5% 0.0-2.0 95% CI 0.1-3.0 95% CI Kigeme Severe: Moderate: 0 10 188 188 0.0% 5.3% 0.0-0.0 95% CI 2.8-9.8 95% CI Table 5. Indicator Results Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target Maternal & Newborn Care (35% LOE) Increase iron-folic acid supplement ation during pregnancy. Percentage of mothers who received tablets; average number of days consumed of those who received pills. (OR) Kaduha 81.0% received (CI: 74.2- 87.8%) Average days: 41.53 243 300 90% 60 days Kigeme 83.7% received (CI: 79.3- 88.0%) Average days: 42.00 251 300 90% 60 days Control of Diarrheal Diseases (15% LOE) Prevention Increase % of households that treat water effectively POU Water Tx: Percentage of households of children age 0-23 months that treat water effectively. (RC15, OR) Kaduha 75.7% (CI: 68.3- 83.0%) 227 300 65% Kigeme 57.0% (CI: 48.6-65.4) 171 300 65% Improve Percentage of Kaduha 73.7% 221 300 65% Rwanda ICSP Year 3 KPC Report Page 31 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target appropriate hand washing practices mothers of children age 0-23 months who live in households with soap at the place for hand washing. (RC16, OR) (CI: 63.5-83.9) Kigeme 73.0% (CI: 63.2- 82.8%) 219 300 65% Hand Washing at Appropriate times (tracking only) Percentage of mothers of children age 0-23 months who wash hands with soap at all four key times Kaduha 29.7% (CI: 19.7- 39.6%) 89 300 N/A Kigeme 15.3% (CI: 9.5-21.2%) 46 300 N/A Latrine/ toilet in good condition (tracking only) Percentage of households of children age 0-23 months that have a toilet facility in appropriate condition Kaduha 27.3% (CI : 19.3- 35.4%) 82 300 N/A Kigeme 23.3% (CI : 17.1- 29.6%) 70 300 N/A Safe feces disposal (tracking only) Percentage of mothers of children 0-23 months who disposed of the youngest child’s feces safely the last time a stool passed. (Key Indicator) Kaduha 80.7% (CI: 74.9- 86.5%) 242 300 N/A Kigeme 81.0% (CI: 75.6- 86.4%) 243 300 N/A Process Indicators related to CHWs and Nutrition Weeks Contact with CHW for health education: Percent of households with children 0-23 months that received health information from a CHW in the past month, according to location (home visit, community meeting, health facility, Growth Monitoring and Counseling, Nutrition Week, etc.) CHW Home Visits Percent of households with children 0-23 months that received a visit from a CHW in the past month, according to reported purpose Kaduha 61.7% (CI: 53.6- 69.8%) 185 300 75% Kigeme 36.7% (CI: 28.2- 45.1%) 110 300 75% Participation in Nutrition Weeks: Percentage of mothers with Kaduha 53.0% (CI : 44.3- 159 300 80% Rwanda ICSP Year 3 KPC Report Page 32 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target children 0-23 months who participated in “Nutrition Week” intervention at least once in the past 6 months for 4 or more days. 61.7%) Kigeme N/A n/a n/a NA Breastfeeding and Nutrition After three years, both Kigeme and Kaduha zones saw significant improvement in nutrition indicators over their baseline values. Both zones saw increases in immediate breastfeeding of newborns from year 2 to year 3, though they were significant only in the Kaduha zone (71.4% at year 2, 95%CI 66.26-76.5; 82.3% at year 3, 95%CI 76.6-88.0%) and not in Kigeme (72.6% at year 2, 95%CI 67.52-77.68; 78.7% at year 3, 95%CI 72.9-84.4%), where the confidence intervals overlapped. The two zones were not significantly different from each other at year 3, as their confidence levels overlapped. Prelacteal feeds, the percentage of children 0-23 months given liquids prior to the initiation of breastfeeding, were lower than their Year 2 values, though not significantly different between the two zones. Kaduha’s value decreased from year 2 to year 3, though the change was not significant. Kigeme’s decrease was a significant decrease from Year 2’s value (Kaduha, year 2: 6.4%, 95%CI 3.6-9.1%, year 3: 3.7%, 95%CI 0.8- 6.5%; Kigeme, year 2: 9.1%, 95%CI 5.8-12.3%, year 3:2.0%, 95%CI 0.5-3.5%). See Figures 1 and 2 for further explanation. Each of the three key indicators—minimum dietary diversity, minimum meal frequency and minimum acceptable diet—increased in Year 3 over their Year 2 values and were higher in the Kaduha zone than in Kigeme, though no change was significant (see Figures 3-5). For Minimum Dietary Diversity, Kaduha saw another year of improvement, increasing from 38.8% at year 2 to 49.4% at year 3 (95%CIs 32.1-45.4% and 42.0-56.9%, respectively). While Kigeme saw a drop in its baseline values to year 2 (38.89% at 0 20 40 60 80 100 Baseline Year 2 Year 3 Figure 1. Immediate Breastfeeding of Newborns Kaduha Kigeme 0 5 10 15 20 25 Baseline Year 2 Year 3 Figure 2. Prelacteal Feeding Kaduha Kigeme Rwanda ICSP Year 3 KPC Report Page 33 baseline to 31.0% at year 2, 95%CI: 24.9-37.0%), year 3 saw an increase to 39.3% (95%CI 32.6-46.3%). Minimum Meal Frequency increased in both zones from year 2, increasing from 66.5% to 70.4% in Kaduha (95%CIs 58.7-74.3% and 63.3-77.8% respectively) and from 50.9% to 60.6% in Kigeme (95%CIs 44.0-57.8% and 53.6-67.3%, respectively). The percentage of children aged 6-23 months who were fed to the Minimum Acceptable Diet (MAD, 2008 WHO Definition) increased from 32.5% to 38.6% in Kaduha from year 2 to year 3 (95%CI: 24.9-40.2% and 31.6-46.0%, respectively) and from 22.8% to 24.5% in Kigeme (95%CI 16.1-29.5% and 18.8-30.9%, respectively). The differences between the two zones at year 3 for MAD appear to be significant due to confidence intervals which do not overlap and similar baseline values which make them comparable. Deeper analysis using a Difference of Differences test could confirm this finding. Results were mixed for indicators on consumption of iron-rich foods, age-appropriate introduction of semi-solid foods and responsive feeding. The percentage of infants 6-23 months who consumed food rich in iron increased, though not significantly, in Kaduha in year 3 (15.3%, 95%CI 10.4-20.1% at year 2 to 25.4%, 95%CI 17.2-33.6% at year 3), while it decreased slightly in Kigeme in year 3 (12.8%, 95%CI 8.4- 17.1% at year 2 to 12.0%, 95%CI 6.3-17.7% at year 3, see Figure 6). Age appropriate introduction of semi-solid foods decreased slightly, though not significantly, in both zones from year 2 to year 3, with 0 20 40 60 80 100 Baseline Year 2 Year 3 Figure 3. Minimum Dietary Diversity Kaduha Kigeme 0 20 40 60 80 100 Baseline Year 2 Year 3 Figure 4. Minimum Meal Frequency Kaduha Kigeme 0 10 20 30 40 50 Baseline Year 2 Year 3 Figure 5. Minimum Acceptable Diet Kaduha Kigeme 0 10 20 30 40 50 Baseline Year 2 Year 3 Figure 6. Consumption of Iron-Rich Foods Kaduha Kigeme Rwanda ICSP Year 3 KPC Report Page 34 Kaduha decreasing from 81.0%(95%CI 69.1-92.8%) to 78.9% (95%CI 55.3-100%) and Kigeme decreasing from 79.1% (95%CI 66.9-91.2%) to 75.0% (95%CI 57.5-92.5%, see Figure 7). Responsive feeding increased in both areas, though not significantly over year 2 values (Kaduha year 2: 95.5%,95%CI 92.6- 98.3%, year 3:96.7%, 95%CI 93.8-99.6%; Kigeme year 2: 92.1%, 95%CI 88.4-95.7%, year 3: 95.0%, 95%CI 89.9-100.0%, see Figure 8). Anthropometry Anthropometric data for underweight, wasting, stunting and acute malnutrition was measured in this KPC for tracking purposes only. Indicators for year 3 were calculated using the SMART anthropometry tool, and therefore were only calculated for children 6-23 months old. Given this, significant differences were seen in the Kaduha zone for underweight for age (see Figures 9 and 10) and acute malnutrition as measured by MUAC (see Figures 13 and 14). No other significant changes occurred in either zone for wasting or stunting. The percentage of children who were underweight for age decreased significantly (over 50%) in Kaduha, with moderate underweight falling by more than half (Kaduha year 2: 21.7%,95%CI 17.0-27.2%, severe underweight: 5.7%, CI: 3.3-9.6%, moderate underweight: 16.0%, CI 11.9-21.1%; year 3: 10.8%, 95%CI 7.1-16.1%, severe underweight: 3.2%, CI: 1.5-6.9%, moderate underweight: 7.6%, CI 4.6-12.3%). In Kigeme, the percent of severe cases declined while moderate cases increased, resulting in a non￾significant increase from year 2 to year 3 (Kigeme year 2: 16.0%,95%CI 11.4-22.1%, severe underweight: 3.0%, CI: 1.5-5.8%, moderate underweight: 13.0%, CI 9.2-18.1%; year 3: 17.6%, 95%CI 12.0-24.9%, severe underweight: 2.1%, CI: 0.8-5.5%, moderate underweight: 15.4%, CI 10.5-22.2%). 0 20 40 60 80 100 Baseline Year 2 Year 3 Figure 7. Age-Appropriate Introduction of Semi-Solid Foods Kaduha Kigeme 0 20 40 60 80 100 Baseline Year 2 Year 3 Figure 8. Responsive Feeding Kaduha Kigeme Rwanda ICSP Year 3 KPC Report Page 35 Wasting, measured as the percent of children who are underweight for height, did not change significantly in either zone (see Figures 11 and 12). It did, however, decrease in Kaduha between year 2 and 3 (Kaduha year 2: 8.7%,95%CI 5.4-13.6%, severe wasting: 2.3%, CI: 1.0-5.2%, moderate wasting: 6.3%, CI 3.6-11.0%; year 3: 6.5%, 95%CI 3.7-11.0%, severe wasting: 1.1%, CI: 0.3-3.9%, moderate wasting: 5.4%, CI 3.0-9.7%) while increasing in the Kigeme zone (Kigeme year 2: 2.7%,95%CI 1.2-6.0%, severe wasting: 1.0%, CI: 0.2-4.4%, moderate wasting: 1.7%, CI 0.7-3.9%; year 3: 5.9%, 95%CI 2.8-11.9%, severe wasting: 0.5%, CI: 0.1-3.9%, moderate wasting: 5.3%, CI 2.6-10.4%). Acute malnutrition as measured by MUAC decreased significantly in Kaduha from year 2 to year 2, while increasing in Kigeme. The change in Kaduha was largely fueled by a significant decrease in Moderate Acute Malnutrition (MAM) cases, from 7.2% (95% CI: 4.1-12.4%) at year 2 to 0.5% (95% CI: 0.1-3.0%) at year 3. Severe Acute Malnutrition (SAM) cases also dropped from 2.4% (95% CI: 1.0-5.5%) at year 2 to 0.0% (95% CI: 0.0-2.0%) at year 3. Overall in Kaduha, cases of acute malnutrition significantly decreased from 9.6% (95% CI: 5.8-15.3%) at year 2 to 0.5% (95% CI: 0.1-3.0%) at year 3. In Kigeme, cases of acute malnutrition increased, though not significantly over year 2 (Kigeme year 2: 4.0%,95%CI 2.0-7.6%, SAM: 0.0%, CI: 0.0-0.0%, MAM: 4.0%, CI 2.0-7.6%; year 3: 5.3%, 95%CI 2.8-9.8%, SAM: 0.0%, CI: 0.0-0.0%, MAM: 5.3%, CI 2.8-9.8%). See Figures 13 and 14 below. 0 10 20 30 Baseline Year 2 Year 3 Figure 9. Underweight Prevalence-Kaduha Severe Underweight Moderate Underweight 0 10 20 30 Baseline Year 2 Year 3 Figure 10. Underweight Prevalence-Kigeme Severe Underweight Moderate Underweight 0 5 10 15 Baseline Year 2 Year 3 Figure 11. Wasting Prevalence, Kaduha Moderate Wasting Severe Wasting 0 5 10 15 Baseline Year 2 Year 3 Figure 12. Wasting Prevalence-Kigeme Moderate Wasting Severe Wasting Rwanda ICSP Year 3 KPC Report Page 36 Stunting was not significantly changed in either zone at year 3: in fact, it increased in Kaduha and decreased in Kigeme. Prevalence in Kaduha increased by less than one percent at year 3 (Kaduha year 2: 33.3%,95%CI 26.1-41.3%, severe stunting: 13.3%, CI: 9.3-18.8%, moderate stunting: 20.0%, CI 15.8- 27.5%; year 3: 34.1%, 95%CI 27.6-41.1%, severe stunting: 13.0%, CI: 8.9-18.6%, moderate stunting: 21.1%, CI 15.8-27.5%). In Kigeme, prevalence fell by one percent, though not a large enough decrease to be significant. In fact, severe stunting increased at year 3 while moderate stunting fell (Kigeme year 2: 34.0%,95%CI 26.9-41.9%, severe stunting: 11.7%, CI: 8.4-16.0%, moderate stunting: 22.3%, CI 17.6- 27.9%; year 3: 33.0%, 95%CI 26.2-40.5%, severe stunting: 13.3%, CI: 8.4-20.4%, moderate stunting: 19.7%, CI 14.5-26.2%). See Figures 15 and 16 below for visual representation. Maternal and Newborn Care 0 5 10 15 Baseline Year 2 Year 3 Figure 13. Acute Malnutrition Prevalence, Kaduha (as measured by MUAC) Severe Acute Malnutrition Moderate Acute Malnutrition 0 5 10 15 Baseline Year 2 Year 3 Figure 14. Acute Malnutrition Prevalence, Kigeme (as measured by MUAC) Severe Acute Malnutrition Moderate Acute Malnutrition 0 10 20 30 40 50 Baseline Year 2 Year 3 Figure 15. Stunting Prevalence, Kaduha Moderate Stunting Severe Stunting 0 10 20 30 40 50 Baseline Year 2 Year 3 Figure 16. Stunting Prevalence, Kigeme Moderate Stunting Severe Stunting Rwanda ICSP Year 3 KPC Report Page 37 The majority of Tangiraneza’s maternal and newborn care indicators were not measured in the abridged year 3 survey. Receipt and supplementation of iron/folic acid (IFA) tablets was, however, included in the survey. The percentage of mothers who received IFA tablets increased in both zones from year 2 to year 3, with a significant improvement in the Kigeme zone (Kaduha, year 2: 69.4%, 95%CI 64.1-76.6%, year 3: 81.0%, 95%CI 74.2-87.8%; Kigeme, year 2: 70.9%, 95%CI 65.7-76.0%, year 3:83.7%, 95%CI 79.3-88.0%). fThe increases in both zones brought both zones just above their baseline levels (Kaduha 40.5%, 95%CI 72.3-84.5; Kigeme 81.4%, 95% CI 77.4-85.4). Both zones also saw increases in the average number of days that mothers consumed the tablets over their baseline and year 2 values, with Kaduha increasing from 39.88 days at year 2 to 41.53 days at year 3 and Kigeme increasing from 33.45 days at year 2 to 42.0 days at year 3 (see Figure 16). Hygiene and Control of Diarrheal Diseases Following drastic improvements between baseline and year 2, key indicators for hygiene decreased at Year 3. The percentage of households who treat water effectively decreased significantly in both zones, though the decrease was smaller in Kaduha (Kaduha, year 2: 98.3%, 95%CI 96.6-99.9%, year 3: 75.7%, 95%CI 68.3-83.0%; Kigeme, year 2: 97.6%, 95%CI 95.2-99.9%, year 3: 57.0%, 95%CI 48.6-65.4%, see Figure 17). The percent of households that had soap at the place of hand washing decreased in a similar way, though the decrease was not significant in Kaduha (Kaduha, year 2: 78.1%, 95%CI 72.9-83.2%, year 3: 73.7%, 95%CI 63.5-83.9%; Kigeme, year 2: 89.4%, 95%CI 85.4-93.3%, year 3: 73.0%, 95%CI 63.2-82.8%, see Figure 18). The percentage of mothers who washed their hands at all four key times: before preparing food, before feeding their child, after using the latrine, and after changing their child’s diaper increased in both zones, though not significantly. While Kaduha was lower than Kigeme at baseline (though not significantly), Kaduha’s indicator at year 3 was almost double of Kigeme’s (Kaduha, year 2: 21.0%, 95%CI 16.3-25.6%, year 3: 29.7%, 95%CI 19.7-39.6%; Kigeme, year 2: 9.7%, 95%CI 6.3-13.0%, year 3: 15.3%, 95%CI 9.5-21.2%, see Figure 19). Rwanda ICSP Year 3 KPC Report Page 38 Community Health Workers and Nutrition Weeks The survey also measured process indicators related to CHW visits and the Nutrition Weeks intervention. The percent of households reporting that they received a home visit from a CHW in the past month increased in both zones from year 2 to year 3, though neither improvement was significant, due to overlapping confidence intervals. Participation in Nutrition Weeks (attending at least four days of one cycle in the last six months) stayed the same, at 53.0% in Kaduha. See Figures 19 and 20 for further explanation of these process indicators. 0 20 40 60 80 100 Baseline Year 2 Year 3 Figure 17. Households of children aged 0-23 months that treat water effectively Kaduha Kigeme 0 20 40 60 80 100 Baseline Year 2 Year 3 Figure 18. Households of children aged 0-23 months that have soap at the place of handwashing Kaduha Kigeme 0 10 20 30 40 50 Baseline Year 2 Year 3 Figure 19. Mothers of children aged 0-23 months who wash hands with soap at all four key times Kaduha Kigeme Rwanda ICSP Year 3 KPC Report Page 39 Discussion External Comparisons Overall, the year 3 KPC survey showed progress on most of the project’s key indicators. Many of the key indicators increased significantly after the first year of implementation, and gains were more modest at the year 3 survey. While some decreases did occur, only the key indicators for hygiene practices fell significantly. These issues, notably proper treatment of water and presence of soap at hand washing stations, will be re-emphasized through Modified Care Groups and other community mobilization efforts in the next year. Both zones saw progress in immediate breastfeeding of newborns and prelacteal feeding at year 3. Immediate breastfeeding increased in both areas, remaining above the EOP target of 70% (82% Kaduha; 79% Kigeme). Prelacteal feeds fell in both zones, and dropped by more than three quarters to 2% in Kigeme, helping surpass its EOP target of 3%. Kaduha has made strong progress in this area as well, with Prelacteal feeds falling to 3.7%, just short of the EOP target. Nutrition and IYCF practices improved in both zones, exceeding some EOP targets one year early. Minimum Dietary Diversity increased in both areas, reaching 49% in Kaduha and 39% in Kigeme, reaching toward EOP targets of 60% and 55%, respectively. Kaduha has more than doubled its MDD measurement since baseline, while Kigeme increased by 0.4% from baseline, well within the confidence limits, indicating no significant improvement. Minimum Meal Frequency increased in both areas, helping both to exceed EOP targets one year in advance (70% Kaduha, 61% Kigeme, EOP targets 55% Kaduha, 60% Kigeme). Minimum Acceptable Diet increased in both areas to 38% in Kaduha and 24% in Kigeme, though more progress will need to be made in the final year of implementation in order to reach the EOP targets of 50% in both zones. The larger increases in these nutrition indicators in the Kaduha zone suggest that the Nutrition Weeks intervention, with its emphasis on IYCF, is making a greater impact on nutrition outcomes than the standard MOH CBNP on its own. 0 20 40 60 80 100 Baseline Year 2 Year 3 Figure 20. Households that received a CHW visit in the last month Kaduha Kigeme 0 20 40 60 80 100 Baseline Year 2 Year 3 Figure 21. Participation in Nutrition Weeks in the last 6 months for 4 or more days (Kaduha Zone only) Rwanda ICSP Year 3 KPC Report Page 40 Improvements in consumption of iron-rich foods in Kaduha (to 25%) were not significant, and neither was the slight decrease in Kigeme (from 12.8% to 12.0%). Both need further emphasis in order to reach the EOP target of 50%. Age appropriate introduction of complementary foods fell in both zones, but both zones still are at or above their EOP target of 75%. Stock outs in IFA tablets at year 2 resulted in large decreases in the percentage of mothers who received supplements. This issue was addressed and levels in both zones returned to slightly above what they were at baseline. The average number of days that pills were consumed increased in both zones as well (to 41.5 in Kaduha and 42 in Kigeme), indicating that the emphasis that ASMs and MCGs give on taking IFA is helping improve these behaviors. Both receipt and consumption still fall under EOP targets of 90% (receipt of IFA) and 60 days (consumption). Point-of-use water treatment decreased at year 3, at least partly because the cost of Sur-Eau (chlorine treatment) more than doubled from 150Rwf to 350Rwf. The project will promote boiling water next year. Qualitative inquiry that accompanied the KPC revealed that construction of latrines and tippy taps was considered difficult by the community, partially explaining why the survey found that few HH have them (latrines: 27%-Kaduha, 23%-Kigeme; neither a significant improvement from yr2). At the same time, improvements in handwashing at the four key times and the percentage of mothers safely disposing of their child’s waste show that hygiene behaviors are improving in both zones and redoubled efforts in hygiene should be focused on key areas, keeping this survey data in mind. The percentage of households receiving a visit from a CHW in the past month increased in both zones, though not significantly. Kaduha recorded much higher rates than Kigeme, with 62% of households recieveing visits in Kaduha as compared to 37% in Kigeme, both short of the 75% EOP target. Nutrition Weeks may cause CHWs to visit households more often, which may explain the disparity between zones. Attendance at NWs remained the same at year 3, however, falling short of the EOP target of 80%, at 53%. Physical support of NWs (namely, ingredients for cooking demonstrations) was withdrawn during Year 2, and mothers were encouraged to contribute their own supplies for sessions. This may be one reason why attendance did not increase, though it is encouraging that these steps toward sustainability of NWs did not result in a decrease in attendance. Programmatic Implications of Findings Improvements in breastfeeding and IYCF indicators are encouraging and show that program interventions are working to improve behaviors in both zones. Declines in hygiene-related indicators must result in redoubled programmatic efforts in hygiene. Given that qualitative data has helped identify barriers to these behaviors (cost of Sur Eau, attitudes on building handwashing stations), the project will utilize MCGs and religious leaders to mobilize communities around these issues. Tangiraneza staff meet with religious leaders on a quarterly basis to plan BCC activities in churches, including the dissemination of key messages, support of MCG church members and support of Rwanda ICSP Year 3 KPC Report Page 41 vulnerable families in getting health insurance, good latrines, kitchen gardens and (occasionally) livestock. By using all avenues of community mobilization and relying heavily on MCGs and religious leaders to address the shortcomings found in these survey results, Tangiraneza hopes to make significant progress and reach all of its EOP targets at the year 4 KPC survey. The goal of Tanigraneza’s innovation Nutrition Weeks is to reduce and prevent undernutrition, as it contributes to stunted growth. While no significant changes were seen between years two and three in stunting prevalence, the significant decrease in severe stunting which was maintained since the baseline in Kaduha (as opposed to a stable, even increased rate of severe stunting in Kigeme) is encouraging looking at this goal. Furthermore, both Underweight and acute malnutrition cases fell significantly in Kaduha at year 3 (underweight fell by half and SAM/MAM fell by 95%), while they increased in Kigeme. As the Nutrition Weeks intervention was the only difference between program activities in these two zones, it is possible that Nutrition Weeks can have an impact not just on stunting, but on in the treatment and prevention of acute malnutrition as well. Overall, the data suggest that NWs is a more effective method to improve diet for young children (with the goal of reducing stunting) than other community mobilization techniques (MCGs). The project will continue working with the MOH and sharing NW results and experiences with the goal of influencing national policy. Community Feedback and Dissemination of Findings Tangiraneza participates in annual project assessments, where results from this survey will be shared with the community, local stakeholders and the MOH, including Nyamagabe District Ministry of Health officials and staff from the Kigeme and Kaduha hospitals, in order to influence project planning and implementation. Results will also be shared with the national Nutrition Technical Working Group, in which World Relief is an active participant. The project continues to share data with policy makers and hopes that its approaches, namely NWs, may be integrated into national nutrition policy. However, certain factors, such as cooking demonstrations at GMP sessions, may make this difficult. 42 Annex 1. Raw Data for Each Survey Question INNOVATION CHILD SURVIVAL TANGIRANEZA PROGRAM NYAMAGABE DISTRICT WRR YEAR 3 KPC RAW DATA GET DATA /TYPE=XLSX /FILE='C:\Users\wrr\Desktop\KPC 3yrs\YEAR 3 WRR KPC DATABASE AUGUST 18 2014.xlsx' /SHEET=name 'Database 12_08_2014' /CELLRANGE=full /READNAMES=on /ASSUMEDSTRWIDTH=32767. DATASET NAME DataSet1 WINDOW=FRONT. SORT CASES BY HospitalCatchment. SPLIT FILE LAYERED BY HospitalCatchment. FREQUENCIES VARIABLES=MotherConsent /ORDER=ANALYSIS. i10) Was consent received? Frequencies [DataSet1] Statistics MotherConsent Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 MotherConsent HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 1 300 100,0 100,0 100,0 Kaduha Valid 1 300 100,0 100,0 100,0 FREQUENCIES VARIABLES=SexChild /ORDER=ANALYSIS. Frequencies Sex Child [DataSet1] Statistics SexChild Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 SexChild HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Rwanda ICSP Year 3 KPC Report Page 43 Kigeme Valid Male 159 53,0 53,0 53,0 Female 141 47,0 47,0 100,0 Total 300 100,0 100,0 Kaduha Valid Male 153 51,0 51,0 51,0 Female 147 49,0 49,0 100,0 Total 300 100,0 100,0 AGE OF A CHILD UNDER 2 YEARS FREQUENCIES VARIABLES=CalcAgeChild /STATISTICS=STDDEV MINIMUM MAXIMUM MEAN MEDIAN MODE /ORDER=ANALYSIS. [DataSet1] GET DATA /TYPE=XLSX /FILE='C:\Users\wrr\Desktop\KPC 3yrs\YEAR 3 WRR KPC DATABASE AUGUST 18 2014.xlsx' /SHEET=name 'Database 12_08_2014' /CELLRANGE=full /READNAMES=on /ASSUMEDSTRWIDTH=32767. DATASET NAME DataSet1 WINDOW=FRONT. SORT CASES BY HospitalCatchment. SPLIT FILE LAYERED BY HospitalCatchment. FREQUENCIES VARIABLES=CalcAgeChild /STATISTICS=STDDEV MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics CalcAgeChild Kigeme N Valid 300 Missing 0 Mean 10,877 Median 11,000 Std. Deviation 6,7533 Kaduha N Valid 300 Missing 0 Mean 10,857 Median 11,000 Std. Deviation 7,3509 CalcAgeChild HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 0 11 3,7 3,7 3,7 1 14 4,7 4,7 8,3 2 17 5,7 5,7 14,0 3 14 4,7 4,7 18,7 4 14 4,7 4,7 23,3 5 11 3,7 3,7 27,0 6 11 3,7 3,7 30,7 7 12 4,0 4,0 34,7 Rwanda ICSP Year 3 KPC Report Page 44 8 14 4,7 4,7 39,3 9 12 4,0 4,0 43,3 10 14 4,7 4,7 48,0 11 17 5,7 5,7 53,7 12 19 6,3 6,3 60,0 13 17 5,7 5,7 65,7 14 13 4,3 4,3 70,0 15 5 1,7 1,7 71,7 16 10 3,3 3,3 75,0 17 10 3,3 3,3 78,3 18 12 4,0 4,0 82,3 19 12 4,0 4,0 86,3 20 10 3,3 3,3 89,7 21 10 3,3 3,3 93,0 22 8 2,7 2,7 95,7 23 13 4,3 4,3 100,0 Total 300 100,0 100,0 Kaduha Valid 0 20 6,7 6,7 6,7 1 15 5,0 5,0 11,7 2 23 7,7 7,7 19,3 3 12 4,0 4,0 23,3 4 14 4,7 4,7 28,0 5 11 3,7 3,7 31,7 6 9 3,0 3,0 34,7 7 10 3,3 3,3 38,0 8 6 2,0 2,0 40,0 9 13 4,3 4,3 44,3 10 9 3,0 3,0 47,3 11 14 4,7 4,7 52,0 12 14 4,7 4,7 56,7 13 14 4,7 4,7 61,3 14 15 5,0 5,0 66,3 15 12 4,0 4,0 70,3 16 9 3,0 3,0 73,3 17 7 2,3 2,3 75,7 18 12 4,0 4,0 79,7 19 12 4,0 4,0 83,7 20 10 3,3 3,3 87,0 21 9 3,0 3,0 90,0 22 10 3,3 3,3 93,3 23 20 6,7 6,7 100,0 Total 300 100,0 100,0 FREQUENCIES VARIABLES=Age2 /ORDER=ANALYSIS. Frequencies Age2 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Rwanda ICSP Year 3 KPC Report Page 45 Kigeme Valid 0-5m 81 27,0 27,0 27,0 6-23m 219 73,0 73,0 100,0 Total 300 100,0 100,0 Kaduha Valid 0-5m 95 31,7 31,7 31,7 6-23m 205 68,3 68,3 100,0 Total 300 100,0 100,0 Frequencies [DataSet1] GET DATA /TYPE=XLSX /FILE='C:\Users\wrr\Desktop\KPC 3yrs\YEAR 3 WRR KPC DATABASE AUGUST 18 2014.xlsx' /SHEET=name 'Database 12_08_2014' /CELLRANGE=full /READNAMES=on /ASSUMEDSTRWIDTH=32767. DATASET NAME DataSet1 WINDOW=FRONT. SORT CASES BY HospitalCatchment. SPLIT FILE LAYERED BY HospitalCatchment. FREQUENCIES VARIABLES=Age2 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics Age2 . N Valid 1 Missing 0 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 Age2 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent . Valid 1 100,0 100,0 100,0 Kigeme Valid 0-5m 81 27,0 27,0 27,0 6-23m 219 73,0 73,0 100,0 Total 300 100,0 100,0 Kaduha Valid 0-5m 95 31,7 31,7 31,7 6-23m 205 68,3 68,3 100,0 Total 300 100,0 100,0 USE ALL. COMPUTE filter_$=(CalcAgeChild < 6). VARIABLE LABEL filter_$ 'CalcAgeChild < 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Age3 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics Rwanda ICSP Year 3 KPC Report Page 46 Age3 Kigeme N Valid 81 Missing 0 Kaduha N Valid 95 Missing 0 Age3 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 0-1m 25 30,9 30,9 30,9 2-3m 31 38,3 38,3 69,1 4-5m 25 30,9 30,9 100,0 Total 81 100,0 100,0 Kaduha Valid 0-1m 35 36,8 36,8 36,8 2-3m 35 36,8 36,8 73,7 4-5m 25 26,3 26,3 100,0 Total 95 100,0 100,0 USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=Age4 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics Age4 Kigeme N Valid 219 Missing 0 Kaduha N Valid 205 Missing 0 Age4 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 12-17m 74 33,8 33,8 33,8 18-23m 65 29,7 29,7 63,5 6-11m 80 36,5 36,5 100,0 Total 219 100,0 100,0 Kaduha Valid 12-17m 71 34,6 34,6 34,6 18-23m 73 35,6 35,6 70,2 6-11m 61 29,8 29,8 100,0 Total 205 100,0 100,0 FILTER OFF. USE ALL. EXECUTE. CROSSTABS /TABLES=SexChild BY Age2 /FORMAT=AVALUE TABLES /CELLS=COUNT ROW Rwanda ICSP Year 3 KPC Report Page 47 /COUNT ROUND CELL. Crosstabs Sex child [DataSet1] Case Processing Summary HospitalCatchment Cases Valid Missing Total N Percent N Percent N Percent Kigeme SexChild * Age2 300 100,0% 0 ,0% 300 100,0% Kaduha SexChild * Age2 300 100,0% 0 ,0% 300 100,0% SexChild * Age2 Crosstabulation HospitalCatchment Age2 0-5m 6-23m Total Kigeme SexChild Male Count 43 116 159 % within SexChild 27,0% 73,0% 100,0% Female Count 38 103 141 % within SexChild 27,0% 73,0% 100,0% Total Count 81 219 300 % within SexChild 27,0% 73,0% 100,0% Kaduha SexChild Male Count 47 106 153 % within SexChild 30,7% 69,3% 100,0% Female Count 48 99 147 % within SexChild 32,7% 67,3% 100,0% Total Count 95 205 300 % within SexChild 31,7% 68,3% 100,0% FREQUENCIES VARIABLES=AgeMother /STATISTICS=MINIMUM MAXIMUM MEAN MEDIAN /ORDER=ANALYSIS. Frequencies Age Mother [DataSet1] Statistics AgeMother . N Valid 0 Missing 1 Kigeme N Valid 300 Missing 0 Mean 28,96 Median 28,00 Minimum 17 Maximum 46 Kaduha N Valid 300 Missing 0 Mean 28,85 Median 28,00 Minimum 17 Maximum 45 Rwanda ICSP Year 3 KPC Report Page 48 AgeMother HospitalCatchment Frequency Percent Valid Percent Cumulative Percent . Missing System 1 100,0 Kigeme Valid 17 1 ,3 ,3 ,3 19 2 ,7 ,7 1,0 20 14 4,7 4,7 5,7 21 11 3,7 3,7 9,3 22 23 7,7 7,7 17,0 23 15 5,0 5,0 22,0 24 12 4,0 4,0 26,0 25 24 8,0 8,0 34,0 26 21 7,0 7,0 41,0 27 18 6,0 6,0 47,0 28 18 6,0 6,0 53,0 29 17 5,7 5,7 58,7 30 20 6,7 6,7 65,3 31 13 4,3 4,3 69,7 32 17 5,7 5,7 75,3 33 7 2,3 2,3 77,7 34 9 3,0 3,0 80,7 35 12 4,0 4,0 84,7 36 4 1,3 1,3 86,0 37 4 1,3 1,3 87,3 38 7 2,3 2,3 89,7 39 6 2,0 2,0 91,7 40 6 2,0 2,0 93,7 41 3 1,0 1,0 94,7 42 6 2,0 2,0 96,7 43 4 1,3 1,3 98,0 44 3 1,0 1,0 99,0 46 3 1,0 1,0 100,0 Total 300 100,0 100,0 Kaduha Valid 17 1 ,3 ,3 ,3 18 1 ,3 ,3 ,7 19 2 ,7 ,7 1,3 20 4 1,3 1,3 2,7 21 10 3,3 3,3 6,0 22 11 3,7 3,7 9,7 23 20 6,7 6,7 16,3 24 29 9,7 9,7 26,0 25 28 9,3 9,3 35,3 26 22 7,3 7,3 42,7 27 12 4,0 4,0 46,7 28 17 5,7 5,7 52,3 29 17 5,7 5,7 58,0 30 24 8,0 8,0 66,0 31 14 4,7 4,7 70,7 32 14 4,7 4,7 75,3 33 14 4,7 4,7 80,0 34 11 3,7 3,7 83,7 Rwanda ICSP Year 3 KPC Report Page 49 35 5 1,7 1,7 85,3 36 9 3,0 3,0 88,3 37 6 2,0 2,0 90,3 38 2 ,7 ,7 91,0 39 11 3,7 3,7 94,7 40 4 1,3 1,3 96,0 41 6 2,0 2,0 98,0 42 3 1,0 1,0 99,0 43 1 ,3 ,3 99,3 44 1 ,3 ,3 99,7 45 1 ,3 ,3 100,0 Total 300 100,0 100,0 FREQUENCIES VARIABLES=AgeMother /STATISTICS=MINIMUM MAXIMUM MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics AgeMother . N Valid 0 Missing 1 Kigeme N Valid 300 Missing 0 Mean 28,96 Median 28,00 Minimum 17 Maximum 46 Kaduha N Valid 300 Missing 0 Mean 28,85 Median 28,00 Minimum 17 Maximum 45 AgeMother HospitalCatchment Frequency Percent Valid Percent Cumulative Percent . Missing System 1 100,0 Kigeme Valid 17 1 ,3 ,3 ,3 19 2 ,7 ,7 1,0 20 14 4,7 4,7 5,7 21 11 3,7 3,7 9,3 22 23 7,7 7,7 17,0 23 15 5,0 5,0 22,0 24 12 4,0 4,0 26,0 25 24 8,0 8,0 34,0 26 21 7,0 7,0 41,0 27 18 6,0 6,0 47,0 28 18 6,0 6,0 53,0 Rwanda ICSP Year 3 KPC Report Page 50 29 17 5,7 5,7 58,7 30 20 6,7 6,7 65,3 31 13 4,3 4,3 69,7 32 17 5,7 5,7 75,3 33 7 2,3 2,3 77,7 34 9 3,0 3,0 80,7 35 12 4,0 4,0 84,7 36 4 1,3 1,3 86,0 37 4 1,3 1,3 87,3 38 7 2,3 2,3 89,7 39 6 2,0 2,0 91,7 40 6 2,0 2,0 93,7 41 3 1,0 1,0 94,7 42 6 2,0 2,0 96,7 43 4 1,3 1,3 98,0 44 3 1,0 1,0 99,0 46 3 1,0 1,0 100,0 Total 300 100,0 100,0 Kaduha Valid 17 1 ,3 ,3 ,3 18 1 ,3 ,3 ,7 19 2 ,7 ,7 1,3 20 4 1,3 1,3 2,7 21 10 3,3 3,3 6,0 22 11 3,7 3,7 9,7 23 20 6,7 6,7 16,3 24 29 9,7 9,7 26,0 25 28 9,3 9,3 35,3 26 22 7,3 7,3 42,7 27 12 4,0 4,0 46,7 28 17 5,7 5,7 52,3 29 17 5,7 5,7 58,0 30 24 8,0 8,0 66,0 31 14 4,7 4,7 70,7 32 14 4,7 4,7 75,3 33 14 4,7 4,7 80,0 34 11 3,7 3,7 83,7 35 5 1,7 1,7 85,3 36 9 3,0 3,0 88,3 37 6 2,0 2,0 90,3 38 2 ,7 ,7 91,0 39 11 3,7 3,7 94,7 40 4 1,3 1,3 96,0 41 6 2,0 2,0 98,0 42 3 1,0 1,0 99,0 43 1 ,3 ,3 99,3 44 1 ,3 ,3 99,7 45 1 ,3 ,3 100,0 Total 300 100,0 100,0 Frequencies Rwanda ICSP Year 3 KPC Report Page 51 i15) Are you the biological mother of the child? [DataSet1] FREQUENCIES VARIABLES=BiologicalMother /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics BiologicalMother Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 BiologicalMother HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 300 100,0 100,0 100,0 Kaduha Valid Yes 300 100,0 100,0 100,0 1.Have you ever attended school FREQUENCIES VARIABLES=q01 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q01 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q01 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 63 21,0 21,0 21,0 Yes 237 79,0 79,0 100,0 Total 300 100,0 100,0 Kaduha Valid No 60 20,0 20,0 20,0 Yes 240 80,0 80,0 100,0 Total 300 100,0 100,0 2.What is the highest grade or level of school you have completed? USE ALL. COMPUTE filter_$=(q01 = 1). VARIABLE LABEL filter_$ 'q01 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q02 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics Rwanda ICSP Year 3 KPC Report Page 52 q02 Kigeme N Valid 237 Missing 0 Kaduha N Valid 240 Missing 0 q02 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid None/Did not complete primary 111 46,8 46,8 46,8 Primary 113 47,7 47,7 94,5 Secondary 13 5,5 5,5 100,0 Total 237 100,0 100,0 Kaduha Valid None/Did not complete primary 113 47,1 47,1 47,1 Primary 109 45,4 45,4 92,5 Secondary 15 6,2 6,2 98,8 Past secondary 1 ,4 ,4 99,2 Other 2 ,8 ,8 100,0 Total 240 100,0 100,0 3.How many people live in your household? FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q03 /STATISTICS=MINIMUM MAXIMUM MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q03 Kigeme N Valid 300 Missing 0 Mean 5,02 Median 5,00 Minimum 3 Maximum 10 Kaduha N Valid 300 Missing 0 Mean 4,66 Median 4,00 Minimum 2 Maximum 10 q03 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 3 81 27,0 27,0 27,0 4 60 20,0 20,0 47,0 5 59 19,7 19,7 66,7 6 37 12,3 12,3 79,0 7 24 8,0 8,0 87,0 8 21 7,0 7,0 94,0 Rwanda ICSP Year 3 KPC Report Page 53 9 11 3,7 3,7 97,7 10 7 2,3 2,3 100,0 Total 300 100,0 100,0 Kaduha Valid 2 5 1,7 1,7 1,7 3 83 27,7 27,7 29,3 4 71 23,7 23,7 53,0 5 62 20,7 20,7 73,7 6 42 14,0 14,0 87,7 7 15 5,0 5,0 92,7 8 14 4,7 4,7 97,3 9 4 1,3 1,3 98,7 10 4 1,3 1,3 100,0 Total 300 100,0 100,0 4. What is your ubudehe category FREQUENCIES VARIABLES=Q04 /ORDER=ANALYSIS. Frequencies. [DataSet1] Statistics Q04 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 Q04 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Those in abject porverty 14 4,7 4,7 4,7 Very poor 59 19,7 19,7 24,3 The poor 210 70,0 70,0 94,3 The resourceful poor 16 5,3 5,3 99,7 The food rich 1 ,3 ,3 100,0 Total 300 100,0 100,0 Kaduha Valid Those in abject porverty 13 4,3 4,3 4,3 Very poor 78 26,0 26,0 30,3 The poor 198 66,0 66,0 96,3 The resourceful poor 11 3,7 3,7 100,0 Total 300 100,0 100,0 4b.Are you using health insurance? FREQUENCIES VARIABLES=Q4b /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics Q4b Kigeme N Valid 300 Rwanda ICSP Year 3 KPC Report Page 54 Missing 0 Kaduha N Valid 300 Missing 0 Q4b HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 91 30,3 30,3 30,3 Yes 209 69,7 69,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 50 16,7 16,7 16,7 Yes 250 83,3 83,3 100,0 Total 300 100,0 100,0 4c.If yes:Can I see your member card? USE ALL. COMPUTE filter_$=(Q4b=1). VARIABLE LABEL filter_$ 'Q4b=1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=4c /ORDER=ANALYSIS. Frequencies [DataSet1] FREQUENCIES VARIABLES=Q4c /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics Q4c Kigeme N Valid 209 Missing 0 Kaduha N Valid 250 Missing 0 Q4c HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No card 21 10,0 10,0 10,0 Card availabe 188 90,0 90,0 100,0 Total 209 100,0 100,0 Kaduha Valid No card 14 5,6 5,6 5,6 Card availabe 236 94,4 94,4 100,0 Total 250 100,0 100,0 21.If biological mother (i15) ask: During your pregnancy with (Name), were you given or did you buy any iron tablets/syrup? USE ALL. COMPUTE filter_$=(BiologicalMother = 1). VARIABLE LABEL filter_$ 'BiologicalMother = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. Rwanda ICSP Year 3 KPC Report Page 55 FREQUENCIES VARIABLES=q21 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q21 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q21 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 49 16,3 16,3 16,3 Yes 251 83,7 83,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 57 19,0 19,0 19,0 Yes 243 81,0 81,0 100,0 Total 300 100,0 100,0 22.During the whole pregnancy, for how many days did you take the tablets/syrup? USE ALL. COMPUTE filter_$=(q21 = 1 AND q22 < 888). VARIABLE LABEL filter_$ 'q21 = 1 AND q22 < 888 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q22 /STATISTICS=MINIMUM MAXIMUM MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q22 Kigeme N Valid 247 Missing 0 Mean 42,00 Median 30,00 Minimum 1 Maximum 180 Kaduha N Valid 243 Missing 0 Mean 41,53 Median 30,00 Minimum 1 Maximum 150 q22 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 1 11 4,5 4,5 4,5 2 5 2,0 2,0 6,5 Rwanda ICSP Year 3 KPC Report Page 56 3 5 2,0 2,0 8,5 4 3 1,2 1,2 9,7 5 1 ,4 ,4 10,1 6 1 ,4 ,4 10,5 7 5 2,0 2,0 12,6 10 4 1,6 1,6 14,2 12 1 ,4 ,4 14,6 14 3 1,2 1,2 15,8 15 4 1,6 1,6 17,4 18 1 ,4 ,4 17,8 20 2 ,8 ,8 18,6 21 3 1,2 1,2 19,8 22 1 ,4 ,4 20,2 24 2 ,8 ,8 21,1 25 1 ,4 ,4 21,5 27 1 ,4 ,4 21,9 28 2 ,8 ,8 22,7 30 95 38,5 38,5 61,1 31 1 ,4 ,4 61,5 32 1 ,4 ,4 61,9 40 1 ,4 ,4 62,3 50 2 ,8 ,8 63,2 60 51 20,6 20,6 83,8 72 1 ,4 ,4 84,2 80 1 ,4 ,4 84,6 85 1 ,4 ,4 85,0 88 2 ,8 ,8 85,8 90 32 13,0 13,0 98,8 120 2 ,8 ,8 99,6 180 1 ,4 ,4 100,0 Total 247 100,0 100,0 Kaduha Valid 1 3 1,2 1,2 1,2 2 2 ,8 ,8 2,1 3 1 ,4 ,4 2,5 4 1 ,4 ,4 2,9 7 2 ,8 ,8 3,7 8 2 ,8 ,8 4,5 14 4 1,6 1,6 6,2 15 4 1,6 1,6 7,8 20 5 2,1 2,1 9,9 21 3 1,2 1,2 11,1 25 5 2,1 2,1 13,2 28 2 ,8 ,8 14,0 30 126 51,9 51,9 65,8 31 1 ,4 ,4 66,3 32 2 ,8 ,8 67,1 40 4 1,6 1,6 68,7 45 6 2,5 2,5 71,2 Rwanda ICSP Year 3 KPC Report Page 57 46 1 ,4 ,4 71,6 50 1 ,4 ,4 72,0 60 32 13,2 13,2 85,2 62 1 ,4 ,4 85,6 88 3 1,2 1,2 86,8 90 31 12,8 12,8 99,6 150 1 ,4 ,4 100,0 Total 243 100,0 100,0 29.Did you ever breastfeed (NAME)? USE ALL. COMPUTE filter_$=(BiologicalMother = 1). VARIABLE LABEL filter_$ 'BiologicalMother = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q29 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q29 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q29 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 1 300 100,0 100,0 100,0 Kaduha Valid 1 300 100,0 100,0 100,0 FREQUENCIES VARIABLES=q29 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q29 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q29 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 300 100,0 100,0 100,0 Kaduha Valid Yes 300 100,0 100,0 100,0 30.How long after birth did you first put (NAME) to the breast? USE ALL. COMPUTE filter_$=(q29 = 1). VARIABLE LABEL filter_$ 'q29 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. Rwanda ICSP Year 3 KPC Report Page 58 FREQUENCIES VARIABLES=q30u /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q30u Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q30u HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Less than 1 hour 236 78,7 78,7 78,7 Hours 56 18,7 18,7 97,3 Days 8 2,7 2,7 100,0 Total 300 100,0 100,0 Kaduha Valid Less than 1 hour 247 82,3 82,3 82,3 Hours 43 14,3 14,3 96,7 Days 10 3,3 3,3 100,0 Total 300 100,0 100,0 31.During the first three days after delivery, did you give (NAME) the liquid that came from your breasts? FREQUENCIES VARIABLES=q31 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q31 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q31 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 4 1,3 1,3 1,3 Yes 296 98,7 98,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 3 1,0 1,0 1,0 Yes 297 99,0 99,0 100,0 Total 300 100,0 100,0 32. During the first three days after delivery, was (NAME) given anything to drink other than breast milk? FREQUENCIES VARIABLES=q32 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics Rwanda ICSP Year 3 KPC Report Page 59 q32 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q32 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 292 97,3 97,3 97,3 Yes 6 2,0 2,0 99,3 Don't know 2 ,7 ,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 289 96,3 96,3 96,3 Yes 11 3,7 3,7 100,0 Total 300 100,0 100,0 33.What else was (NAME) given to drink during the first three days? USE ALL. COMPUTE filter_$=(q32 = 1). VARIABLE LABEL filter_$ 'q32 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. /ORDER=ANALYSIS. Frequencies [DataSet1] FREQUENCIES VARIABLES=q33 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q33 Kigeme N Valid 6 Missing 0 Kaduha N Valid 11 Missing 0 q33 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Milk (Other than breast milk 1 16,7 16,7 16,7 Milk (Other than breast milk) Plain water 1 16,7 16,7 33,3 Plain water 3 50,0 50,0 83,3 Other 1 16,7 16,7 100,0 Total 6 100,0 100,0 Kaduha Valid Milk (Other than breast milk 2 18,2 18,2 18,2 Plain water 7 63,6 63,6 81,8 Plain water , sugar or glucose water 1 9,1 9,1 90,9 Other 1 9,1 9,1 100,0 Rwanda ICSP Year 3 KPC Report Page 60 Statistics q33 Kigeme N Valid 6 Missing 0 Kaduha N Valid 11 Total 11 100,0 100,0 34.Was (NAME) breastfed yesterday during the day or at night? USE ALL. COMPUTE filter_$=(q29 = 1). VARIABLE LABEL filter_$ 'q29 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q34 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q34 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q34 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 15 5,0 5,0 5,0 Yes 285 95,0 95,0 100,0 Total 300 100,0 100,0 Kaduha Valid No 16 5,3 5,3 5,3 Yes 284 94,7 94,7 100,0 Total 300 100,0 100,0 35.Did (NAME) consume breast milk in any of these ways yesterday during the day or at night? USE ALL. COMPUTE filter_$=(q34 = 0). VARIABLE LABEL filter_$ 'q34 = 0 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q35 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q35 Kigeme N Valid 15 Missing 0 Kaduha N Valid 16 Missing 0 q35 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Rwanda ICSP Year 3 KPC Report Page 61 Kigeme Valid No 13 86,7 86,7 86,7 Yes 2 13,3 13,3 100,0 Total 15 100,0 100,0 Kaduha Valid No 14 87,5 87,5 87,5 Yes 2 12,5 12,5 100,0 Total 16 100,0 100,0 36. Was (NAME) given any vitamin drops or other medicines as drops yesterday during the day or night? FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q36a Frequencies [DataSet1] Statistics q36a Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q36a HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 286 95,3 95,3 95,3 Yes 14 4,7 4,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 290 96,7 96,7 96,7 Yes 9 3,0 3,0 99,7 Don't know 1 ,3 ,3 100,0 Total 300 100,0 100,0 37.Was (NAME) given ORS yesterday during the day or at night? FREQUENCIES VARIABLES=37a /ORDER=ANALYSIS. Frequencies [DataSet1] FREQUENCIES VARIABLES=q37a /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q37a Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q37a HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 0 295 98,3 98,3 98,3 Rwanda ICSP Year 3 KPC Report Page 62 Yes 5 1,7 1,7 100,0 Total 300 100,0 100,0 Kaduha Valid 0 294 98,0 98,0 98,0 Yes 6 2,0 2,0 100,0 Total 300 100,0 100,0 38.Did (NAME) drink anything from a bottle with a nipple yesterday or last night? FREQUENCIES VARIABLES=q38x1 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q38x1 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q38x1 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 281 93,7 93,7 93,7 Yes 19 6,3 6,3 100,0 Total 300 100,0 100,0 Kaduha Valid No 295 98,3 98,3 98,3 Yes 5 1,7 1,7 100,0 Total 300 100,0 100,0 39. Did (Name) have any (ITEM FROM LIST)? FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q39a q39b q39c q39d q39e q39f q39g q39h q39i 39all /ORDER=ANALYSIS. Frequencies [DataSet1] FREQUENCIES VARIABLES=q39a q39b q39c q39d q39e q39f q39g q39h q39i q39all /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics HospitalCatchment q39a q39b q39c q39d q39e q39f q39g q39h q39i q39all Kigeme N Valid 300 300 300 300 300 300 300 300 300 300 Missing 0 0 0 0 0 0 0 0 0 0 Kaduha N Valid 300 300 300 300 300 300 300 300 300 300 Missing 0 0 0 0 0 0 0 0 0 0 39a.Plain water? Frequency Table q39a HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 258 86,0 86,0 86,0 Yes 42 14,0 14,0 100,0 Rwanda ICSP Year 3 KPC Report Page 63 Total 300 100,0 100,0 Kaduha Valid No 260 86,7 86,7 86,7 Yes 40 13,3 13,3 100,0 Total 300 100,0 100,0 39b.Infant formula such as Kigozi, Rinda and others? q39b HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 294 98,0 98,0 98,0 Yes 6 2,0 2,0 100,0 Total 300 100,0 100,0 Kaduha Valid No 297 99,0 99,0 99,0 Yes 3 1,0 1,0 100,0 Total 300 100,0 100,0 39c.Milk such as tinned, powdered or fresh animal milk? q39c HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 257 85,7 85,7 85,7 Yes 43 14,3 14,3 100,0 Total 300 100,0 100,0 Kaduha Valid No 254 84,7 84,7 84,7 Yes 46 15,3 15,3 100,0 Total 300 100,0 100,0 39d. Juice or juice drinks? q39d HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 287 95,7 95,7 95,7 Yes 13 4,3 4,3 100,0 Total 300 100,0 100,0 Kaduha Valid No 284 94,7 94,7 94,7 Yes 16 5,3 5,3 100,0 Total 300 100,0 100,0 39.e. Clear broth? q39e HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 260 86,7 86,7 86,7 Yes 40 13,3 13,3 100,0 Total 300 100,0 100,0 Kaduha Valid No 261 87,0 87,0 87,0 Yes 39 13,0 13,0 100,0 Total 300 100,0 100,0 Rwanda ICSP Year 3 KPC Report Page 64 39f. Yogurt? q39f HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 298 99,3 99,3 99,3 Yes 2 ,7 ,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 297 99,0 99,0 99,0 Yes 3 1,0 1,0 100,0 Total 300 100,0 100,0 39g. Thin porridge? q39g HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 154 51,3 51,3 51,3 Yes 146 48,7 48,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 189 63,0 63,0 63,0 Yes 111 37,0 37,0 100,0 Total 300 100,0 100,0 39h. Any other water-based liquids such as (insert local) sorghum juice? q39h HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 258 86,0 86,0 86,0 Yes 42 14,0 14,0 100,0 Total 300 100,0 100,0 Kaduha Valid No 239 79,7 79,7 79,7 Yes 61 20,3 20,3 100,0 Total 300 100,0 100,0 39i.Any other liquids? q39i HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 289 96,3 96,3 96,3 Yes 11 3,7 3,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 291 97,0 97,0 97,0 Yes 9 3,0 3,0 100,0 Total 300 100,0 100,0 39all q39all HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 97 32,3 32,3 32,3 Yes 203 67,7 67,7 100,0 Total 300 100,0 100,0 Rwanda ICSP Year 3 KPC Report Page 65 Kaduha Valid No 114 38,0 38,0 38,0 Yes 186 62,0 62,0 100,0 Total 300 100,0 100,0 USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q39a q39b q39c q39d q39e q39f q39g q39h q39i q39all /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics HospitalCatchment q39a q39b q39c q39d q39e q39f q39g q39h q39i q39all Kigeme N Valid 219 219 219 219 219 219 219 219 219 219 Missing 0 0 0 0 0 0 0 0 0 0 Kaduha N Valid 205 205 205 205 205 205 205 205 205 205 Missing 0 0 0 0 0 0 0 0 0 0 Frequency Table q39a HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 180 82,2 82,2 82,2 Yes 39 17,8 17,8 100,0 Total 219 100,0 100,0 Kaduha Valid No 165 80,5 80,5 80,5 Yes 40 19,5 19,5 100,0 Total 205 100,0 100,0 q39b HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 214 97,7 97,7 97,7 Yes 5 2,3 2,3 100,0 Total 219 100,0 100,0 Kaduha Valid No 202 98,5 98,5 98,5 Yes 3 1,5 1,5 100,0 Total 205 100,0 100,0 q39c HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 178 81,3 81,3 81,3 Yes 41 18,7 18,7 100,0 Total 219 100,0 100,0 Kaduha Valid No 160 78,0 78,0 78,0 Yes 45 22,0 22,0 100,0 Total 205 100,0 100,0 q39d HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 208 95,0 95,0 95,0 Yes 11 5,0 5,0 100,0 Rwanda ICSP Year 3 KPC Report Page 66 Total 219 100,0 100,0 Kaduha Valid No 190 92,7 92,7 92,7 Yes 15 7,3 7,3 100,0 Total 205 100,0 100,0 q39e HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 179 81,7 81,7 81,7 Yes 40 18,3 18,3 100,0 Total 219 100,0 100,0 Kaduha Valid No 166 81,0 81,0 81,0 Yes 39 19,0 19,0 100,0 Total 205 100,0 100,0 q39f HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 217 99,1 99,1 99,1 Yes 2 ,9 ,9 100,0 Total 219 100,0 100,0 Kaduha Valid No 202 98,5 98,5 98,5 Yes 3 1,5 1,5 100,0 Total 205 100,0 100,0 q39g HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 75 34,2 34,2 34,2 Yes 144 65,8 65,8 100,0 Total 219 100,0 100,0 Kaduha Valid No 97 47,3 47,3 47,3 Yes 108 52,7 52,7 100,0 Total 205 100,0 100,0 q39h HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 177 80,8 80,8 80,8 Yes 42 19,2 19,2 100,0 Total 219 100,0 100,0 Kaduha Valid No 144 70,2 70,2 70,2 Yes 61 29,8 29,8 100,0 Total 205 100,0 100,0 q39i HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 208 95,0 95,0 95,0 Yes 11 5,0 5,0 100,0 Total 219 100,0 100,0 Kaduha Valid No 197 96,1 96,1 96,1 Yes 8 3,9 3,9 100,0 Rwanda ICSP Year 3 KPC Report Page 67 q39a HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 180 82,2 82,2 82,2 Yes 39 17,8 17,8 100,0 Total 219 100,0 100,0 Kaduha Valid No 165 80,5 80,5 80,5 Yes 40 19,5 19,5 100,0 Total 205 100,0 100,0 q39all HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 0 23 10,5 10,5 10,5 1 196 89,5 89,5 100,0 Total 219 100,0 100,0 Kaduha Valid 0 25 12,2 12,2 12,2 1 180 87,8 87,8 100,0 Total 205 100,0 100,0 40.Yesterday during the day or night, did (NAME) drink/eat any (FOOD GROUP ITEMS)? USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q40a q40b q40c q40d q40e q40f q40g q40h q40i q40j q40k q40l q40m q40n q40o q40p q40q q40r q40s /ORDER=ANALYSIS. Frequencies [DataSet1] Statistis HospitalCatchment q40a q40b q40c q40d q40e q40f q40g q40h q40i q40j q40k q40l q40m q40n q40o q40p q40q q40r q40s Kigeme N Valid 219 219 219 219 219 219 219 219 219 219 219 219 219 219 219 219 219 219 219 Missing 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Kaduha N Valid 205 205 205 205 205 205 205 205 205 205 205 205 205 205 205 205 205 205 205 Missing 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40a.Thicker porridge, bread, rice, noodles, or other foods made from grains Frequency Table q40a HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 98 44,7 44,7 44,7 Yes 121 55,3 55,3 100,0 Total 219 100,0 100,0 Kaduha Valid No 84 41,0 41,0 41,0 Yes 121 59,0 59,0 100,0 Total 205 100,0 100,0 40b.Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside q40b Rwanda ICSP Year 3 KPC Report Page 68 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 170 77,6 77,6 77,6 Yes 49 22,4 22,4 100,0 Total 219 100,0 100,0 Kaduha Valid No 141 68,8 68,8 68,8 Yes 64 31,2 31,2 100,0 Total 205 100,0 100,0 40c.White potatoes, white yams, cassava, or any other foods made from roots q40c HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 86 39,3 39,3 39,3 Yes 133 60,7 60,7 100,0 Total 219 100,0 100,0 Kaduha Valid No 47 22,9 22,9 22,9 Yes 158 77,1 77,1 100,0 Total 205 100,0 100,0 40d.Any dark or green leafy vegetables q40d HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 94 42,9 42,9 42,9 Yes 125 57,1 57,1 100,0 Total 219 100,0 100,0 Kaduha Valid No 62 30,2 30,2 30,2 Yes 143 69,8 69,8 100,0 Total 205 100,0 100,0 40e.Ripe mangoes, ripe papayas or ripe guava q40e HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 203 92,7 92,7 92,7 Yes 16 7,3 7,3 100,0 Total 219 100,0 100,0 Kaduha Valid No 178 86,8 86,8 86,8 Yes 27 13,2 13,2 100,0 Total 205 100,0 100,0 40f.Any other fruits or vegetables (such as avocado) q40f HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 141 64,4 64,4 64,4 Yes 78 35,6 35,6 100,0 Total 219 100,0 100,0 Rwanda ICSP Year 3 KPC Report Page 69 Kaduha Valid No 116 56,6 56,6 56,6 Yes 89 43,4 43,4 100,0 Total 205 100,0 100,0 40g.Liver, kidney, heart or other organ meats q40g HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 218 99,5 99,5 99,5 Yes 1 ,5 ,5 100,0 Total 219 100,0 100,0 Kaduha Valid No 203 99,0 99,0 99,0 Yes 2 1,0 1,0 100,0 Total 205 100,0 100,0 40h. Any meat, such as beef, pork, lamb, goat, chicken or duck q40h HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 211 96,3 96,3 96,3 Yes 8 3,7 3,7 100,0 Total 219 100,0 100,0 Kaduha Valid No 193 94,1 94,1 94,1 Yes 12 5,9 5,9 100,0 Total 205 100,0 100,0 40i. Eggs q40i HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 214 97,7 97,7 97,7 Yes 5 2,3 2,3 100,0 Total 219 100,0 100,0 Kaduha Valid No 187 91,2 91,2 91,2 Yes 18 8,8 8,8 100,0 Total 205 100,0 100,0 40j.Fresh or dried fish, shellfish or seafood q40j HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 201 91,8 91,8 91,8 Yes 18 8,2 8,2 100,0 Total 219 100,0 100,0 Kaduha Valid No 162 79,0 79,0 79,0 Yes 42 20,5 20,5 99,5 8 1 ,5 ,5 100,0 Total 205 100,0 100,0 Rwanda ICSP Year 3 KPC Report Page 70 40k. Any foods made from beans, peas, lentils, nuts or seeds q40k HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 57 26,0 26,0 26,0 Yes 162 74,0 74,0 100,0 Total 219 100,0 100,0 Kaduha Valid No 52 25,4 25,4 25,4 Yes 153 74,6 74,6 100,0 Total 205 100,0 100,0 40l.Cheese, yogurt, or other milk products q40l HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 218 99,5 99,5 99,5 Yes 1 ,5 ,5 100,0 Total 219 100,0 100,0 Kaduha Valid No 201 98,0 98,0 98,0 Yes 4 2,0 2,0 100,0 Total 205 100,0 100,0 40m.Any oil, fats or butter, or foods made with any of these q40m HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 203 92,7 92,7 92,7 Yes 16 7,3 7,3 100,0 Total 219 100,0 100,0 Kaduha Valid No 174 84,9 84,9 84,9 Yes 31 15,1 15,1 100,0 Total 205 100,0 100,0 40n.Any sugary foods such as chocolates, sweets, candies, pastries cakes or biscuits q40n HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 173 79,0 79,0 79,0 Yes 46 21,0 21,0 100,0 Total 219 100,0 100,0 Kaduha Valid No 144 70,2 70,2 70,2 Yes 61 29,8 29,8 100,0 Total 205 100,0 100,0 40o.Condiments for flavor, such as chilies, spices, herbs or fish powder q40o HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 176 80,4 80,4 80,4 Rwanda ICSP Year 3 KPC Report Page 71 Yes 43 19,6 19,6 100,0 Total 219 100,0 100,0 Kaduha Valid No 150 73,2 73,2 73,2 Yes 54 26,3 26,3 99,5 8 1 ,5 ,5 100,0 Total 205 100,0 100,0 40p.Grubs, snails or insects q40p HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 219 100,0 100,0 100,0 Kaduha Valid No 203 99,0 99,0 99,0 Yes 2 1,0 1,0 100,0 Total 205 100,0 100,0 40q.Foods made with red palm oil, red palm nut or red palm nut pulp sauce q40q HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 133 60,7 60,7 60,7 Yes 86 39,3 39,3 100,0 Total 219 100,0 100,0 Kaduha Valid No 105 51,2 51,2 51,2 Yes 99 48,3 48,3 99,5 8 1 ,5 ,5 100,0 Total 205 100,0 100,0 40r.Other foods not recorded on the list q40r HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 189 86,3 86,3 86,3 Yes 30 13,7 13,7 100,0 Total 219 100,0 100,0 Kaduha Valid No 192 93,7 93,7 93,7 Yes 12 5,9 5,9 99,5 8 1 ,5 ,5 100,0 Total 205 100,0 100,0 40s.Check categories A-Q q40s HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid N0 8 3,7 3,7 3,7 Yes 211 96,3 96,3 100,0 Total 219 100,0 100,0 Kaduha Valid N0 5 2,4 2,4 2,4 Yes 200 97,6 97,6 100,0 Rwanda ICSP Year 3 KPC Report Page 72 q40s HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid N0 8 3,7 3,7 3,7 Yes 211 96,3 96,3 100,0 Total 219 100,0 100,0 Kaduha Valid N0 5 2,4 2,4 2,4 Yes 200 97,6 97,6 100,0 Total 205 100,0 100,0 42.Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night? USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6 and q40s=0). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 and q40s=0 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q42 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q42 Kigeme N Valid 8 Missing 0 Kaduha N Valid 5 Missing 0 q42 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 8 100,0 100,0 100,0 Kaduha Valid No 5 100,0 100,0 100,0 43.How many times did (NAME) eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night? USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6 and q40s=1 and q43 < 88). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 and q40s=1 and q43 < 88 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q43 /STATISTICS=MINIMUM MAXIMUM MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q43 Kigeme N Valid 211 Missing 0 Mean 2,70 Median 3,00 Minimum 1 Maximum 6 Rwanda ICSP Year 3 KPC Report Page 73 Kaduha N Valid 199 Missing 0 Mean 3,10 Median 3,00 Minimum 1 Maximum 8 q43 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 1 18 8,5 8,5 8,5 2 68 32,2 32,2 40,8 3 93 44,1 44,1 84,8 4 26 12,3 12,3 97,2 5 4 1,9 1,9 99,1 6 2 ,9 ,9 100,0 Total 211 100,0 100,0 Kaduha Valid 1 16 8,0 8,0 8,0 2 43 21,6 21,6 29,6 3 77 38,7 38,7 68,3 4 44 22,1 22,1 90,5 5 14 7,0 7,0 97,5 6 1 ,5 ,5 98,0 8 4 2,0 2,0 100,0 Total 199 100,0 100,0 44.At what age did (NAME) begin eating solid, semi-solid, or soft foods? USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6 and q40s=1and q44 < 88). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 and q40s=1and q44 < 88 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q44 /STATISTICS=MINIMUM MAXIMUM MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q44 Kigeme N Valid 210 Missing 0 Mean 6,66 Median 6,00 Minimum 1 Maximum 12 Kaduha N Valid 198 Missing 0 Mean 6,18 Median 6,00 Minimum 3 Maximum 12 Rwanda ICSP Year 3 KPC Report Page 74 q44 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 1 1 ,5 ,5 ,5 2 3 1,4 1,4 1,9 3 1 ,5 ,5 2,4 4 9 4,3 4,3 6,7 5 11 5,2 5,2 11,9 6 89 42,4 42,4 54,3 7 46 21,9 21,9 76,2 8 25 11,9 11,9 88,1 9 16 7,6 7,6 95,7 10 5 2,4 2,4 98,1 12 4 1,9 1,9 100,0 Total 210 100,0 100,0 Kaduha Valid 3 2 1,0 1,0 1,0 4 6 3,0 3,0 4,0 5 18 9,1 9,1 13,1 6 121 61,1 61,1 74,2 7 36 18,2 18,2 92,4 8 12 6,1 6,1 98,5 9 2 1,0 1,0 99,5 12 1 ,5 ,5 100,0 Total 198 100,0 100,0 44a.Does (NAME) eat from his/her own separate bowl/cup? USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6 and q40s = 1). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 and q40s = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q44aBowl /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q44aBowl Kigeme N Valid 211 Missing 0 Kaduha N Valid 200 Missing 0 q44aBowl HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 19 9,0 9,0 9,0 Yes 192 91,0 91,0 100,0 Total 211 100,0 100,0 Kaduha Valid No 11 5,5 5,5 5,5 Yes 189 94,5 94,5 100,0 Rwanda ICSP Year 3 KPC Report Page 75 Statistics q44aBowl Kigeme N Valid 211 Missing 0 Kaduha N Valid 200 Total 200 100,0 100,0 45.Are you or someone in your family helping (NAME) eat? (ie. physically feeding them) FREQUENCIES VARIABLES=q45 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q45 Kigeme N Valid 211 Missing 0 Kaduha N Valid 200 Missing 0 q45 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 10 4,7 4,7 4,7 Yes 201 95,3 95,3 100,0 Total 211 100,0 100,0 Kaduha Valid No 7 3,5 3,5 3,5 Yes 193 96,5 96,5 100,0 Total 200 100,0 100,0 46a. IF NO: At what age did (NAME) start eating by himself/herself? USE ALL. COMPUTE filter_$=(q45 = 0 and CalcAgeChild >= 6 and q46 < 88). VARIABLE LABEL filter_$ 'q45 = 0 and CalcAgeChild >= 6 and q46 < 88 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q46 /ORDER=ANALYSIS. Statistics q46 Kigeme N Valid 11 Missing 0 Kaduha N Valid 7 Missing 0 q46 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 8 2 18,2 18,2 18,2 9 1 9,1 9,1 27,3 Rwanda ICSP Year 3 KPC Report Page 76 10 3 27,3 27,3 54,5 12 3 27,3 27,3 81,8 14 1 9,1 9,1 90,9 18 1 9,1 9,1 100,0 Total 11 100,0 100,0 Kaduha Valid 7 1 14,3 14,3 14,3 9 2 28,6 28,6 42,9 12 2 28,6 28,6 71,4 18 2 28,6 28,6 100,0 Total 7 100,0 100,0 46b.Do you encourage (NAME) to eat/feed (including when you breastfeed)? FREQUENCIES VARIABLES=Q46b_Encourage /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics Q46b_Encourage Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 Q46b_Encourage HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 65 21,7 21,7 21,7 Yes 235 78,3 78,3 100,0 Total 300 100,0 100,0 Kaduha Valid No 38 12,7 12,7 12,7 Yes 262 87,3 87,3 100,0 Total 300 100,0 100,0 49.Has (NAME) taken any drug for intestinal worms in the past 6 months? GET DATA /TYPE=XLSX /FILE='C:\Users\World Relief RWANDA\Desktop\YEAR 3 WRR KPC DATABASE AUGUST 18 2014.x lsx' /SHEET=name 'Database 12_08_2014' /CELLRANGE=full /READNAMES=on /ASSUMEDSTRWIDTH=32767. DATASET NAME DataSet1 WINDOW=FRONT. SORT CASES BY HospitalCatchment. SPLIT FILE LAYERED BY HospitalCatchment. FREQUENCIES VARIABLES=q49 /ORDER=ANALYSIS. Frequencies Statistics q49 Kigeme N Valid 300 Rwanda ICSP Year 3 KPC Report Page 77 Missing 0 Kaduha N Valid 300 Missing 0 q49 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 205 68,3 68,3 68,3 Yes 95 31,7 31,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 201 67,0 67,0 67,0 Yes 97 32,3 32,3 99,3 Don't know 2 ,7 ,7 100,0 Total 300 100,0 100,0 76. Do you treat your water in any way to make it safer for drinking? FREQUENCIES VARIABLES=q76 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q76 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q76 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 121 40,3 40,3 40,3 Yes 179 59,7 59,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 69 23,0 23,0 23,0 Yes 231 77,0 77,0 100,0 Total 300 100,0 100,0 77. What do you usually do to the water to make it safer to drink? USE ALL. COMPUTE filter_$=(q76 = 1). VARIABLE LABEL filter_$ 'q76 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q77A q77B q77C q77D q77E q77F q77G q77H /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics Rwanda ICSP Year 3 KPC Report Page 78 HospitalCatchment q77A q77B q77C q77D q77E q77F q77G q77H Kigeme N Valid 179 179 179 179 179 179 179 179 Missing 0 0 0 0 0 0 0 0 Kaduha N Valid 231 231 231 231 231 231 231 231 Missing 0 0 0 0 0 0 0 0 Frequency Table 77A.Let It Stand and Settle q77A HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 162 90,5 90,5 90,5 Yes 17 9,5 9,5 100,0 Total 179 100,0 100,0 Kaduha Valid No 228 98,7 98,7 98,7 Yes 3 1,3 1,3 100,0 Total 231 100,0 100,0 77B.Strain It through Cloth q77B HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 178 99,4 99,4 99,4 Yes 1 ,6 ,6 100,0 Total 179 100,0 100,0 Kaduha Valid No 229 99,1 99,1 99,1 Yes 2 ,9 ,9 100,0 Total 231 100,0 100,0 77C.Boil q77C HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 29 16,2 16,2 16,2 Yes 150 83,8 83,8 100,0 Total 179 100,0 100,0 Kaduha Valid No 22 9,5 9,5 9,5 Yes 209 90,5 90,5 100,0 Total 231 100,0 100,0 77D.Add Bleach/Chlorine q77D HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 126 70,4 70,4 70,4 Yes 53 29,6 29,6 100,0 Total 179 100,0 100,0 Kaduha Valid No 193 83,5 83,5 83,5 Yes 38 16,5 16,5 100,0 Rwanda ICSP Year 3 KPC Report Page 79 q77D HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 126 70,4 70,4 70,4 Yes 53 29,6 29,6 100,0 Total 179 100,0 100,0 Kaduha Valid No 193 83,5 83,5 83,5 Yes 38 16,5 16,5 100,0 Total 231 100,0 100,0 77E.Water Filter (Ceramic, Sand, Composite q77E HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 179 100,0 100,0 100,0 Kaduha Valid No 230 99,6 99,6 99,6 Yes 1 ,4 ,4 100,0 Total 231 100,0 100,0 77F.Solar Disinfection q77F HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 179 100,0 100,0 100,0 Kaduha Valid No 231 100,0 100,0 100,0 77GDon’t Know q77G HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 178 99,4 99,4 99,4 Yes 1 ,6 ,6 100,0 Total 179 100,0 100,0 Kaduha Valid No 231 100,0 100,0 100,0 77H.Other q77H HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 179 100,0 100,0 100,0 Kaduha Valid No 230 99,6 99,6 99,6 Yes 1 ,4 ,4 100,0 Total 231 100,0 100,0 78.When do you wash your hands FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q78A q78B q78C q78D q78E q78F q78o /ORDER=ANALYSIS. Frequencies Rwanda ICSP Year 3 KPC Report Page 80 [DataSet1] Statistics HospitalCatchment q78A q78B q78C q78D q78E q78F q78o Kigeme N Valid 300 300 300 300 300 300 0 Missing 0 0 0 0 0 0 300 Kaduha N Valid 300 300 300 300 300 300 0 Missing 0 0 0 0 0 0 300 Frequency Table 78A.Never q78A HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 299 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 300 100,0 100,0 Kaduha Valid No 300 100,0 100,0 100,0 78B.Before Food Preparation q78B HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 88 29,3 29,3 29,3 Yes 212 70,7 70,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 61 20,3 20,3 20,3 Yes 239 79,7 79,7 100,0 Total 300 100,0 100,0 78C.Before Feeding Child q78C HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 90 30,0 30,0 30,0 Yes 210 70,0 70,0 100,0 Total 300 100,0 100,0 Kaduha Valid No 60 20,0 20,0 20,0 Yes 240 80,0 80,0 100,0 Total 300 100,0 100,0 78D.After Defecation/Visiting the Toilet q78D HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 112 37,3 37,3 37,3 Yes 188 62,7 62,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 76 25,3 25,3 25,3 Yes 224 74,7 74,7 100,0 Total 300 100,0 100,0 Rwanda ICSP Year 3 KPC Report Page 81 78E.After attending to a child who has defecated/soiled q78E HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 198 66,0 66,0 66,0 Yes 102 34,0 34,0 100,0 Total 300 100,0 100,0 Kaduha Valid No 148 49,3 49,3 49,3 Yes 152 50,7 50,7 100,0 Total 300 100,0 100,0 78F.Other q78F HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 205 68,3 68,3 68,3 Yes 95 31,7 31,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 249 83,0 83,0 83,0 Yes 51 17,0 17,0 100,0 Total 300 100,0 100,0 79. Can you show me where you usually wash your hands and what you use to wash hands? FREQUENCIES VARIABLES=q79 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q79 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q79 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Inside/ Near Toilet facility 12 4,0 4,0 4,0 Inside/ Near Kitchen/ cooking place 23 7,7 7,7 11,7 Elsewhere in Yard 203 67,7 67,7 79,3 Outside Yard 4 1,3 1,3 80,7 No specific place 57 19,0 19,0 99,7 No Permission to see 1 ,3 ,3 100,0 Total 300 100,0 100,0 Kaduha Valid Inside/ Near Toilet facility 25 8,3 8,3 8,3 Inside/ Near Kitchen/ cooking place 44 14,7 14,7 23,0 Elsewhere in Yard 158 52,7 52,7 75,7 Outside Yard 23 7,7 7,7 83,3 No specific place 49 16,3 16,3 99,7 Rwanda ICSP Year 3 KPC Report Page 82 No Permission to see 1 ,3 ,3 100,0 Total 300 100,0 100,0 80.OBSERVATION ONLY: Is there soap or detergent or locally used cleansing agent? FREQUENCIES VARIABLES=q80 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q80 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q80 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Soap 265 88,3 88,3 88,3 Mud 10 3,3 3,3 91,7 None 24 8,0 8,0 99,7 Other 1 ,3 ,3 100,0 Total 300 100,0 100,0 Kaduha Valid Soap 268 89,3 89,3 89,3 Mud 7 2,3 2,3 91,7 None 24 8,0 8,0 99,7 Other 1 ,3 ,3 100,0 Total 300 100,0 100,0 80b.OBSERVATION ONLY: Specify what kind of hand washing facility is used, if any? FREQUENCIES VARIABLES=q80b_A q80b_B q80b_C q80b_D q80b_E q80b_F q80b_G /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics HospitalCatchment q80b_A q80b_B q80b_C q80b_D q80b_E q80b_F q80b_G Kigeme N Valid 300 300 300 300 300 300 300 Missing 0 0 0 0 0 0 0 Kaduha N Valid 300 300 300 300 300 300 300 Missing 0 0 0 0 0 0 0 Frequency Table 80b_A.Tippy tap q80b_A HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 282 94,0 94,0 94,0 Yes 18 6,0 6,0 100,0 Total 300 100,0 100,0 Kaduha Valid No 277 92,3 92,3 92,3 Yes 23 7,7 7,7 100,0 Rwanda ICSP Year 3 KPC Report Page 83 q80b_A HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 282 94,0 94,0 94,0 Yes 18 6,0 6,0 100,0 Total 300 100,0 100,0 Kaduha Valid No 277 92,3 92,3 92,3 Yes 23 7,7 7,7 100,0 Total 300 100,0 100,0 80b_B.Basin q80b_B HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 31 10,3 10,3 10,3 Yes 269 89,7 89,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 21 7,0 7,0 7,0 Yes 279 93,0 93,0 100,0 Total 300 100,0 100,0 80b_C.Jerry can / jug q80b_C HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 256 85,3 85,3 85,3 Yes 44 14,7 14,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 276 92,0 92,0 92,0 Yes 24 8,0 8,0 100,0 Total 300 100,0 100,0 80b_D.Pan / pot q80b_D HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 292 97,3 97,3 97,3 Yes 8 2,7 2,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 290 96,7 96,7 96,7 Yes 10 3,3 3,3 100,0 Total 300 100,0 100,0 80b_E.Sink q80b_E HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 298 99,3 99,3 99,3 Yes 2 ,7 ,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 300 100,0 100,0 100,0 Rwanda ICSP Year 3 KPC Report Page 84 80b_F.None q80b_F HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 290 96,7 96,7 96,7 Yes 10 3,3 3,3 100,0 Total 300 100,0 100,0 Kaduha Valid No 299 99,7 99,7 99,7 Yes 1 ,3 ,3 100,0 Total 300 100,0 100,0 80b_G.Other q80b_G HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 256 85,3 85,3 85,3 Yes 44 14,7 14,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 276 92,0 92,0 92,0 Yes 24 8,0 8,0 100,0 Total 300 100,0 100,0 80c.(If pan, pot, bowl, or basin) What else, if anything, are you using this receptacle for other than hand washing? USE ALL. COMPUTE filter_$=(q80b_B = 1 or q80b_D = 1). VARIABLE LABEL filter_$ 'q80b_B = 1 or q80b_D = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. USE ALL. COMPUTE filter_$=(q80b_B = 1 or q80b_D = 1). VARIABLE LABEL filter_$ 'q80b_B = 1 or q80b_D = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q80c_1 q80c_2 q80c_3 q80c_4 q80c_5 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics HospitalCatchment q80c_1 q80c_2 q80c_3 q80c_4 q80c_5 Kigeme N Valid 271 271 271 271 271 Missing 0 0 0 0 0 Kaduha N Valid 285 285 285 285 285 Missing 0 0 0 0 0 Frequency Table 80c_1.Nothing else q80c_1 Rwanda ICSP Year 3 KPC Report Page 85 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 225 83,0 83,0 83,0 Yes 46 17,0 17,0 100,0 Total 271 100,0 100,0 Kaduha Valid No 189 66,3 66,3 66,3 Yes 96 33,7 33,7 100,0 Total 285 100,0 100,0 80c_2.Food preparation q80c_2 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 240 88,6 88,6 88,6 Yes 31 11,4 11,4 100,0 Total 271 100,0 100,0 Kaduha Valid No 265 93,0 93,0 93,0 Yes 20 7,0 7,0 100,0 Total 285 100,0 100,0 80c_3.Laundry q80c_3 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 53 19,6 19,6 19,6 Yes 218 80,4 80,4 100,0 Total 271 100,0 100,0 Kaduha Valid No 113 39,6 39,6 39,6 Yes 172 60,4 60,4 100,0 Total 285 100,0 100,0 80c_4.Other q80c_4 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 232 85,6 85,6 85,6 Yes 39 14,4 14,4 100,0 Total 271 100,0 100,0 Kaduha Valid No 265 93,0 93,0 93,0 Yes 20 7,0 7,0 100,0 Total 285 100,0 100,0 81.What kind of toilet facility do you have? Can I see it? FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q81 /ORDER=ANALYSIS. Rwanda ICSP Year 3 KPC Report Page 86 Frequencies [DataSet1] Statistics q81 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q81 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No toilet facility 34 11,3 11,3 11,3 Open latrine 196 65,3 65,3 76,7 Closed latrine 70 23,3 23,3 100,0 Total 300 100,0 100,0 Kaduha Valid No toilet facility 31 10,3 10,3 10,3 Open latrine 187 62,3 62,3 72,7 Closed latrine 81 27,0 27,0 99,7 Flush toilet 1 ,3 ,3 100,0 Total 300 100,0 100,0 82.The last time (NAME) passed stools, where were the feces disposed of? DATASET NAME DataSet0 WINDOW=FRONT. GET DATA /TYPE=XLSX /FILE='C:\Users\World Relief RWANDA\Desktop\YEAR 3 WRR KPC DATABASE AUGUST 18 2014.x lsx' /SHEET=name 'Database 12_08_2014' /CELLRANGE=full /READNAMES=on /ASSUMEDSTRWIDTH=32767. DATASET NAME DataSet1 WINDOW=FRONT. SORT CASES BY HospitalCatchment. SPLIT FILE LAYERED BY HospitalCatchment. FREQUENCIES VARIABLES=q82 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q82 1 N Valid 300 Missing 0 2 N Valid 300 Missing 0 q82 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent 1 Valid Disposed into a latrine or toilet facility 235 78,3 78,3 78,3 Disposed into a garbage 6 2,0 2,0 80,3 Dug and buried – near the house or in the yard 7 2,3 2,3 82,7 Dug and buried – far from the house or yard 10 3,3 3,3 86,0 Did not bury – near the house or yard 2 ,7 ,7 86,7 Rwanda ICSP Year 3 KPC Report Page 87 Did not bury – far from the house or yard 2 ,7 ,7 87,3 Other 38 12,7 12,7 100,0 Total 300 100,0 100,0 2 Valid Disposed into a latrine or toilet facility 241 80,3 80,3 80,3 Disposed into a garbage 9 3,0 3,0 83,3 Dug and buried – near the house or in the yard 8 2,7 2,7 86,0 Dug and buried – far from the house or yard 9 3,0 3,0 89,0 Did not bury – near the house or yard 2 ,7 ,7 89,7 Did not bury – far from the house or yard 4 1,3 1,3 91,0 Don’t know 2 ,7 ,7 91,7 Other 25 8,3 8,3 100,0 Total 300 100,0 100,0 93.May I weigh (name of child)? FREQUENCIES VARIABLES=q93 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q93 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q93 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 300 100,0 100,0 100,0 Kaduha Valid Yes 300 100,0 100,0 100,0 93.weight_average FREQUENCIES VARIABLES=q93weight_average /STATISTICS=MINIMUM MAXIMUM MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q93weight_average Kigeme N Valid 300 Missing 0 Mean 7,54 Median 8,00 Minimum 2 Maximum 12 Kaduha N Valid 300 Missing 0 Mean 7,51 Rwanda ICSP Year 3 KPC Report Page 88 Median 8,00 Minimum 2 Maximum 13 q93weight_average HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 2 3 1,0 1,0 1,0 3 9 3,0 3,0 4,0 4 15 5,0 5,0 9,0 5 30 10,0 10,0 19,0 6 34 11,3 11,3 30,3 7 52 17,3 17,3 47,7 8 50 16,7 16,7 64,3 9 48 16,0 16,0 80,3 10 35 11,7 11,7 92,0 11 18 6,0 6,0 98,0 12 6 2,0 2,0 100,0 Total 300 100,0 100,0 Kaduha Valid 2 2 ,7 ,7 ,7 3 16 5,3 5,3 6,0 4 22 7,3 7,3 13,3 5 28 9,3 9,3 22,7 6 24 8,0 8,0 30,7 7 41 13,7 13,7 44,3 8 55 18,3 18,3 62,7 9 51 17,0 17,0 79,7 10 41 13,7 13,7 93,3 11 10 3,3 3,3 96,7 12 7 2,3 2,3 99,0 13 3 1,0 1,0 100,0 Total 300 100,0 100,0 94.May I use MUAC Tape with (name of child)? Frequencies USE ALL. COMPUTE filter_$=(CalcAgeChild >= 6). VARIABLE LABEL filter_$ 'CalcAgeChild >= 6 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q94 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q94 Kigeme N Valid 219 Missing 0 Kaduha N Valid 205 Rwanda ICSP Year 3 KPC Report Page 89 Statistics q94 Kigeme N Valid 219 Missing 0 Kaduha N Valid 205 Missing 0 q94 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 219 100,0 100,0 100,0 Kaduha Valid Yes 205 100,0 100,0 100,0 94.muac_average FREQUENCIES VARIABLES=q94muac_average /STATISTICS=STDDEV MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q94muac_average Kigeme N Valid 219 Missing 0 Mean 13,82 Median 14,00 Std. Deviation 1,272 Kaduha N Valid 205 Missing 0 Mean 13,90 Median 14,00 Std. Deviation 1,196 q94muac_average HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 11 6 2,7 2,7 2,7 12 25 11,4 11,4 14,2 13 59 26,9 26,9 41,1 14 67 30,6 30,6 71,7 15 42 19,2 19,2 90,9 16 15 6,8 6,8 97,7 17 5 2,3 2,3 100,0 Total 219 100,0 100,0 Kaduha Valid 7 1 ,5 ,5 ,5 12 15 7,3 7,3 7,8 13 59 28,8 28,8 36,6 14 73 35,6 35,6 72,2 15 43 21,0 21,0 93,2 16 10 4,9 4,9 98,0 17 3 1,5 1,5 99,5 18 1 ,5 ,5 100,0 Total 205 100,0 100,0 Rwanda ICSP Year 3 KPC Report Page 90 95.May I measure length for (name of child)? FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q95 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q95 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q95 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 300 100,0 100,0 100,0 Kaduha Valid Yes 300 100,0 100,0 100,0 95.length_Average FREQUENCIES VARIABLES=q95length_Average /STATISTICS=STDDEV MINIMUM MEAN MEDIAN MODE /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q95length_Average Kigeme N Valid 300 Missing 0 Mean 68,61 Median 70,00 Mode 74 Std. Deviation 8,786 Minimum 46 Kaduha N Valid 300 Missing 0 Mean 68,46 Median 70,00 Mode 71a Std. Deviation 9,673 Minimum 47 a. Multiple modes exist. The smallest value is shown q95length_Average HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 46 2 ,7 ,7 ,7 47 1 ,3 ,3 1,0 48 1 ,3 ,3 1,3 50 4 1,3 1,3 2,7 Rwanda ICSP Year 3 KPC Report Page 91 51 2 ,7 ,7 3,3 52 7 2,3 2,3 5,7 53 2 ,7 ,7 6,3 54 2 ,7 ,7 7,0 55 5 1,7 1,7 8,7 56 2 ,7 ,7 9,3 57 8 2,7 2,7 12,0 58 9 3,0 3,0 15,0 59 10 3,3 3,3 18,3 60 12 4,0 4,0 22,3 61 5 1,7 1,7 24,0 62 6 2,0 2,0 26,0 63 9 3,0 3,0 29,0 64 8 2,7 2,7 31,7 65 7 2,3 2,3 34,0 66 10 3,3 3,3 37,3 67 9 3,0 3,0 40,3 68 8 2,7 2,7 43,0 69 10 3,3 3,3 46,3 70 16 5,3 5,3 51,7 71 17 5,7 5,7 57,3 72 14 4,7 4,7 62,0 73 13 4,3 4,3 66,3 74 18 6,0 6,0 72,3 75 15 5,0 5,0 77,3 76 8 2,7 2,7 80,0 77 15 5,0 5,0 85,0 78 12 4,0 4,0 89,0 79 7 2,3 2,3 91,3 80 9 3,0 3,0 94,3 81 3 1,0 1,0 95,3 82 1 ,3 ,3 95,7 83 4 1,3 1,3 97,0 84 3 1,0 1,0 98,0 85 5 1,7 1,7 99,7 86 1 ,3 ,3 100,0 Total 300 100,0 100,0 Kaduha Valid 47 3 1,0 1,0 1,0 48 1 ,3 ,3 1,3 49 2 ,7 ,7 2,0 50 3 1,0 1,0 3,0 51 5 1,7 1,7 4,7 52 6 2,0 2,0 6,7 53 6 2,0 2,0 8,7 54 3 1,0 1,0 9,7 55 8 2,7 2,7 12,3 56 9 3,0 3,0 15,3 Rwanda ICSP Year 3 KPC Report Page 92 57 6 2,0 2,0 17,3 58 5 1,7 1,7 19,0 59 9 3,0 3,0 22,0 60 9 3,0 3,0 25,0 61 3 1,0 1,0 26,0 62 9 3,0 3,0 29,0 63 6 2,0 2,0 31,0 64 11 3,7 3,7 34,7 65 3 1,0 1,0 35,7 66 7 2,3 2,3 38,0 67 10 3,3 3,3 41,3 68 7 2,3 2,3 43,7 69 8 2,7 2,7 46,3 70 15 5,0 5,0 51,3 71 18 6,0 6,0 57,3 72 12 4,0 4,0 61,3 73 7 2,3 2,3 63,7 74 16 5,3 5,3 69,0 75 12 4,0 4,0 73,0 76 15 5,0 5,0 78,0 77 11 3,7 3,7 81,7 78 18 6,0 6,0 87,7 79 7 2,3 2,3 90,0 80 6 2,0 2,0 92,0 81 5 1,7 1,7 93,7 82 4 1,3 1,3 95,0 83 7 2,3 2,3 97,3 84 3 1,0 1,0 98,3 87 2 ,7 ,7 99,0 89 2 ,7 ,7 99,7 99 1 ,3 ,3 100,0 Total 300 100,0 100,0 96.May I use MUAC Tape with you? FREQUENCIES VARIABLES=q96 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q96 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q96 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Yes 300 100,0 100,0 100,0 Kaduha Valid Yes 300 100,0 100,0 100,0 96.muac_Average Rwanda ICSP Year 3 KPC Report Page 93 FREQUENCIES VARIABLES=q96muac_Average /STATISTICS=STDDEV MINIMUM MEAN MEDIAN /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q96muac_Average Kigeme N Valid 300 Missing 0 Mean 25,17 Median 25,00 Std. Deviation 2,468 Minimum 20 Kaduha N Valid 300 Missing 0 Mean 25,06 Median 25,00 Std. Deviation 2,349 Minimum 20 q96muac_Average HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid 20 3 1,0 1,0 1,0 21 11 3,7 3,7 4,7 22 24 8,0 8,0 12,7 23 34 11,3 11,3 24,0 24 54 18,0 18,0 42,0 25 51 17,0 17,0 59,0 26 48 16,0 16,0 75,0 27 32 10,7 10,7 85,7 28 17 5,7 5,7 91,3 29 10 3,3 3,3 94,7 30 6 2,0 2,0 96,7 31 4 1,3 1,3 98,0 32 3 1,0 1,0 99,0 34 3 1,0 1,0 100,0 Total 300 100,0 100,0 Kaduha Valid 20 3 1,0 1,0 1,0 21 6 2,0 2,0 3,0 22 16 5,3 5,3 8,3 23 58 19,3 19,3 27,7 24 56 18,7 18,7 46,3 25 57 19,0 19,0 65,3 26 38 12,7 12,7 78,0 27 17 5,7 5,7 83,7 28 20 6,7 6,7 90,3 29 15 5,0 5,0 95,3 30 7 2,3 2,3 97,7 31 2 ,7 ,7 98,3 Rwanda ICSP Year 3 KPC Report Page 94 32 3 1,0 1,0 99,3 33 2 ,7 ,7 100,0 Total 300 100,0 100,0 97.In the past year, have you participated in a week-long training on child feeding and food preparation? FREQUENCIES VARIABLES=q97 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q97 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q97 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 261 87,0 87,0 87,0 Yes 29 9,7 9,7 96,7 Don't know 10 3,3 3,3 100,0 Total 300 100,0 100,0 Kaduha Valid No 61 20,3 20,3 20,3 Yes 238 79,3 79,3 99,7 Don't know 1 ,3 ,3 100,0 Total 300 100,0 100,0 98.IF YES: How many times? USE ALL. COMPUTE filter_$=(q97 = 1). VARIABLE LABEL filter_$ 'q97 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q98 /ORDER=ANALYSIS. Frequencies Statistics q98 Kigeme N Valid 29 Missing 0 Kaduha N Valid 238 Missing 0 q98 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid Once 9 31,0 31,0 31,0 Twice 9 31,0 31,0 62,1 Three or more 11 37,9 37,9 100,0 Rwanda ICSP Year 3 KPC Report Page 95 Total 29 100,0 100,0 Kaduha Valid Once 20 8,4 8,4 8,4 Twice 60 25,2 25,2 33,6 Three or more 158 66,4 66,4 100,0 Total 238 100,0 100,0 101.Did you receive a visit related to health in the past month? FILTER OFF. USE ALL. EXECUTE. FREQUENCIES VARIABLES=q101 /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics q101 Kigeme N Valid 300 Missing 0 Kaduha N Valid 300 Missing 0 q101 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 190 63,3 63,3 63,3 Yes 110 36,7 36,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 114 38,0 38,0 38,0 Yes 185 61,7 61,7 99,7 Don't know 1 ,3 ,3 100,0 Total 300 100,0 100,0 101a. If yes, who visited you? USE ALL. COMPUTE filter_$=(q101 = 1). VARIABLE LABEL filter_$ 'q101 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q101a_A q101a_B q101a_C q101a_D /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics HospitalCatchment q101a_A q101a_B q101a_C q101a_D Kigeme N Valid 300 300 300 300 Missing 0 0 0 0 Kaduha N Valid 300 300 300 300 Missing 0 0 0 0 Frequency Table 101a_A.Care group member Rwanda ICSP Year 3 KPC Report Page 96 q101a_A HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 202 67,3 67,3 67,3 Yes 98 32,7 32,7 100,0 Total 300 100,0 100,0 Kaduha Valid No 125 41,7 41,7 41,7 Yes 175 58,3 58,3 100,0 Total 300 100,0 100,0 101a_B.Health facilities staff q101a_B HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 293 97,7 97,7 97,7 Yes 7 2,3 2,3 100,0 Total 300 100,0 100,0 Kaduha Valid No 286 95,3 95,3 95,3 Yes 14 4,7 4,7 100,0 Total 300 100,0 100,0 101a_C Local government staff q101a_C HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 294 98,0 98,0 98,0 Yes 6 2,0 2,0 100,0 Total 300 100,0 100,0 Kaduha Valid No 289 96,3 96,3 96,3 Yes 11 3,7 3,7 100,0 Total 300 100,0 100,0 101a_D Others q101a_D HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 290 96,7 96,7 96,7 Yes 10 3,3 3,3 100,0 Total 300 100,0 100,0 Kaduha Valid No 293 97,7 97,7 97,7 Yes 7 2,3 2,3 100,0 Total 300 100,0 100,0 102.If yes, can you tell me what the purpose of the visit was USE ALL. COMPUTE filter_$=(q101 = 1). VARIABLE LABEL filter_$ 'q101 = 1 (FILTER)'. VALUE LABELS filter_$ 0 'Not Selected' 1 'Selected'. Rwanda ICSP Year 3 KPC Report Page 97 FORMAT filter_$ (f1.0). FILTER BY filter_$. EXECUTE. FREQUENCIES VARIABLES=q102A q102B q102C q102D q102E q102F q102G /ORDER=ANALYSIS. Frequencies [DataSet1] Statistics HospitalCatchment q102A q102B q102C q102D q102E q102F q102G Kigeme N Valid 110 110 110 110 110 110 110 Missing 0 0 0 0 0 0 0 Kaduha N Valid 185 185 185 185 185 185 185 Missing 0 0 0 0 0 0 0 Frequency Table 102A.FOLLOW UP ON SICK CHILD q102A HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 95 86,4 86,4 86,4 Yes 15 13,6 13,6 100,0 Total 110 100,0 100,0 Kaduha Valid No 161 87,0 87,0 87,0 Yes 24 13,0 13,0 100,0 Total 185 100,0 100,0 102B.PROVIDE HEALTH EDUCATION ON MALARIA PREVENTION q102B HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 105 95,5 95,5 95,5 Yes 5 4,5 4,5 100,0 Total 110 100,0 100,0 Kaduha Valid No 153 82,7 82,7 82,7 Yes 32 17,3 17,3 100,0 Total 185 100,0 100,0 102C.PROVIDE HEALTH EDUCATION ON DIARRHEA PREVENTION q102C HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 99 90,0 90,0 90,0 Yes 11 10,0 10,0 100,0 Total 110 100,0 100,0 Kaduha Valid No 154 83,2 83,2 83,2 Yes 31 16,8 16,8 100,0 Total 185 100,0 100,0 102D.PROVIDE HEALTH EDUCATION ON PNEUMONIA q102D Rwanda ICSP Year 3 KPC Report Page 98 HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 96 87,3 87,3 87,3 Yes 14 12,7 12,7 100,0 Total 110 100,0 100,0 Kaduha Valid No 158 85,4 85,4 85,4 Yes 27 14,6 14,6 100,0 Total 185 100,0 100,0 102E.PROVIDE HEALTH EDUCATION ON NUTRITION q102E HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 43 39,1 39,1 39,1 Yes 67 60,9 60,9 100,0 Total 110 100,0 100,0 Kaduha Valid No 56 30,3 30,3 30,3 Yes 129 69,7 69,7 100,0 Total 185 100,0 100,0 102F.PROVIDE HEALTH EDUCATION ON IMMUNIZATION q102F HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 89 80,9 80,9 80,9 Yes 21 19,1 19,1 100,0 Total 110 100,0 100,0 Kaduha Valid No 156 84,3 84,3 84,3 Yes 29 15,7 15,7 100,0 Total 185 100,0 100,0 102G.OTHER q102G HospitalCatchment Frequency Percent Valid Percent Cumulative Percent Kigeme Valid No 58 52,7 52,7 52,7 Yes 52 47,3 47,3 100,0 Total 110 100,0 100,0 Kaduha Valid No 134 72,4 72,4 72,4 Yes 51 27,6 27,6 100,0 Total 185 100,0 100,0 99 Annex 2. Monitoring and Evaluation Tables Demographic Information Kigeme Kaduha Mother’s Age Mean Median 28.96 28 28.85 28 Mother’s Education None/ Did not complete primary: 58.0% Primary: 37.67% Secondary: 4.33% Past Secondary: 0% None/ Did not complete primary: 57.67% Primary: 36.33% Secondary: 5% Past Secondary: 0.33% Household Size Mean Median 5.02 5 4.66 4 Poverty Level (Ubudehe) 6. 4.67% 7. 19.67% 8. 70.0% 9. 5.33% 10. 0.33% 6. 4.33% 7. 26.0% 8. 66.0% 9. 3.67% 10. 0% Health Insurance (Mutuelle) Percent Yes (ConfInt) Percent No (ConfInt) 69.67% (58.9-80.3) 30.33% (19.6-41.1) 83.3% (77.4-89.2) 16.6% (10.8-22.6) Health Insurance Card Percent Yes (ConfInt) Percent No (ConfInt) 89.95% (79.8-100.0) 10.04% (0-20.1) 94.4% (90.6-98.2) 5.6% (1.8-9.4) Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target Breastfeeding and Nutrition (40% LOE) Improve breastfeeding practices Immediate breastfeeding of newborns: Percent of children 0-23 months who were put to the breast within one hour of birth. (Key indicator MNC) (OR) Kaduha 48.32% (CI: 43.14- 53.50%) 71.4% (CI: 66.26- 76.54%) 82.3% (CI: 76.6- 88.0%) 247 300 70% Kigeme 51.1% (CI: 45.94- 56.26%) 72.6% (CI: 67.52- 77.68%) 78.7% (CI: 72.9-84.4%) 236 300 70% Rwanda ICSP Year 3 KPC Report Page 100 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target Prelacteal feeding Percent of children 0-23 months given liquids prior to the initiation of breastfeeding. Kaduha 10.99% (CI: 7.74-14.24%) 6.4% (CI: 3.6-9.1%) 3.7% (CI : 0.8-6.5%) 11 300 3% Kigeme 10.70% (CI:7.42-13.92%) 9.1% (CI: 5.8-12.3%) 2.0% (CI: 0.5-3.5%) 6 300 3% Exclusive Breastfeeding (tracking only) Percent of children age 0-5 months who were exclusively breastfed during the last 24 hours. (RC) Kaduha 91.11% (CI:85.23- 96.99%) By age: 0-1m: 64.0% 2-3m: 86.2% 4-5m: 63.6% 0-3m:87.0% 90.1% (CI: 83.96-96.24) By age: 0-1 m: 91.7% 2-3 m: 91.7% 4-5 m: 87.1% 0-3 m: 91.7% 92.9% (CI: 85.1-97.3%) By age: 0-1 m: 91.4% 2-3 m: 94.3% 4-5 m: 84.0% 0-3 m: 93.1% 78 84 N/A Kigeme 98.89% (CI:96.73- 100.00%) 0-1m: 87.5% 2-3m: 96.8% 4-5m: 96.8% 0-3m: 98.2% 83.8% (CI: 75.41- 92.19%) 0-1m: 87.5% 2-3m: 96.8% 4-5m: 96.8% 0-3m: 98.2% 94.3% (CI: 86.0-98.4) By age: 0-1 m: 96.0% 2-3 m: 96.8% 4-5 m: 80.0% 0-3 m: 95.7% 66 70 N/A Continued breastfeeding at 1 year (tracking only) Percent of children 12-15 months who are still breastfeeding. Kaduha 85.42% (CI:5.44-95.40%) 100.0% (CI: 100.0- 100.0%) 93.0% (CI: 85.2-100%) 40 43 N/A Kigeme 93.44% (87.23-99.65%) 97.9% (CI: 93.8- 101.9%) 98.0% (CI: 93.9-100%) 49 50 N/A Rwanda ICSP Year 3 KPC Report Page 101 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target Continued breastfeeding at 2 years (tracking only) Percent of children 20-23 months who are still breastfeeding. Kaduha 86.79% (CI:77.67- 95.91%) 97.4% (CI: 92.4- 102.3%) 87.9% (CI: 75.8-99.9%) 29 33 N/A Kigeme 90.91% (CI: 82.4-99.4%) 88.4% (CI: 78.8-97.9%) 93.3% (CI: 83.9-100%) 28 30 N/A Improve Infant and Young Child Feeding Practices % infants and young children age 6-23 months fed according to the Minimum Dietary Diversity (OR) Kaduha 21.85% (CI: 16.92- 26.78%) By age: 6-11m: 0.0% 12-17m: 31.7% 18-23m: 40% 38.8% (CI: 32.1- 45.4 %) By age: 6-11m: 32.2% 12-17m: 36.8% 18-23m: 51.9% 49.4% (CI: 42.0-56.9%) By age: 6-11m: 41.0% 12-17m: 54.9% 18-23m: 54.8% 91 184 60% Kigeme 38.89% (CI: 33.08- 44.70%) By age: 6-11m: 0.0% 12-17m: 50.6% 18-23m: 51.6% 31.0% (CI: 24.9-37.0%) By age: 6-11m: 22.2% 12-17m: 38.5% 18-23m: 34.2% 39.3% (CI: 32.6-46.3%) By age: 6-11m: 36.3% 12-17m: 41.9% 18-23m : 38.5% 81 206 55% % infants and young children age 6-23 months fed according to the Minimum Meal Frequency (OR) Kaduha 7.04% (CI: 3.99-10.09%) 66.5% (CI: 58.7 - 74.3%) 70.4% (CI: 63.3-67.8%) 133 189 55% Kigeme 7.41% (CI: 4.07-10.21%) 50.9% (CI: 44.0-57.8%) 60.6% (CI: 53.6-67.3%) 126 208 60% % infants and young children age 6-23 months fed according to the Minimum Acceptable Diet *WHO 2008 definition (OR, RC*) Kaduha 2.96% (CI: 0.92-4.94%) 32.5% (CI: 24.9-40.2%) 38.6% (CI: 31.6 – 46.0%) 73 189 50% Kigeme 3.33% (CI: 1.19-5.47%) 22.8% (CI: 16.1-29.5%) 24.5% (CI: 18.8-30.9%) 51 208 50% Rwanda ICSP Year 3 KPC Report Page 102 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target Consumption of iron￾rich foods % infants 6–23 months of age who consumed food rich in iron. (Include micronutrient powders if/when program expands to Nyamagabe) Kaduha 15.19% (CI: 10.91- 19.47%) 15.3% (CI: 10.4-20.1%) 25.4% (CI: 17.2-33.6%) 48 189 50% Kigeme 23.33% (CI: 18.29- 28.37%) 12.8% (CI: 8.4-17.1%) 12.0% (CI: 6.3-17.7%) 25 208 50% Age appropriate introduction of semi￾solid foods Proportion of infants 6–8 months of age who receive solid, semi-solid or soft foods. Kaduha 52.0% (CI: 38.15- 65.85%) 81.0% (CI: 69.1- 92.8)%) 78.9% (CI: 55.3-100%) 15 19 75% Kigeme 58.5% (CI:45.2-71.77%) 79.1% (CI: 66.9-91.2%) 75.0% (CI: 57.5-92.5%) 18 24 75% Responsive feeding Percent of Caregivers who assist child when eating (of children who consume soft, semi-solid or solid foods) Kaduha 95.51% (CI:92.9-98.12%) 95.5% (CI: 92.6-98.3%) 96.7% (CI: 93.8-99.6%) 178 184 TBD Kigeme 79.05% (CI:74.0-84.1%) 92.1% (CI: 88.4-95.7%) 95.0% (CI: 89.9-100%) 190 200 TBD Self- Feeding (tracking only) Percent of children who consume soft, semi-solid or solid foods) who are self￾feeding Kaduha 94.81% (CI:91.95- 97.67%) 4.5% (CI:1.6-7.3%) 3.3% (CI: 0.4-6.2%) 6 184 N/A Kigeme 87.34% (CI: 83.1-91.57%) 7.9% (CI: 4.9-11.5%) 5.0% (CI: 0-10.1%) 10 200 N/A Vitamin A Supplementation in the last 6 months Percent of children age 6-23 months who received a dose of Vitamin A in the last 6 months: card verified or mother’s recall. (RC 8, OR) Kaduha 70.37% ( CI:64.9-75.82%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Kigeme 77.04% (CI: 72.02- 82.06%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Anthropometry Rwanda ICSP Year 3 KPC Report Page 103 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target Underweight for Age (tracking only) Percent of children 0-23 months who are underweight (-2 SD for the median weight for age, according to WHO reference population) Disaggregate underweight by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) (RC) Kaduha 17.8% (CI:14.00- 22.50%) Severe: 7.2% (CI: 4.8-10.8%) Moderate: 10.6%(CI:7.9- 14.1%) 21.7% (CI : 17.0 – 27.2%) Severe : 5.7% (CI : 3.3-9.6%) Moderate : 16.0% (CI : 11.9-21.1%) 10.8% (CI : 7.1- 16.1%) Severe : 3.2% (CI : 1.5-6.9%) Moderate : 7.6% (CI :4.6-12.3%) Yr 3 indicator calculated for 6-23 mos 20 6 14 185 185 185 N/A Kigeme 8.9% (CI:6.6-15.0%) Severe: 2.2% (CI: 1.2-4.2%) Moderate: 6.7%(CI:4.5- 9.9%) 16.0% (CI: 11.4- 22.1%) Severe: 3.0% (CI: 1.5-5.8%) Moderate: 13.0% (CI: 9.2- 18.1%) 17.6% (CI: 12.0- 24.9%) Severe: 2.1% (CI: 0.8-5.5%) Moderate: 5.4% (CI: 10.5-22.2%) Yr 3 indicator calculated for 6-23 mos 33 4 29 188 188 188 N/A Acute Malnutrition/ Wasting (tracking only) % children 0-23 months who are underweight for height (-2SD for the median height for age, according to WH0 reference population) Disaggregate wasting by moderate (≤-2SD and >-3SD) and severe (≤ -3SD) (OR) Kaduha 7.6% (CI: 4.9-11.6%) Severe 3.9% (CI:2.3-6.8%) Moderate 3.7% (CI:2.2-5.9%) 8.7% (CI : 5.4-13.6%) Severe 2.3% (CI : 1.0-5.2%) Moderate 6.3% (CI : 3.6-11.0%) 6.5% (CI: 3.7-11.0%) Severe: 1.1% (CI: 0.3-3.9%) Moderate: 5.4% (CI : 3.0-9.7%) Yr 3 indicator calculated for 6-23 mos 12 2 10 185 185 185 N/A Kigeme 6.1% (CI:4.1 -9.1%) Severe 2.2% 2.7% (CI : 1.2-6.0%) Severe : 1.0% 5.9 % (CI: 2.8 - 11.9) Severe : 0.5 % 11 1 188 188 N/A Rwanda ICSP Year 3 KPC Report Page 104 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target (CI:1.1-4.6%) Moderate: 3.9% (CI:2.3-6.4%) (CI: 0.2-4.4%) Moderate : 1.7% (CI: 0.7-3.9%) (CI: 0.1 - 3.9) Moderate : 5.3% (CI: 2.6-10.4%) Yr 3 indicator calculated for 6-23 mos 10 188 Acute Malnutrition (tracking only) Percent of children 6-23 months acutely malnourished as measured by MUAC Disaggregate by ‘at risk’, moderate and severe acute malnutrition Kaduha 8.3% (CI: 5.3-12.7%) Severe : 1.5% Moderate 6.8% At Risk 18.52% 9.6% (CI: 5.8-15.3%) Severe 2.4% (CI: 1.0-5.5%) Moderate 7.2% (CI: 4.1-12.4%) 0.5% (CI: 0.1-3.0%) Severe : 0.0% (CI : 0.0-2.0%) Moderate : 0.5% (CI : 0.1-3.0%) Yr 3 indicator calculated for 6-23 mos 1 0 1 185 185 185 N/A Kigeme 5.2% (CI: 3.0-8.9%) 0.4% severe 4.8% mod. 20.37% at-risk 4.0% (CI: 2.0-7.6%) Severe 0.0% (CI: 0.0-0.0%) Moderate: 4.0% (CI: 2.0-7.6%) 5.3% (CI: 2.8-9.8%) Severe : 0.0% (CI : 0.0-0.0%) Moderate : 5.3% (2.8-9.8%) Yr 3 indicator calculated for 6-23 mos 10 0 10 188 188 188 N/A Stunting (tracking only) Percentage of children 0-23 months who are under height/length for age (-2SD for the median height for age, according to WHO reference population) Disaggregate stunting by moderate (≤- 2SD and >-3SD) and severe (≤ -3SD) Kaduha 44.3% (CI:37.6-51.2%) Severe 25.1% Moderate 19.2% 33.3% (CI: 26.1-41.3%) Severe: 13.3% (CI: 9.3-18.8%) Moderate: 20.0% (CI: 14.8- 26.4%) 34.1% (CI: 27.6-41.1%) Severe : 13.0% (CI : 8.9-18.6%) Moderate : 21.1% (CI : 15.8- 27.5%) 63 24 39 185 185 185 N/A Rwanda ICSP Year 3 KPC Report Page 105 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target Yr 3 indicator calculated for 6-23 mos Kigeme 33.4% (CI:27.1-40.4%) Severe : 12.5% Moderate 20.9% 34.0% (CI: 26.9-41.9%) Severe: 11.7% (CI: 8.4-16.0%) Moderate: 22.3% (CI: 17.6-27.9%) 33.0% (CI: 26.2-40.5%) Severe : 13.3% (CI: 8.4-20.4%) Moderate : 19.7% (CI: 14.5-26.2%) Yr 3 indicator calculated for 6-23 mos 62 25 37 188 188 188 N/A Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target Maternal & Newborn Care (35% LOE) Increase % of mothers who have 4+ ANC visits % mothers of children age 0-23 months who had four or more antenatal visits when they were pregnant with the youngest child. (RC1) Kaduha 45.5% (CI: 40.34- 50.66%) Not included in abridged survey Not included in abridged survey n/a n/a 75% Kigeme 48.9% (CI: 43.74- 54.06%) Not included in abridged survey Not included in abridged survey n/a n/a 75% Increase % of mothers who have ANC in their first trimester (tracking only) % mothers of children age 0-23 months who had antenatal visit in the first trimester when they were pregnant with the youngest child Kaduha 54.5% (CI: 49.34- 59.56%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Kigeme 54.7% (CI: 49.56- Not included in abridged survey Not included in abridged survey n/a n/a N/A Rwanda ICSP Year 3 KPC Report Page 106 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target 59.84%) Increase % of mothers who get at least two TT %mothers with children age 0-23 months who received at least two Tetanus toxoid vaccinations before the birth of their youngest child. (RC2) Kaduha 68.43% (CI: 63.58- 73.22%) Not included in abridged survey Not included in abridged survey n/a n/a 80% 68.33% (CI: 63.49- 73.11%) Not included in abridged survey Not included in abridged survey n/a n/a 80% Increase skilled birth attendance (tracking only) % children age 0-23 months whose births were attended by skilled personnel. (RC3) Kaduha 83.0% (CI: 79.11- 86.89%) Not included in abridged survey Not included in abridged survey n/a n/a N/A 91.7% (CI: 88.85- 94.55%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Increase % of newborns who get a post-natal check-up within 2 days of birth (RC 4) % of mothers of children 0-23 m. whose youngest child received a post-natal visit from an appropriate trained health worker within 2 days of birth. (RC4) Kaduha 37.70% (CI: 32.68- 42.72%) Not included in abridged survey Not included in abridged survey n/a n/a 60% Kigeme 44.2% (CI: 39.07- 49.33%) Not included in abridged survey Not included in abridged survey n/a n/a 60% Current Contraceptive Use Among Mothers of Young Children (tracking only) % mothers of children 0-23 months who are using a modern contraceptive method. (RC5) Kaduha 57.5% (CI: 52.38- 62.62%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Kigeme 62.5% (CI: 57.5-67.5%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Increase iron-folic acid supplementation during pregnancy. Percentage of mothers who received tablets; average number of days consumed of those who received pills. (OR) Kaduha 80.4% received (CI: 72.29- 84.51%) Average days: 69.4% received (CI: 64.1-76.6%) Average days: 39.88 81.0% received (CI: 74.2-87.8%) Average days: 41.53 243 300 90% 60 days Rwanda ICSP Year 3 KPC Report Page 107 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target 35.37 Kigeme 81.4% received (CI: 77.38- 85.42%) Average days: 33.45 70.9% received (CI: 65.7-76.0%) Average days: 33.45 83.7% received (CI: 79.3-88.0%) Average days: 42.00 251 300 90% 60 days Control of Diarrheal Diseases (15% LOE) Prevention Increase % of households that treat water effectively POU Water Tx: Percentage of households of children age 0-23 months that treat water effectively. (RC15, OR) Kaduha 50.0% (CI: 44.83- 55.17%) 98.3% (CI: 96.6- 99.9%) 75.7% (CI: 68.3-83.0%) 227 300 65% Kigeme 56.4% (CI: 51.28- 61.52%) 97.6% (CI: 95.2- 99.9%) 57.0% (CI: 48.6-65.4) 171 300 65% Improve appropriate hand washing practices Percentage of mothers of children age 0- 23 months who live in households with soap at the place for hand washing. (RC16, OR) Kaduha 38.6% (CI:33.57-43.63) 78.1% (CI:72.9-83.2%) 73.7% (CI: 63.5-83.9) 221 300 65% Kigeme 43.9% (CI: 38.77-49.03) 89.4% (CI: 85.4- 93.3%) 73.0% (CI: 63.2-82.8%) 219 300 65% Hand Washing at Appropriate times (tracking only) Percentage of mothers of children age 0- 23 months who wash hands with soap at all four key times Kaduha 2.8% (CI: 1.40-5.20% 21.0% (CI: 16.3-25.6% 29.7% (CI: 19.7-39.6%) 89 300 N/A Kigeme 5.0% (CI: 3.10-7.90%) 9.7% (CI: 6.3-13.0%) 15.3% (CI: 9.5-21.2%) 46 300 N/A Latrine/toilet in good condition Percentage of households of children age 0-23 months that have a toilet facility in appropriate condition Kaduha 15.0% (CI: 11.31- 18.69%) 20.7% (CI: 16.1- 25.2%) 27.3% (CI : 19.3-35.4%) 82 300 N/A Rwanda ICSP Year 3 KPC Report Page 108 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target (tracking only) Kigeme 26.9% (CI: 22.32- 31.48%) 14.0% (CI: 10.0- 17.9%) 23.3% (CI : 17.1-29.6%) 70 300 N/A Safe feces disposal (tracking only) Percentage of mothers of children 0-23 months who disposed of the youngest child’s feces safely the last time a stool passed. (Key Indicator) Kaduha 71.4% (CI: 66.73- 76.07%) 69.0% (CI: 63.7- 74.2%) 80.7% (CI: 74.9-86.5%) 242 300 N/A Kigeme 82.8% (CI: 78.90- 86.70%) 76.3% (CI: 71.4- 81.1%) 81.0% (CI: 75.6-86.4%) 243 300 N/A Prevalence Two week prevalence of diarrhea (tracking only) Percentage of children 0-23 months with diarrhea in the previous two weeks (Key Indicator) Kaduha 17.2% (CI: 13.30- 21.10%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Kigeme 19.4% (CI: 15.32- 23.48%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Improve home management of diarrhea (ORT use, increased fluids and continued feeding) Percentage of children age 0-23 months with diarrhea in the last 2 weeks who received ORS and/ or recommended home fluids. (RC13) Kaduha 23.1% (CI: 12.85-33- 35%) Not included in abridged survey Not included in abridged survey n/a n/a 70% Kigeme 22.9% (CI: 13.06- 32.74%) Not included in abridged survey Not included in abridged survey n/a n/a 70% Percentage of children 0-23 months with diarrhea in the last two weeks who were offered more fluids during the illness. (Key Indicator) Kaduha 36.9% (CI: 25.17- 48.63%) Not included in abridged survey Not included in abridged survey n/a n/a 70% Kigeme 40.0% (CI: 28.52- 51.48%) Not included in abridged survey Not included in abridged survey n/a n/a 70% Percentage of children 0-23 months with Kaduha 63.1% Not included in Not included in n/a n/a 75% Rwanda ICSP Year 3 KPC Report Page 109 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target diarrhea in the last two weeks who were offered the same amount or more food during the illness. (Key Indicator) (CI: 51.37- 74.83%) abridged survey abridged survey Kigeme 64.3% (CI: 53.08- 75.52%) Not included in abridged survey Not included in abridged survey n/a n/a 75% Zinc Treatment Increase use of zinc to treat diarrhea Percentage of children 0-23 months with diarrhea in the last two weeks who were treated with zinc supplements. (Key Indicator) Kaduha 24.6% (CI: 14.13- 35.07%) Not included in abridged survey Not included in abridged survey n/a n/a 70% Kigeme 10.0% (CI: 2.97-17.03%) Not included in abridged survey Not included in abridged survey n/a n/a 70% Pneumonia Case Management (LOE 10%) Prevalence Two week prevalence of suspected pneumonia (tracking only) Percent of children 0-23 months with cough and rapid and/or difficult breathing during two weeks prior to survey Kaduha 23.9% (CI: 19.49- 28.31%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Kigeme 31.4% (CI: 26.61- 36.19%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Care Seeking Improve appropriate care seeking for pneumonia Percent of children age 0-23 months with chest-related cough and fast and/ or difficult breathing in the last 2 weeks who were taken to an appropriate health provider. (RC14) Kaduha 44.2% (CI: 33.70- 54.70%) Not included in abridged survey Not included in abridged survey n/a n/a 70% Kigeme 45.1% (CI: 35.93- 54.27%) Not included in abridged survey Not included in abridged survey n/a n/a 70% Immunization – Not an intervention; Rapid CATCH Only Measles vaccination Percentage of children age 12-23 months who received a measles vaccination.(RC9) Kaduha 87.4% (CI: 81.2-92.10%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Kigeme 83.4% Not included in Not included in n/a n/a N/A Rwanda ICSP Year 3 KPC Report Page 110 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target (tracking only) (CI: 76.49- 89.10%) abridged survey abridged survey Access to immunization services (tracking only) Percentage of children aged 12-23 months who received Pentavalent-1 (DTP1 +HepB + Hib) by vaccination card or mother’s recall by the time of the survey . (RC10) Kaduha 89.3% (CI: 83.40- 93.60%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Kigeme 86.9% (CI: 80.30- 91.90%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Health System Performance regarding Immunization services (tracking only) Percentage of children aged 12-23 months who received Pentavalent-3 (DTP3 with HepB and Hib) according to the vaccination card or mother’s recall by the time of the survey. (RC) Kaduha 84.3% (CI: 77.0-89.7%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Kigeme 84.1% (CI: 77.20- 89.70%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Malaria – Not an official intervention; Rapid CATCH Prevention LLIN/ITN use Percentage of children age 0-23 months who slept under an insecticide-treated bed net (in malaria risk areas, where bed net use is effective) the previous night. (RC17) Kaduha 66.9% (CI: 61.80- 71.80%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Kigeme 66.9% (CI: 61.80- 71.80%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Prevalence Two week prevalence of fever (tracking only) Percent of children 0-23m with fever in the past two weeks. Kaduha 20.8% (CI: 16.61- 24.99%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Kigeme 23.9% (CI: 19.49- 28.31%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Treatment of fever Percentage of children age 0-23 months Kaduha 14.0% Not included in Not included in n/a n/a N/A Rwanda ICSP Year 3 KPC Report Page 111 Result/ Objective Indicators (OR) = OR Indicator (RC) = Rapid CATCH 2008 (Key Indicator) = Recommended by USAID Location Baseline Value (95% Confidence Int.) Year 2 KPC Value (95% Confidence Int.) Year 3 KPC Value (95% Confidence Int.) Numerator Denominator EOP Target Treatment of Fever in Malarious Zones (tracking only) . 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. (RC12) NOTE: Because of Rapid Diagnostic Testing, only children with a positive test should receive a drug. This is not reflected in Rapid Catch Indicator (CI: 7.60-24.70%) abridged survey abridged survey Kigeme 1.2% (CI: 0.0-6.3%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Care-seeking for fever (Measured because of RDT issues explained above.) Percentage of children age 0-23 months with a febrile episode during the last two weeks who sought treatment from appropriate provider. Kaduha 53.30% (CI: 42.01- 64.59%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Kigeme 52.3% (CI41.74-62.86%) Not included in abridged survey Not included in abridged survey n/a n/a N/A Process Indicators related to CHWs and Nutrition Weeks Contact with CHW for health education: Percent of households with children 0-23 months that received health information from a CHW in the past month, according to location (home visit, community meeting, health facility, Growth Monitoring and Counseling, Nutrition Week, etc.) CHW Home Visits Percent of households with children 0-23 months that received a visit from a CHW in the past month, according to reported purpose Kaduha 26.7% (CI: 22.13- 31.27%) 52.2% (CI: 46.3- 57.6%) 61.7% (CI: 53.6- 69.8%) 185 300 75% Kigeme 21.9% (CI 17.63-26.17%) 27.7% (CI 22.6- 32.7%) 36.7% (CI: 28.2- 45.1%) 110 300 75% Participation in Nutrition Weeks: Percentage of mothers with children 0-23 months who participated in “Nutrition Week” intervention at least once in the past 6 months for 4 or more days. Kaduha 53.0% (CI: 47.3- 58.6%) 53.0% (CI : 44.3- 61.7%) 159 300 80% Kigeme N/A N/A N/A n/a n/a NA 112 Annex 3. Population Data Used to Select Clusters Kaduha & Kigeme Samples - July 2014 Kaduha Samples HEALTH CENTER SECTOR CELL VILLAGE CLUSTERS 6 RUGEGE GATARE SHYERU BAZIRO 1 16 RUGEGE GATARE RUGANDA GITUNTU 2 24 MUSEBEYA Buruhukiro BUSHIGISHIGI GIHARAYUMBU 3 34 MUSEBEYA Buruhukiro GIFURWE NGANZO 4 43 MUSEBEYA Buruhukiro KIZIMYAMURIRO MUJERENGE 5 51 MUSEBEYA Musebeya GATOVU BISEREGANYA 6 59 MUSEBEYA Musebeya NYARURAMBI GATITI 7 68 MUSEBEYA Musebeya RUGANO KIBANDIRWA 8 77 MUSEBEYA Musebeya RUNEGE RUKARANKA 9 85 MUSEBEYA Musebeya SEKERA Nkomero 10 97 KIBUMBWE KIBUMBWE GAKANKA NKURUBUYE 11 106 KIBUMBWE KIBUMBWE NYAKIZA DUSENYI 12 118 MUGANO MUGANO YONDE GISOVU 13 128 MUGANO MUGANO SOVU KIGARAMA 14 134 MUGANO MUGANO GITONDORERO GITONDORERO 15 143 MUGANO MUGANO GITWA RYAMIGABO 16 153 MUSHUBI MUSHUBI GISHWATI MUHEMBE 17 162 MUSHUBI MUSHUBI CYOBE NYARUSHIKE 18 172 NYARWUNGO NKOMANE NKOMANE MUTARAMA 19 183 NYARWUNGO NKOMANE MUSARABA ROSOYO 20 195 NYARWUNGO NKOMANE TWIYA TWIYA 21 205 JENDA MUSANGE MASANGANO GASAGARA 22 214 JENDA MUSANGE NYAGISOZI KIBAGA 23 225 JENDA MUSANGE GASAGARA MUHORORO 24 234 JENDA MUSANGE JENDA NYAKIBUNGO 25 242 KADUHA KADUHA NYABISINDU Kanyege 26 252 KADUHA KADUHA NYAMIYAGA RUKERI 27 261 KADUHA KADUHA KAVUMU GAHAMA 28 269 RUGEGE GATARE BAKOPFU KALAMBO 29 278 RUGEGE GATARE MUNINI MAGUMIRA 30 Rwanda ICSP Year 3 KPC Report Page 113 Kigeme Samples HEALTH CENTER SECTOR CELL VILLAGE CLUSTERS 203 MBUGA TARE NYAMIGINA UWINYANA 31 213 MBUGA TARE BUHORO NYABWOMA 32 223 MBUGA TARE KAGANZA KIMICANGA 33 228 NYAMAGABE GASAKA NGIRYI NGIRYI 34 237 NYAMAGABE GASAKA NYABIVUMU DUSEGO 35 243 NYAMAGABE GASAKA NYAMUGALI KABACUZI 36 250 NYAMAGABE KIBILIZI GASHIHA GASHARU 37 5 CYANIKA CYANIKA GITEGA KIGARAMA 38 16 CYANIKA CYANIKA NYANZOGA GAFUHISHA 39 24 CYANIKA CYANIKA NYANZA NYABISINDU 40 34 CYANIKA CYANIKA KARAMA MUGAMBA 41 44 CYANIKA CYANIKA KIYUMBA NYARUCYAMU 42 53 KITABI KITABI KAGANO TURONZI 43 60 KITABI KITABI MUJUGA MUKAKA 44 67 KITABI KITABI MUKUNGU GATARE 45 74 KITABI KITABI SHABA MUYANGE 46 80 KITABI KITABI UWINGUGU UWURUNAZI 47 88 NYARUSIZA KAMEGELI KIZI GAKOMEYE 48 97 NYARUSIZA KAMEGELI RUSUSA KIGARAMA 49 106 NGARA MBAZI MUTIWINGOMA GATWA 50 116 NGARA MBAZI NGARA BUTARE 51 125 KIGEME GASAKA KIGEME GAKOMA 52 131 KIGEME KIBILIZI RUHUNGA RUHURURA 53 139 UWINKINGI UWINKINGI MUNYEGE MUNYEGE 54 147 UWINKINGI UWINKINGI GAHIRA GITITI 55 155 UWINKINGI UWINKINGI BIGUMIRA BIGUMIRA 56 163 UWINKINGI UWINKINGI KIBYAGIRA BISHYA 57 172 MBUGA KIBILIZI BUGARAMA KARANDURA 58 182 MBUGA KIBILIZI UWINDEKEZI MUGOTE 59 193 MBUGA TARE GATOVU GASENGE 60 114 Annex 4. Year 3 KPC Survey Questionnaire Year 3 KPC Monitoring Survey Questionnaire with Translation WORLD RELIEF RWANDA TANGIRANEZA INNOVATION CHILD SURVIVAL PROJECT, 2014 i. RESPONDENT IDENTIFICATION/ UMWIRONDORO W’USUBIZA 0) Hospital catchment area / Aho ibitaro bikorera Kigeme…………….. 1 Kaduha……………. 2 i1) Cluster No. / Nimero y’itsinda |___|___| i2) Household No. / Nimero y’urugo |___|___|___|___| i4) Interviewer Name/ Amazina y’ubaza ______________________________ i5) Sector/ Umurenge i6) Cell/ Akagali i7) Village/ Umudugudu i8) Health center/ Ikigo Nderabuzima i9) Date of Interview/ Itariki y’ibazwa 2013 - ___ ___ - ___ ___ MM - DD i10) Was consent received? Ubazwa yabyemeye? Yes/ Yego……………………………….1  i12 No/ Oya…………………………………..2 i11) If no, why not? Niba ari Oya, kubera iki? Unavailable/ Ntaboneka………………..1 End/ Iherezo Unwilling/ Ntameze neza……………….2 End/ Iherezo Rwanda ICSP Year 3 KPC Report Page 115 Child not Home/ Umwana ntahari……3 End/ Iherezo Other/ Ibindi…………………….…………4 End/ Iherezo ________________________________ (Specify/ Sobanura) i12) What are the name, sex, and date of birth of your youngest child that is still alive? Umwana wawe muto ufite yitwa nde? Yavutse ryari? Igitsina cye ni ikihe? i12a) NAME OF THE CHILD LESS THAN 24 MONTHS AMAZINA Y’UMWANA URI MUNSI Y’AMEZI 24 ____________________________________________ i12b) SEX OF CHILD (1=MALE, 2=FEMALE/ IGITSINA CY’UMWANA( 1=GABO, 2=GORE)……1……..2 i12c) DATE OF BIRTH IGIHE YAVUKIYE ___ ___ ___ ___/___ ___/ ___ ___ Y Y Y Y / M M / D D i12d) AGE OF THE CHILD (IN MONTHS) |___|___| IMYAKA Y’UMWANA (MU MEZI) i13) Ask the mother: What is your name? / Baza umubyeyi w’umwana: Witwa nde? ____________________________________________ i14) Ask the mother: What is your age in years? / Baza umubyeyi w’umwana: Ufite imyaka ingahe? |___|___| i15) Are you the biological mother of the child? / Ni wowe wabyaye uyu mwana? YES/ YEGO………………………..1 NO/ OYA…...………………….…...0 Rwanda ICSP Year 3 KPC Report Page 116 i16) Time interview began / Isaha ibazwa ryatangiriye AM/ Mbere ya saasita ___ ___:___ ___ PM/ Nyuma ya saasita ___ ___:___ ___ SECTION I: SOCIO-DEMOGRAPHICS / IGICE CYA 1: IMIBEREHO RUSANGE INSTRUCTIONS: Ask the questions exactly as they are written. Do not read responses unless directed to do so. Words in Italics are instructions for the interviewer and should not be read aloud. Follow skip patterns as directed. Write answers in the box unless otherwise directed. AMABWIRIZA: Baza ibibazo nkuko byanditse. Irinde kumu somera ibisubizo. Amagambo yanditse mu buryo buberamye ni amabwiriza y’ubaza ntabwo ugomba kuyasomera ubazwa. Aho ugomba gu simbuka hasimbuke. Andika igisubizo mu kazu kabugenewe. # Questions Ibibazo Responses Ibisubizobishoboka 1 Have you ever attended school? Mwaba mwarageze mu ishuri? Yes/ Yego…………………......……….1 No/ Oya……………………….......…....2 3 Don’t know/ Simbizi………………...88 3 2 If yes, then ask: What is the highest grade or level of school you have completed? Niba ari yego, mubaze uti: Warangije ayahe mashuri? None/ Did not complete primary Ntayo/Ntiyarangije amashuri abanza....0 Primary/ Amashuri abanza ….……….....1 Secondary/ Amashuri yisumbuye….….2 Past Secondary/ Amashuri makuru…...3 Other/ Ibindi…………………….…………4 ________________________________ (Specify/ Sobanura) 3 How many people live in your household? Muri uru rugo mubamo muri bangahe? Number/ Umubare………………….…|___|___| Don’t know/ Simbizi…………………….....88 4.a What is your ubudehe category according to the participatory poverty assessment as defined by MINALOC? Read options if needed. Mwashyizwe mu kihe cyiciro cy’ubudehe 1. Umutindi nyakujya (those in abject poverty)…………....……1 2. Umutindi (the very poor)…………...........2 Rwanda ICSP Year 3 KPC Report Page 117 4.b 4.c nyuma y’ubushakashatsi bwakozwe na MINALOC kubijanye n’ubukire cyangwa ubukene? Musomere ibyiciro niba atabizi If the category is unknown, the interviewer should check the list at the health center so that data is entered for every household. If there is debate, use the category assigned by MINALOC. Niba ubazwa atazi icyiciro arimo, ubaza ajye kureba kuri lisiti yo ku Kigo Nderabuzima iriho ibyiciro by’ingo zose, Niba ubazwa ajya impaka ku cyiciro yashyizwemo, koresha icyiciro kiri ku ilisiti ya MINALOC Are you using health insurance? Ese waba uri mu bwisungane mu kwivuza? If yes: Can I see your member card? Niba ari yego, nshobora kureba ikarita yawe y’ubwisungane mu kwivuza? 3. Umukene (the poor) ……………….……..3 4. Umukene wifashije (the resourceful poor)………..………...…4 5. Umukungu (the food rich)……….…….....5 6. Umukire (the money rich)………..……….6 8. Simbizi (don’t know) …….………………8 (Source: Government of Rwanda Poverty Reduction- Strategy Paper,June 2002 – p.15.) Yes/ Yego……………………………………1 No/ Oya……………………………………...0 21 Card available/ Ikarita irahari…………….1 No card/ Ikarita ntayo afite………………..0 SECTION II: MATERNAL AND NEWBORN CARE/ IGICE CYA KABIRI KWITA K’UMUBYEYI NURUHINJA # Questions Ibibazo Responses Ibisubizo bishoboka 5-20 Q5-Q20 removed for Y2 Uyu mwaka ibi bibazo ntibizabazwa 21 21 If biological mother (i15) ask: Rwanda ICSP Year 3 KPC Report Page 118 During your pregnancy with (Name), were you given or did you buy any iron tablets/syrup? Mubaze iki kibazo niba ariwe wabyaye uyu mwana (i15): Mu gihe wari utwite (izinary’umwana muto) wigeze uhabwa cyangwa ugura ibinini/umushongi bya feri byongera amaraso? SHOW TABLETS/ BIMWEREKE YES/ YEGO…………………...………….1 NO/ OYA………………………………….0 29 DON’T KNOW/ SIMBIZI...…………….88 29 22 During the whole pregnancy, for how many days did you take the tablets/syrup? If the answer is not numeric, probe for the approximate number of days. Igihe wari utwite, ibyo binini bya feri wabifashe mu minsi ingahe? Niba igisubizo aguhaye Atari umubare, komeza umubaze agereranye mu mibare. DAYS/ IMINSI………………………..…|___|___| DON’T KNOW/ SIMBIZI……………….….888 23- 28 Q23-28 removed for Year 2 Uyu mwaka ibi bibazo ntibizabazwa 29 SECTION III: BREASTFEEDING AND CHILD NUTRITION / KONSA NO KUGABURIRAUMWANA 29 Did you ever breastfeed (NAME)? Wigeze wonsa (izinary’umwana muto)? YES/ YEGO ............................ 1 NO/ OYA .............................. 0 36 30 How long after birth did you first put (NAME) to the breast? IF LESS THAN 1 HOUR, CIRCLE ‘000’ Less than 1 hour / lgihe kitageze ku isaha …………………….0 0 0 Rwanda ICSP Year 3 KPC Report Page 119 HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. Ukimara kubyara kanaka (izinary’umwana muto) wamwonkeje bwa mbere amaze igihe kingana iki avutse? NIBA ARI MUNSI Y’ISAHA IMWE SHYIRA AKAZIGA KURI 000,NIBA ARI MUNSI Y’AMASAHA 24, ANDIKA UMUBARE W’AMASAHA, NIBA ARI HEJURU Y’AMASAHA 24, ANDIKA IMINSI. or / cyangwa Hours / Amasaha……………... |___|___| or / cyangwa Days / Iminsi …………………...|___|___| 31 During the first three days after delivery, did you give (NAME) the liquid that came from your breasts? Mu minsi itatu ya mbere umaze kubyara, waba waronkeje ( IZINA RY’UMWANA MUTO)? YES/ YEGO ........................... 1 NO / OYA .............................. 0 DON’T KNOW/ SIMBIZI ........ 88 32 During the first three days after delivery, was (NAME) given anything to drink other than breast milk? Mu minsi itatu ya mbere umaze kubyara, hari ikinyobwa wahaye kanaka kitari amashereka? YES/ YEGO ........................... 1 NO / OYA .............................. 0  34 DON’T KNOW/ SIMBIZI ....... 88  34 33 What else was (NAME) given to drink during the first three days? Ni ibihe binyobwa bindi wahaye (IZINA RY’UMWANA MUTO) mu minsi itatu ya mbere? Anything else? Nta kindi? DO NOT READ THE LIST NTUMUSOMERE IBISUBIZO. RECORD ALL MENTIONED BY CIRCLING LETTER FOR EACH ONE MENTIONED SHYIRA AKAZIGA KUCYO AKUBWIYE MILK (OTHER THAN BREAST MILK) AMATA (ATARI AMASHEREKA…………....…A PLAIN WATER / AMAZI……...……...……........B SUGAR OR GLUCOSE WATER / AMAZI ARIMO ISUKARI………..………….…….C HOME REMEDY/ IMITI YATEGURIWE MU RUGO ITARI IYO KWA MUGANGA……..…D SUGAR-SALT-WATER SOLUTION / AMAZI ARIMO UMUNYU N’ISUKARI……………E Rwanda ICSP Year 3 KPC Report Page 120 FRUIT JUICE/ UMUTOBE W’IMBUTO ………...F INFANT FORMULA / AMATA Y’ABANA YO MU BIKOMBE……………………………..….G TEA / ICYAYI………………………….....H HONEY/ UBUKI …………………………I OTHER/ IBINDI…………………….……X ________________________________ (SPECIFY/ SOBANURA) 34 Was (NAME) breastfed yesterday during the day or at night? (Izinary’umwana muto) waramwonkeje ejo kumanywa cyangwa nijoro? YES/ YEGO ........................... 1 36 NO / OYA............................... 0 DON’T KNOW / SIMBIZI ...... 88 35 Sometimes babies are fed breast milk in different ways, for example by spoon, cup or bottle. This can happen when the mother cannot always be with her baby. Sometimes babies are breastfed by another woman, or given breast milk from another woman by spoon, cup or bottle or some other way. This can happen if a mother cannot breastfeed her own baby. Did (NAME) consume breast milk in any of these ways yesterday during the day or at night? Rimwe n arimwe abana bahabwa amashereka mu buryo butandukanye, urugero: kukayiko, mu gikombe cg mu icupa. Ibyo bishobora kuba iyo umubyeyi adashoboye kuba ari kumwe n’umwana we. Bishobora no kuba iyo umubyeyi adashobora konsa umwana we. Mbese (KANAKA) yaba yarahawe YES / YEGO ........................... 1 NO / OYA .............................. 0 DON’T KNOW / SIMBIZI ....... 88 Rwanda ICSP Year 3 KPC Report Page 121 amashereka ejo kumanywa cg nijoro hakoreshejwe bumwe muri ubwo buryo maze kukubwira? 36 Now I would like to ask you about some medicines and vitamins that are sometimes given to infants. Was (NAME) given any vitamin drops or other medicines as drops yesterday during the day or night? Ubu ndashaka kukubaza ibyerekeranye n’imiti cyangwa amavitamini ajya ahabwa abana. Ese (KANAKA) yaba yarahawe ibitonyanga bya vitamin cyangwa indi miti ejo ku manywa cg nijoro? YES/ YEGO ............................ 1 NO / OYA ............................... 0 DON’T KNOW/ SIMBIZI ......... …..88 37 Was (NAME) given ORS yesterday during the day or at night? Haba hari uruvange rw’imyunyu n’isukari(SRO) waba warahaye (izinary’umwanamuto) ejo kumanywa cg nijoro? YES / YEGO .......................... 1 NO / OYA ............................... 0 DON’T KNOW / SIMBIZI ........ 88 38 Did (NAME) drink anything from a bottle with a nipple yesterday or last night? (Izinary’umwana muto) yaba yaranywesheje bibero ejo kumanywa cyangwa iri joro? YES / YEGO .......................... 1 NO / OYA............................... 0 DON’T KNOW / SIMBIZI ....... 88 Read out Q.39 below. Read the list of liquids one by one and mark ‘yes’ or ‘no’, accordingly. After you have completed the list, follow by asking Q. 40. [See far right hand column for those items (40B, 40C, and/or 40F) where the respondent replied ‘YES’.] Soma ibibazo biri hasi, Birebana n’ikibazo cya 39. Soma urutonde rw’ibinyobwa kimwe kimwe ushyireho yego cyangwa oya, nyuma yo kurangiza urutonde, komeza ubaze ikibazo cya 40 [reba ibyanditse iburyo ( 40B, na 40C/cyangwa 40F) aho igisubizo ari ‘YEGO’]. No. QUESTIONS AND FILTERS/ IBIBAZO CODING CATEGORIES/ IBISUBIZO BITEGEREJWE QUESTIONS AND CODING CATEGORIES/ IBIBAZO N’IBISUBIZO BITEGEREJWE 39 YES NO DK 40 Rwanda ICSP Year 3 KPC Report Page 122 Next I would like to ask you about some liquids that (Name) may have had yesterday during the day or at night. Did (Name) have any (ITEM FROM LIST)? READ THE LIST OF LIQUIDS STARTING WITH ‘PLAIN WATER.’ Noneho ndifuza kukubaza ibinyobwa waba wahaye umwana wawe ejo kumanywa cg nijoro. Hari ibyo waba wamuhaye? (IBIRI KU ILISTI) SOMA URUTONDE RW’IBINYOBWA UHEREYE KU “AMAZI GUSA”. YEGO OYA SINZI READ QUESTION 40 FOR ITEMS B, C AND F, IF CHILD CONSUMED THE ITEM. RECORD 88 for DON’T KNOW. How many times yesterday during the day or at night did (Name) consume any (ITEM FROM LIST)? SOMA IKIBAZO CYA 40 KU BISUBIZO B, C NA F, NIBA UMWANA YARABINYOYE. WANDIKE 88 AHO YASHUBIJE SIMBIZI. Ibi binyobwa kanaka (izinary’umwanamuto) yabifashe inshuro zingahe ku munsi haba ku manywa cyangwa nijoro? A Plain water? Amazi ? 1 0 88 B Infant formula such as Kigozi, Rinda and others? Amata y’abana yo mu bikombe nka Kigozi, Rinda n’andi? 1 0 88 B. TIMES/ Inshuro I__I__I C Milk such as tinned, powdered or fresh animal milk? Amata yo mu dukarito, ay’ifu cyangwa inshyushyu( y’inka, ihene)? 1 0 88 C. TIMES/ Inshuro I__I__I D Juice or juice drinks? Umutobe w’ibitoke cyangwa ubundi bwoko bw’imitobe? 1 0 88 E Clear broth? Isupu imeze nk’amazi? 1 0 88 F Yogurt? Yawurute? 1 0 88 F. TIMES/ InshuroI__I__I G Thin porridge? Igikoma kidafashe? 1 0 88 H Any other water-based liquids such as (insert local) sorghum juice? Ibindi binyobwa nk’ umusururu ? 1 0 88 I Any other liquids? Ibindi binyobwa? 1 0 88 Rwanda ICSP Year 3 KPC Report Page 123 41 Please describe everything that (NAME) ate yesterday during the day or night, whether at home or outside the home. a) Think about when (Name) first woke up yesterday. Did (NAME) eat anything at that time? IF YES: Please tell me everything (NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. IF NO, CONTINUE TO QUESTION b). b) What did (NAME) do after that? Did (NAME) eat anything at that time? IF YES: please tell me everything (NAME) ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. REPEAT QUESTION b) ABOVE UNTIL RESPONDENT SAYS THE CHILD WENT TO SLEEEP UNTIL THE NEXT DAY. c) IF RESPONDENT MENTIONS MIXED DISHES LIKE A PORRIDGE, SAUCE OR STEW, PROBE: What ingredients were in that (MIXED DISH)? PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. AS THE RESPONDENT RECALLS FOODS, UNDERLINE THE CORRESPONDING FOOD AND CIRCLE ‘1’ IN THE COLUMN NEXT TO THE FOOD GROUP. IF THE FOOD IS NOT LISTED IN ANY OF THE FOOD GROUPS BELOW WRITE THE FOOD IN THE BOX LABELLED ‘OTHER FOODS.’ IF FOODS ARE USED IN SMALL AMOUNTS FOR SEASONING OR AS A CONDIMENT, INCLUDE THEM UNDER THE CONDIMENTS FOOD GROUP. ONCE THE RESPONDENT FINISHES RECALLING FOODS EATEN, READ EACH FOOD GROUP WHERE ‘1’ WAS NOT CIRCLED, ASK THE FOLLOWING QUESTION AND CIRCLE ‘1’ IF RESPONDENT SAYS YES, ‘0’ IF NO AND ‘8’ IF DON’T KNOW: Yesterday during the day or night, did (NAME) drink/eat any (FOOD GROUP ITEMS)? Mwatubwira ibiribwa (IZINA RY’UMWANA MUTO) yagaburiwe ejo hashize kumanywa na nijoro murugo cyangwa ahandi a) Tekereza mugihe (kanaka) yamaragakubyuka ,hari icyo kurya yaba yarahawe? NIBA ARI YEGO watubwira buri kimwe cyose yaba yarariye muri icyo gihe? KOMEZA UMUBAZE UTI: Nta kindi? KUGEZA UBWO ASUBIZA KO NTA KINDI. NIBA NTACYO, KOMEZA KUKIBAZO CYA b). b) Nyuma yibyo (kanaka) yakoze iki? Hari ikintu (Kanaka) yariye muri icyo gihe? NIBA ARI YEGO: watubwira buri kimwe cyose yaba yarariye? KOMEZA UMUBAZE UTI: Nta kindi? KUGEZA UBWO ASUBIZA KO NTA KINDI. SUBIRAMO IKIBAZO CYA b) CYO HARUGURU KUGEZA UBWO UBAZWA AKUBWIRA KO UMWANA YAGIYE KURYAMA AGAKANGUKA K’UWUNDI MUNSI. c) NIBA AGUSHUBIJE IBYO KURYA BIVANGAVANZE NK’IGIKOMA, ISOSI CYANGWA IBINDI BIRYO BITETSE, KOMEZA UMUBAZE UTI: Ni ibihe biribwa byari muri iyo MVANGE y’ibiryo? KOMEZA UMUBAZE UTI: Nta cyindi yariye? KUGEZA UBWO ASUBIZA KO NTA KINDI. Rwanda ICSP Year 3 KPC Report Page 124 UKO USUBIZA AGENDA YIBUKA IBIRYO UMWANA YARIYE, UGENDE USHYIRAHO IKIMENYETSO KUCYO BIHUJE KANDI UZENGURUTSE AKAZIGA KURI”1” MU KUMBA KEGEREYE ITSINDA RY”IBIRIBWA. NIBA IBIRYO AVUZE BITARI KU ILISITI IRI HASI HANO, IBIRYO AVUZE UBYANDIKE AHAGENEWE “IBINDI BIRYO” NIBA HARI IBIRIBWA BYAKORESHEJWE MU KURYOSHYA IBIRYO NK’IBIRUNGO, UBISHYIRE AHAGENEWE ITSINDA RY’IBIRUNGO. MU GIHE USUBIZA ARANGIJE KUVUGA IBIRYO BYOSE UMWANA YARIYE< SOMA BURI KICIRI CY’IBIRYO AHO UTIGEZE USHYIRA AKAZIGA KURI “1” , UBAZE IKIBAZO GIKURIKIRA HANYUMA USHYIRE AKAZIGA KURI “1” NIBA ASHUBIJE YEGO, KURI “0” NIBA ASHUBIJE OYA, KURI “88” NIBA ASHUBIJE SIMBIZI: Ejo kumanywa cyangwa nijoro, ese (Kanaka) yaba yarariye cyangwa yaranyoye ibiryo biri muri ibi biryo ngiye kukubaza (IBIRYO MU BYICIRO)? OTHER FOODS: PLEASE WRITE DOWN OTHER FOODS IN THIS BOX THAT RESPONDENT MENTIONED BUT ARE NOT IN THE LIST BELOW IBINDI BIRIBWA: ANDIKA IBINDI BIRIBWA YAVUZE BITAGARAGARA KURUTONDE RWO HASI. NO. QUESTIONS AND FILTERS/ IBIBAZO CODING CATEGORIES/ IBISUBIZO BITEGEREJWE YES/ YEGO NO/ OYA DK/ SIMBIZI A Thicker porridge, bread, rice, noodles, or other foods made from grains Igikoma gifashe, umugati, umuceri, amakaroni, cyangwa ibindi biribwa bikomoka kubinyampeke 1 0 88 B Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside Ibihaza, karoti, ibijumba by’ umuhondo cyangwa bya orange 1 0 88 C White potatoes, white yams, cassava, or any other foods made from roots Ibirayi, ibikoro, imyumbati, cyangwa ibindi biribwa bikomoka kubinyabijumba. 1 0 88 D Any dark or green leafy vegetables Imboga z’icyatsi kibisi cyane, Imboga rwatsi 1 0 88 E Ripe mangoes, ripe papayas or ripe guava Imyembe ihishije,ipapayi ihishije, cyangwe amapera ahishije 1 0 88 F Any other fruits or vegetables (such as avocado) Hari izindi mbuto cyangwa imboga uha umwana zitavuzwe 1 0 88 Rwanda ICSP Year 3 KPC Report Page 125 haruguru (nka avoka) G Liver, kidney, heart or other organ meats Umwijima, impyiko, umutima, cyangwa izindi nyama zo munda 1 0 88 H Any meat, such as beef, pork, lamb, goat, chicken or duck Izindinyama / Iz’inka, ingururube, intama, ihene, inkoko cyangwa imbata 1 0 88 I Eggs / Amagi 1 0 88 J Fresh or dried fish, shellfish or seafood Amafi mabisi cyangwa yumye,isambaza ,injanga/indagara 1 0 88 K Any foods made from beans, peas, lentils, nuts or seeds Ibindi biribwank’ibishyimbo, amashaza, lantiye, ubunyobwa 1 0 88 L Cheese, yogurt, or other milk products foromage,yawurute,cyangwa ibindi bikomoka ku mata 1 0 88 M Any oil, fats or butter, or foods made with any of these Andi mavuta,ibinure cyangwa mayonese, cyangwa ibiribwa bikomoka kubyo tuvuze. 1 0 88 N Any sugary foods such as chocolates, sweets, candies, pastries cakes or biscuits Ibindi biribwa birimo isukari nka shokora, bombo, shikareti, gato cyangwa biswi 1 0 88 O Condiments for flavor, such as chilies, spices, herbs or fish powder ibiribwaby’ibirungo nk’urusenda, utundi twatsi, ifu y’indagara 1 0 88 P Grubs, snails or insects inswa ,isenani cyangwa utundi dusimba duto tuguruka 1 0 88 Q Foods made with red palm oil, red palm nut or red palm nut pulp sauce Ibiribwa byatekeshejwe amamesa 1 0 88 R Other foods not recorded on the list Ibindi biryo bitavuzwe haruguru 1 0 88 Check categories A-Q / GENZURA IBYICIRO A-Q IF ALL “NO” or “DK”  GO TO 42 IF AT LEAST ONE “YES”  GO TO 43 NIBA BYOSE ARI “OYA” CYANGWA “SIMBIZI” JYA KURI 42 NIBA BYIBUZE KIMWE MURI BYO ARI “YEGO” JYA KURI 43 Rwanda ICSP Year 3 KPC Report Page 126 42 Did (NAME) eat any solid, semi-solid, or soft foods yesterday during the day or at night? IF ‘YES’ PROBE: What kind of solid, semi-solid, or soft foods did (NAME) eat? Ese (KANAKA) yigeze arya ibiryo bikomeye , bidakomeye cyane cyangwa byoroshye ejocyangwa ijoro ryakeye? NIBA ARI YEGO KOMEZA UBAZE UTI: Ni ubuhe bwoko bw’ ibiryo bikomeye , bidakomeye cyane cyangwa byoroshye yafashe? YES/ YEGO ………………………...1 NO / OYA ………………………......0 44 DON’T KNOW/ SIMBIZI……..….88 44 GO BACK TO Q41 AND RECORD FOODS EATEN THEN CONTINUE. Subira kukibazo cya 41 umusubiriremo byabibazo nyuma ukomeze 43 How many times did (NAME) eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night? Such as pureed cassava, potatoes, avocado or other pureed foods? WE WANT TO FIND OUT HOW MANY TIMES THE CHILD ATE ENOUGH TO BE FULL. SMALL SNACKS AND SMALL FEEDS SUCH AS ONE OR TWO BITES OF MOTHER’S OR SISTER’S FOOD SHOULD NOT BE COUNTED. LIQUIDS DO NOT COUNT FOR THIS QUESTION. DO NOT INCLUDE THIN SOUPS OR BROTH, WATERY GRUELS, OR ANY OTHER LIQUID. USE PROBING QUESTIONS TO HELP THE RESPONDENT REMEMBER ALL THE TIMES THE CHILD ATE YESTERDAY Ibiryo bikomeye ,bidakomeye cyane cyangwa ibindi biryo byoroshye ariko bitarink’amazi yabifashe inshuro zingahe ejo kumanywa cyangwa nijoro? Urugero: Ese mwamuhaye inombe y’imyumbati, y’ibijumba? Y’avoka? Cyangwa inombe y’ibindi biryo? TURIFUZA KUMENYA UMUBARE W’INSHURO UMWANA AGABURIRWA KUGEZA AHAZE. NTUBARIREMO UTWO GUHUGENZA UMWANA N’UTUNDI TUNTU DUTO ASHOBORA GUHABWA NA NYINA CYANGWA BAKURU BE. IBINYOBWA NTIBIBARWA MURI IKI KIBAZO. NTUBARIREMO AMASUPU AMEZE NK’AMAZI N’IBINDI BIRYO BIMEZE NK’AMAZI CYANGWA BINYOBWA. KOMEZA UMUBAZE KUGIRA NGO UMUFASHE KWIBUKA No. OF TIMES/ INSHURO………………...|___|___| DON’T KNOW/ SIMBIZI ……….88 Rwanda ICSP Year 3 KPC Report Page 127 INSHURO ZOSE UMWANA YAGABURIWE UMUNSI W’EJO. 44 (If yes to 41 or 42) At what age did (NAME) begin eating solid, semi-solid, or soft foods? (NIBA ARI YEGO)( kanaka) yanganaga iki mutangira kumuha ibiryo bikomeye cyangwa bidakomeye cyane cyangwa byoroshye? Age (months)/ Imyaka mumezi..|___|___| DON'T KNOW/ SIMBIZI……………….88 44a (If yes to 41 or 42) Does (NAME) eat from his/her own separate bowl/cup? (Niba ari yego) Ese (Izina ry”umwana) yaba arira cyangwa agaburirwa ku gasahane/ mu gakombe ke? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0 45 Are you or someone in your family helping (NAME) eat? (ie. physically feeding them) Ujya ufasha (IZINA RY’UMWANA MUTO) kurya cyangwa hari undi wo mu muryango umufasha? YES/ YEGO……..………………..…..146b NO/ OYA……………….…………..…0 46a IF NO: At what age did (NAME) start eating by himself/herself? NIBA ARI OYA: ni ku yahe mezi izina ry’umwanamuto ) yatangiye kwigaburira ubwe? Age (months)/ Imyaka mumezi...|___|___| DON'T KNOW/ SIMBIZI………….88 46b Do you encourage (NAME) to eat/feed (including when you breastfeed)? Mbese ujya ushishikariza (IZINA RY’UMWANA) kurya (no mu gihe umwonsa)? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0 47-48 Q47- 48 removed for Y2 Uyu mwaka ibi bibazo ntibizabazwa 49 49 Has (NAME) taken any drug for intestinal worms in the past 6 months? Kanaka (izinary’umwana Muto) yaba hari utunini tw’inzoka zomunda yahawe mu mezi atandatu ashize? Show example of drug for worms YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0 DON’T KNOW / SIMBIZI......... …...88 Rwanda ICSP Year 3 KPC Report Page 128 Mwereke urugero rw’ibinini by’inzoka SECTION IV: INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS/ UBUVUZIBUKOMATANIJEBW’INDWARAZ’ABANA 50-75 Q51-75 removed for Y2 Uyu mwaka ibi bibazo ntibizabazwa 76 SECTION V: WATER & SANITATION / AMAZI N’ISUKURA 76 Do you treat your water in any way to make it safer for drinking? Hari uburyo mukoresha mu gutu nganya amazi yokunywa? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………...…0  78 77 IF YES: What do you usually do to the water to make it safer to drink? Niba ariYego: ubikora ute ngo wize reko amazi ari meza yokunyobwa? (ONLY CHECK MORE THAN ONE RESPONSE, IF SEVERAL METHODS ARE USUALLY USED TOGETHER, FOR EXAMPLE, CLOTH FILTRATION AND CHLORINE) SHYIRA IKIMENYETSO KU GISUBIZO KIRENZE KIMWE NIBA AKORESHA UBWO BURYO BWOSE ICYARIMWE, URUGERO: KUYAYUNGURURA UKORESHEJE CHLORINE CYANGWA AGATAMBARO. Let It Stand And Settle/ Sedimentation kuyatereka akiyungurura…………….A Strain It Through Cloth Kuyayunguruza agatambaro…………………………...B Boil/ kuyateka……………………………………………..C Add Bleach/Chlorine Kuyashyiramo sur’eau/kolorine……………………….D Water Filter (Ceramic, Sand, Composite) Kuyayunguruza filitire(iyakizungu, amakara, umucanga…………………..….………………………….E Solar Disinfection/ Kwica udukoko ukoresheje izuba………………….....F Don’t Know/ simbizi………………………………….….G Other/ Ikindi_________________________________H (Specify/ Sobanura) 78 When do you wash your hands? Ni ryari ukaraba intoki? DO NOT PROMPT. CIRCLE ALL MENTIONED. Never / nta narimwe …………..……………………….A 81 Before Food Preparation / Mbere yogutegura amafunguro.…………………………………………….B Before Feeding Child / Mbere yo konsa/ mbereyo kugaburira Rwanda ICSP Year 3 KPC Report Page 129 NTUMUHAGARIKE, KOMEZA WUMVE IBYO AKUBWIRA USHYIRE AKAMENYETSO KU BYO AKUBWIRA BYOSE. umwana……………………………..…C After Defecation/Visiting The Toilet / Nyuma yo kuva ku musarane ……………………………………………….D After attending to a child who has defecated/soiled / Nyuma yo gutunganya/guhanagura umwana umaze kwituma…………………………….……………………E Other/ Ikindi ihe.____________________________F (Specify/ Sobanura) 79 Can you show me where you usually wash your hands and what you use to wash hands? Mushobora kunyereka aho mukarabira intoki n’icyo mukoresha mukaraba intoki? ASK TO SEE AND OBSERVE MUSABE ABIKWEREKE NAWE WITEGEREZE. Inside/Near Toilet Facility/ Mu musarane imbere cyangwa hafi yawo…….……….1 Inside/Near Kitchen/Cooking Place/ mu gikoni, Iruhande rwacyo/ aho batekera…………………….…. 2 Elsewhere In Yard Ahantu aho ari ho hose mu rugo……………..…….....3 Outside Yard/ inyumay’urugo…………………....…….4 No Specific Place Nta mwanya wihariye uhari……………………..….…..5 No Permission To See Ntakwemereye kuhareba …………………….…………8 80a OBSERVATION ONLY: Is there soap or detergent or locally used cleansing agent? This item should be either in place or brought by the interviewee within one minute. If the item is not present within one minute check none, even if brought out later. (ONLY CHECK MORE THAN ONE IF SEVERAL CLEANING AGENTS ARE USED) ITEGEREZE GUSA: Hari isabune cyangwa ibindi bikoreshwa mu gukaraba intoki? Icyo gikoresho gishobora kuba gihari cyangwa kikazanwa n’umubyeyi mu gihe cy’umunota umwe gusa. Niba kitabonetse mu munota umwe, kibarwa nk’ikidahari. Soap/ Isabune isanzwe………………….…………A Detergent/ Isabune y’ifu nka omo………………..B Ash/ Ivu…………………………………………….…C Mud/Sand/ Icyondo/ Akabuye………………….…D None/ Ntanakimwe………………………………....E Other/ Ikindi______________________________F (Specify/ Sobanura) Rwanda ICSP Year 3 KPC Report Page 130 (SHYIRA IKIMENYETSO KU GIKORESHO CYOSE YIFASHISHA AKARABA INTOKI ) 80b OBSERVATION ONLY: Specify what kind of hand washing facility is used, if any? (ONLY CHECK MORE THAN ONE IF SEVERAL FACILITIES ARE USED) ITEGEREZE GUSA: Bakoresha ibihe bikoresho bakaraba? (SHYIRA IKIMENYETSO KU GIKORESHO CYOSE YIFASHISHA AKARABA INTOKI ) Tippy tap / Kandagira ukarabe …………………………….A Basin/ Ibase…………………………………………………… B Jerry can / jug: injerekani / ijage……………………………C Pan / pot / : Isafuliya/ Inkono ………………………………D Sink / Lavabo ………………………………………………...E None/ Nta nakimwe ……………………………………………F Other/ Ikindi______________________________________G (Specify/ Sobanura) 80c (If pan, pot, bowl, or basin) What else, if anything, are you using this receptacle for other than hand washing? (ONLY CHECK MORE THAN ONE IF SEVERAL ARE PRACTICED) (Niba ari isafuliya,inkono cyangwa ibase ) mubaze undi murimo akoresha ibi bikoresho utari gukaraba intoki? (SHYIRA IKIMENYETSO KU BYO AKUBWIYE BYOSE) Nothing else/ Ntakindi……………………………………………A Food preparation/ Gutegura Amafunguro……………………B Laundry/ Kumesa………………………………………………..C Other/ Ibindi_______________________________________D (Specify/ Sobanura) 81 What kind of toilet facility do you have? Can I see it? Umusarane mukoresha umeze ute? Nshobora kuwureba ? No toilet facility/ Nta musarane ………………………….1 Open latrine/ Umusarane udapfundikiye ………………2 Closed latrine/ umusarane upfundikiye…………….….3 Flush toilet/ umusarane wa kizungu……………………4 No permission to see/ ntiyakwemereye kureba…...….5 Rwanda ICSP Year 3 KPC Report Page 131 82 The last time (NAME) passed stools, where were the feces disposed of? Igihe cyashize (izina ry’umwana) amaze kwituma umwanda we wawushyize he? Probe to find the location. Komeza umubaze wumve aho yaba ashyira umwanda w’umwana. Disposed into a latrine or toilet facility Yawushyize mu musarane …………………………………....1 Disposed into a garbage/ trash bin yawushyize mu kintu kijyamo imyanda cyangwa ahagenewe imyanda………………………………………..….2 Dug and buried – near the house or in the yard?/ Yawushyize iruhande rwinzu cyangwa kure yayo ..............3 Dug and buried – far from the house or yard?/ Yawushyize cyangwa yawutabye kure yinzu cyangwa ahandi................4 Did not bury – near the house or yard / Ntiyawutabye hafi yinzu cyangwa ahandi……………………………………..…...5 Did not bury – far from the house or yard / Ntiyawutabye kure yinzu cyangwa ahandi ……………………………..…....6 Don’t know/ Simbizi……………………………………............7 Other/ Ahandi_____________________________________8 (Specify/ Sobanura) SECTION VI: IMMUNIZATION/ IKINGIRA 83-92 Q82 - 92 removed for Y2 Uyu mwaka ibi bibazo ntibizabazwa 93 SECTION VII: ANTHROMPOMETRICS/ IBIPMO 93 May I weigh (name of child)? Nshobora gupima (izinary’umwana muto) ibiro? Measure twice. If difference in weight is more than 0.5 KG, measure a third time. Pima umwana inshuro ebyiri ,niba ikinyuranyo cy’ibiro by’umwana ari inusu( 500 gs) ongera umupime bwa gatatu Yes/ Yego ……………….1st __________ Kilograms/ Ibiro 2nd __________ Kilograms/ Ibiro 3rd __________ Kilograms/ Ibiro No/ Oya…………….0 Rwanda ICSP Year 3 KPC Report Page 132 94 May I use MUAC Tape with (name of child)? Nshobora gupima umuzenguruko w’ikizigira (izinary’umwanamuto)? Measure twice. If difference in length is more than 0.5 CM, measure a third time. Pima umwana inshuro ebyiri ,niba ikinyuranyo cy’umuzenguruko w’ikizigira by’umwana ari 0.5 cm ongera umupime bwa gatatu Yes / Yego……………1st ____________ cm/ santimetero 2nd ____________ cm/ santimetero 3rd ____________ cm/ santimetero No/ Oya…………….0 95 May I measure length for (name of child)? Nshobora gupima uburebure bw’umwana? Measure twice. If difference in length is more than 0.5 CM, measure a third time. Pima umwana inshuro ebyiri ,niba ikinyuranyo cy’uburebure bw’umwana ari 0.5 cm ongera umupime bwa gatatu Yes / Yego……………1st ____________ cm/ santimetero 2nd ____________ cm/ santimetero 3rd ____________ cm/ santimetero No/ Oya…………….0 96 May I use MUAC Tape with you? Nshobora gupima umuzenguruko w’ikizigira cy’akaboko kawe? Measure twice. If difference in length is more than 0.5 CM, measure a third time. Pima umubyeyi inshuro ebyiri ,niba ikinyuranyo cy’umuzenguruko w’ikizigira cy’umubyeyi ari 0.5 cm ongera umupime bwa gatatu Yes / Yego…………..1st ____________ cm/ santimetero 2nd ____________ cm/ santimetero 3rd ____________ cm/ santimetero Rwanda ICSP Year 3 KPC Report Page 133 No/ Oya…………….0 SECTION VIII: BEHAVIOR CHANGE COMMUNICATION/IKIGANIRO KIGAMIJE GUHINDURA IMYITWARIRE 97 In the past year, have you participated in a week-long training on child feeding and food preparation? Mu mezi 12 ashije , waba warigeze witabira inyigisho zimara icyumweru zijyanye no kugaburira umwana no gutegura amafunguro mu mudugudu? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0  101 DON’T KNOW / SIMBIZI……..........88  101 98 IF YES: How many times? NIBA ARI YEGO: wazigiyemo inshuro zingahe ? Once/ Rimwe………………………………………1 Twice/ Kabiri………………………….………...…2 Three or more/ Gatatu cyangwa karenga…….3 99 When was the most recent time you participated in such a week-long training? Ni ryari uherutse gukurikirana izo nyigisho zimara icyumweru? Month/Ukwezi ______________________ Year/ Umwaka ______________________ 100 The most recent time, how many of the days did you participate? Izo uherutse wazitabiriye iminsi ingahe? Number / Umubare……………………|___|___| Don’t know/ Simbizi………………..…88 No response/ Nta gisubizo………….9 101 Did you receive a visit related to health in the past month? Hari uwaba yaragusuye mu byerekeranye n’ubuzima mu kwezi gushize? YES/ YEGO……..………………..…..1 NO/ OYA……………….…………..…0 DON’T KNOW / SIMBIZI……..........88 Rwanda ICSP Year 3 KPC Report Page 134 101 a If yes, who visited you? Niba ari yego ni nde? Do not prompt; Circle all that apply. Wimuca mu ijambo andika ibyo akubwiye aho bigomba kujya. Care group member/ Uri mu itsinda ry’ubuzima (care group)…………A Health facilities staff/ Umukozi w’ivuriro…………………………………..B Local government staff/ Umuyobozi mu nzego z’ibanze…………………..C Others?/ Abandi?________________________D (Specify/ Sobanura) 102 If yes, can you tell me what the purpose of the visit was? Niba ari yego, wambwira icyamugenzaga? Do not prompt; Circle all that apply. Wimuca mu ijambo andika ibyo akubwiye aho bigomba kujya. A. FOLLOW UP ON SICK CHILD GUKURIKIRANA UMWANA URWAYE B. PROVIDE HEALTH EDUCATION ON MALARIA PREVENTION GUTANGA INYIGISHO ZO KWIRINDA MALARIYA C. PROVIDE HEALTH EDUCATION ON DIARRHEA PREVENTION GUTANGA INYIGISHO ZO KWIRINDA IMPISWI D. PROVIDE HEALTH EDUCATION ON PNEUMONIA GUTANGA INYIGISHO KUNDWARA Y’UMUSONGA E. PROVIDE HEALTH EDUCATION ON NUTRITION GUTANGA INYIGISHO KU MIRIRE F. PROVIDE HEALTH EDUCATION ON IMMUNIZATION GUTANGA INYIGISHO KU IKINGIRA G. OTHER/ IKINDI: ____________________ (Specify/ Sobanura) Time interview ended/ Igihe ibazwa ryarangiriye AM Mbere ya saasita ___ ___:___ ___ PM Nyuma ya saasita ___ ___:___ ___ Thank you. Murakoze. 135 Annex 5. Survey Enumerators and Participants Name Position KABADEGE Melene UMUTONI Grace Carmen WR-HQ Technical Advisor ICSP Nicole UBC NKURIZA ALOYS SED-TARE BIZIMUNGU GASPARD KGH M&E NIKUZE LAURENTINE HC-MBUGA H.C NDIKUMANA MARTIN ICSP MUSAFIRI JEAN BAPTISTE ICSP Emily Hunn UBC KWIZERA AOUDITH SED-Kitabi NYIRAHABIMANA EMMA￾MARIE SED-Kitabi MUTUYIMANA MARIE FRANDRIE HC-Kitabi RUSAGARA GERMAINE ICSP Emilly Miller UBC UNYIZIHIYE VESTINE HC-KIBIRIZI NIYITEGEKA PAUL SED-KIBIRIZI MUSANGWA ADOLPHE ICSP Emily Warren UBC NTAWUKURIRYAYO FIDELE ICSP NYIRASIKAMWE M.JEANNE SED-UWINKINGI NZABAMWITA EVARISTE SED-WINKINGI NTAWURUHUNGA MARCELLINE HC-UWINKINGI Nyiranzeyimana Beatrice ICSP RWASIBO JOSEPH SED_KAMEGERI BAMPORIKI GEMILA HC-KAMEGERI MUSONI JEAN M VIANNEY SED-KAMEGERI NTAWURUHUNGA MARCELLINE HC-UWINKINGI NGIRUWONSANGA NARCISSE ICSP NYIRAHABIMANA SARAH SED-GASAKA NYIRACUMI ALPHONSINE SED-GASAKA NYIRANSENGIYUMVA CLAUTILDE HC-KIGEME MUHIRE UWIMANA M. CLAIRE ICSP Allison Flynn WR-HQ Health Technical Advisor Mugisha ICSP MUHAYIMANA THIMOTHE SED-MBAZI DUSHIMIMANA CLAUDE SED-MBAZI AYINKAMIYE ESPERANCE HC-NGARA UWIMANA CONSOLE HC-NYAMAGABE Name RUGANZA RUTAMBWE CAMALADE Position ICSP NIYONZIMA VIATEUR CYANIKA UWAMAHIRWE DOROTHE HC-CYANIKA HATEGEKIMANA AUGUSTIN SED-CYANIKA 138 Annex 6. Training schedule for supervisors and interviewers Innovation Child Survival Tangiraneza Program Nyamagabe District Refresher training of 3rd Years KPC Enumerators Refresher training Agenda Date: July 25, 2014 Moderator: Narcisse Venue: Ubumwe Center Time Item/activity Responsible 7h00-7h30 Registration Fidel 7h30-7h40 Opening remarks District in Charge of Health 7h40-7h50 Training Objectives Carmen 7h50-8h20 Overview on data collection Melene 8h20-8h50 Review of KPC Consent form Narcisse& Gaspard (M&E Kigeme) 8h50-10h30 Review of KPC Questionnaire & Practice on Tablets Daniel, Beatrice 10h30-10h15 Tea break 10h15- 11h15 Anthropometric Measures Claire, Interns 11h15-12h00 Review of KPC Questionnaire & Practice on Tablets Daniel, Beatrice 12h00-12h30 Organizing data collection teams Fidel & Innocent (M&E Kaduha) 12h30-13h15 Launch 13h15-15h45 Field test Camarade 15h45-16h20 Feedback on field test Participants 16h20-16h30 Closing remarks District in Charge of Health 16h30 Departure Participants Rwanda ICSP Year 3 KPC Report Page 985 Annex 7. Project Resource Requirements of the Survey ICSP Tangiraneza Nyamagabe Distrrict Budget for Enumerators Traning Item Qnte #jrs PU PT Perdiem Enumerators from H.C 15 1 19,500 292,500 Enumerators from CELL(SED) 27 1 19,500 526,500 Supervisors from District 3 1 19,500 58,500 Transport ,Perdiem for H.C & SED Partcipants Kaduha Zone 23 1 15,000 345,000 Transport, Perdiem for H.C & SED Partcipants Kigeme Zone 21 1 10,000 210,000 Transport for District Supervisors 3 1 10,000 30,000 Overnigth for project surveyors 2 2 16,100 64,400 Translater 1 1 7,500 7,500 Lunch 70 1 4,000 280,000 Pause café 70 1 2,500 175,000 Water 140 1 500 70,000 Location Salle 1 1 40,000 40,000 S/Total 2,099,400 Spplies & Logistics Item Qnte #jrs PU PT Flip shart 1 1 5,500 5,500 Marqueur 1 1 4,500 4,500 Pens 68 1 100 6,800 Folder & Notes books 38 1 3,500 133,000 Phone cards 5 1 2,000 10,000 Projector rental 1 1 20,000 20,000 Vehicle rental 1 1 100,000 100,000 S/Total 279,800 Grand Total 2,379,200 Rwanda ICSP Year 3 KPC Report Page 986 ICSP Tangiraneza Nyamagabe Distrrict Budget for Data Collection Item Qnte #jrs PU PT Perdiem & Transport for Enumerators from H.C 15 5 20,000 1,500,000 Perdiem & Transport Enumerators from CELL(SED) 27 5 20,000 2,700,000 Perdiem & Transport for Supervisors from District 3 5 25,000 375,000 Overnigth for project surveyors 2 5 16,100 161,000 Translater 1 5 7,500 37,500 Water 70 5 500 175,000 Location Vehicle 2 5 100,000 1,000,000 ICSP accomodation 1 1 85,300 85,300 Community Guides 1 1 200,000 200,000 S/Total 6,233,800 Spplies & Logistics Item Qnte #jrs PU PT Phone cards 38 1 1,000 38,000 Vehicle rental H.H Survey 2 8 100,000 1,600,000 Vehicle rental -QA 1 2 100,000 200,000 Renewal fees 1 1 450,000 450,000 Bags 24 1 800 19,200 Toilet Papers 24 1 2,000 48,000 Bon Motos 8 1 20,000 160,000 Bon - Vehicule IT )81 RC 1 1 35,000 35,000 Printing 1 1 1 65,000 Sitick for hanging Scales 1 1 1,000 1,000 S/Total 2,616,200 Grand Total 8,850,000 Rwanda ICSP Final Evaluation Report September 2015 Page 987 ANNEX 17. OPTIONAL ANNEXES List of Dissemination Participants External Evaluator 1. Anbrasi Edward, John Hopkins University World Relief HQ Staff 2. Deborah Dortzbach – World Relief Global Director of Health and Social Development World Relief Rwanda Kigali Staff 3. Moses Ndahiro – Country Director 4. Melene Kabadege – Regional Technical Advisor, MCH 5. Rhona Murungi – Director of Programs 6. Clemence Nkurikiyinka – Research & Development Manager 7. Eric Nzamwita – Program Coordinator, Mobilizing for Life Program 8. Pascasie Nsanzabozwa – Program Manager, Savings for Life 9. Aloys Nsabimana – Program Manager, Water Project 10. Bizimana Olivier – Health Program Manager, ONE-UN Projects 11. Christelle Umuhoza – Assistant to Director of Programs 12. Bob Karemera – Church Partnership Communications Officer 13. Denise Umwali – 12+ Project Manager 14. Alice Uwizeyimana – Assistant to Country Director Representatives from Partner Organisations 15. Ministry of Health - Alexis Mucumbutsi, In-charge of Nutrition 16. USAID Mission – Dr. Elizabeth Uwanyiligira 17. UNICEF - Kristine Dandanell Garn, Nutrition Specialist 18. CRS – Jerica Youngken, Fellow and Vanessa Vohn, STA 19. University of British Columbia – Caitlin Gomez 20. World Vision 21. Jhpiego 22. Water Aid Rwanda - Mr. Maurice Kwizera, Country Representative 23. FAO-Rwanda 24. Concern World Wide Participants from Nyamagabe District 25. Umutoni Grace Carmen , World Relief ICSP Tangiraneza Project Manager 26. Ntawukuriryayo Fidele , World Relief ICSP Tangiraneza Project Staff 27. Ngiruwonsanga Narcisse , World Relief ICSP Tangiraneza Project Staff 28. Rusagara Germaine, World Relief ICSP Tangiraneza Project Staff 29. Nyiranzeyimana Beatrice , World Relief ICSP Tangiraneza Project Staff 30. Byiringiro Emile, Nyamagabe Vice Mayor 31. Hategekimana Sylvestre, Nyamagabe District M&E 32. Munezero Eric , Kigeme Hospital Director 33. Watukarusu Hubert, Kaduha Hospital Director 34. Mwizerwa Jean de Dieu , Head of Health Center 35. Sr Marie Lucie Nikuze, Head of Health Center 36. Bunani Jean Francois Regis, Head of Health Center 37. Uwabyawe Miriere, Head of Health Center 38. Mukamana Aloysie, Head of Health Center Rwanda ICSP Final Evaluation Report September 2015 Page 988 39.Kayibanda Abhdala, Head of Health Center 40.Lidie Nyiraneza, Head of Health Center 41.Leone Uwizera, Head of Health Center 42. Sr Drocelle Mukabera, Head of Health Center 43. Eliezer Nzigiyimana, Head of Health Center 44. Kimonyo Donath, Head of Health Center 45. Epiphanie Mukabaganwa, Head of Health Center 46. Ntakirutimana Eliab, Head of Health Center 47. Mbonankira Julienne, Head of Health Center 48. Sr Matie Therese Uwamwiza, Head of Health Center 49. Nsengimana Didas, Head of Health Center 50. Charlotte Mukanyange, Head of Health Center 51. Sr Rosy Varghese, Head of Health Center 52. Mukamana Veneranda, Nyamagabe Community Health Worker 53. Pastor Musabimana Assiel, Church Leader 54. Pastor Callixte Nsabimana, Church Leader 55. Pastor Celstin Nzabamwita, Church Leader Rwanda ICSP Final Evaluation Report September 2015 Page 989 Field Implementation Schedule Team # Team members Hospital, Sector, Cell Field Interview & FGDs May 20, 2015 May 21, 2015 Team 1 TL: WR 2 ICSP staff 1 WR non-ICSP Staff 1 NGO partner 1 Sector Leader 1 Religious Leader Kigeme Hospital Zone Cyanika Sector Kiyumba Cell AM FGD with Mothers participant to NW sessions- Gikomero Village FGD with Father participant to NW sessions- Kagarama Village FGD with Fathers non participant to NW sessions- Gikomero Village AM FGD Religious Leaders- Cyanika Sector FGD Sector Leaders - Cyanika Sector PM FGD with 5 members of Village Nutrition Committee- Gikomero Village FGD with 7-10 Integrated Care Group Members- Kagarama Village PM FGD with Cyanika HC staff KII with Head of Cyanika HC Team 2 TL: District 2 ICSP staff 2 WR non-ICSP Staff 1 NGO partner 1 Sector Leader 1 Religious Leader Kigeme Hospital Zone Kitabi Sector Mukungu Cell AM FGD with Mother- participants to NW sessions- Uwurunazi Village FGD with Father- participants to NW sessions- Karambi Village FGD with Father non- participants to NW sessions- Uwurunazi Village AM FGD with Religious Leaders- Kitabi Sector FGD with Sector Leaders - Kitabi Sector PM FGD with 5 members of Village Nutrition Committee- Uwurunazi Village FGD with 7-10 Integrated Care Group Members- Karambi Village PM FGD with Kitabi HC staff KII with Head of Kitabi HC Team 3 TL: NGO 1 ICSP staff 2 WR non-ICSP Staff 1 NGO partner 1 Sector Leader 1 Hospital Supervisor Kaduha Hospital Zone Gatare Sector Mukongoro Cell AM FGD with Mother- participants to NW sessions- Ruhereko Village FGD with Father- participants to NW sessions- Kageyo Village FGD with Father non- participants to NW sessions- Ruhereko Village AM FGD with Religious Leaders- Gatare Sector FGD with Sector Leaders - Gatare Sector PM FGD with 5 members of Village Nutrition Committee- Ruhereko Village FGD with 7-10 Integrated Care Group Members- Kageyo Village PM FGD with Rugege HC staff KII with Head of Rugege HC Team 4 TL: Hospital 1 ICSP staff 2 WR non-ICSP Staff 1 NGO partner 1 Sector Leader 1 Hospital Supervisor Kaduha Hospital Zone Mugano Sector Ruhinga Cell AM FGD with Mother- participants to NW sessions- Gitarama Village FGD with Father- participants to NW sessions- Kabuye Village FGD with Father non- participants to NW sessions- Gitarama Village AM FGD with Religious Leaders- Mugano Sector FGD with Sector Leaders - Mugano Sector PM FGD with 5 members of Village Nutrition Committee- Gitarama Village FGD with 7-10 Integrated Care Group Members- Kabuye Village PM FGD with Mugano HC staff KII with Head of Mugano HC Team 5 1 ICSP staff Kaduha Hospital Zone AM AM Rwanda ICSP Final Evaluation Report September 2015 Page 990 TL: MOH 2 WR non-ICSP Staff 1 NGO partner 1 Sector Leader 1 District Leader Mushubi Sector Gashwati Cell FGD with Mother- participants to NW sessions- Muhembe Village FGD with Father- participants to NW sessions- Mushubi Village FGD with Father non- participants to NW sessions- Muhembe Village FGD with Religious Leaders- Mushubi Sector FGD with Sector Leaders - Mushubi Sector PM FGD with 5 members of Village Nutrition Committee- Mushubi Village FGD with 7-10 Integrated Care Group Members- Muhembe Village PM FGD with Mushubi HC staff KII with Head of Mushubi HC Anbrasi & Debbie KII with Kaduha Hospital in charge of Community Health KII with Kaduha Hospital Nutritionist KII with Director of Kaduha Hospital , KII with CWW KII with Kigeme Hospital in charge of Community Health, Hospital Nutritionist, Director, KII with District Director of Health, KII with WVI Rwanda ICSP Final Evaluation Report September 2015 Page 991 ANNEX 18. QUALITIATIVE DATA FINDINGS Stakeholder Perspectives of Project Contributions and Performance Project Stakeholders Key Findings on Project Value and Effectiveness District Health System Vice Mayor and District Health Director Perception of Project Contributions; The team was extremely appreciative to the unique contributions of the ICG model in achieving the goals and objectives of the district, as they work in close collaboration with community entities especially in reducing the prevalence of malnutrition. Whilst other NGOs work along the main roads and towns, this project worked in extremely remote and rural areas reaching the most vulnerable. During the Vice Mayor’s visit to the NW demonstration, he was impressed to see a man teaching his wife how to cook a nutritious meal, which defied the existing cultural norms. ICGs unified community members, CHWs and the healthcare system to bring awareness, mobilize and improve service utilization and adopt healthy behaviors. The attendance and expansion of kitchen gardens was also a unique phenomenon in this project, which he believed was instrumental in inspiring communities for change. Savings groups help families enroll in mutuelle. The ICG mechanism was strategic in providing important information for other health issues, especially in launching the GBV initiative. The BCC messages, songs and material developed in the project were so effective, that they were being used by other projects. All key priority health indicators had improved since the project interventions. There is self confidence in the people, and they are motivated to bring change and improvement. District health information indicates reduction in child mortality and morbidity since the inception of the project. Women readily accept CCM, and prefer receiving treatment in their communities. The district is the process of planning an effective CHW support system through the cooperatives. The dramatic change in personal and community hygiene was attributed to project interventions. Sustainability: The district intends to work with ICG post project and also advocate that all other projects in the district working in communities function through the ICG mechanism. ICG quarterly meetings will be monitored by the district, and the district staff will organize visits for their oversight through the in-charge of social affairs. Since the community has a sense of ownership to the ICG, this strategy will be beneficial in the future. Engagement of pastors and religious leaders was stated as an essential support mechanism for ICG oversight, as they participate in meetings and also receive the reports on health indicators and performance targets, and also engage them in evaluations. Hospital Teams Perception of Project Contributions: Director greatly valued the collaboration and partnership and the focus on working with the poorest and remote communities. The ICG fostered a change in the mindset of communities. Joint implementation and sharing of activity plans enhanced the efficiency of both healthcare service delivery systems. Reduced admissions for severe malnutrition, no stigma associated with malnutrition due to the sensitization of CHWs. Project and hospital and health center staff worked in partnership to improve mobilization for health and nutrition activities. Communities appreciated the importance of utilizing formal healthcare, having clean toilets, importance of ANC, husbands understand the importance of growth monitoring and participate in child feeding and healthcare, accompany their wives for family planning. NW interventions were perceived to improve nutritional status of children, engage grandmothers and fathers, and instructed communities to use local produce for a balanced diet. The nutritionists at both hospitals were extremely appreciative of the enormous project investments to compliment and support the priorities for nutrition interventions, monitoring systems, case management, tracking and follow up of severely malnourished children, BCC communication through radio and other media, mobilization for campaigns etc. Monitoring and information systems designed and supported by the project staff were appreciated. Supervisory oversight, training, incentives and monitoring tools and follow up of the CHWs was a critical capacity building measure that strengthened their performance. Establishing the data systems and analysis, especially the Rapid SMS with CHWs, and their ability to provide treatment through the iCCM strategy was particularly emphasized as a key capacity building measure. Improved hygiene in all communities was the most obvious outcome measure mentioned by all. The role of religious leaders and pastors was particularly emphasized, as they play an important role in reinforcing the messages and trusting the community entities. Sustainability: Knowledge acquired by communities with support from the district can sustain NW activities which can also be used as a platform to launch other interventions. Interventions requiring additional financing would phase out, but those integrated with the district would continue. Challenges: Project was focused mostly on community and not hospital level. Though NW interventions could continue with CHWs, provision of cookware would not be feasible. Communities are inaccessible during rainy seasons, supervision by foot to communities located in high mountains was challenging. Rwanda ICSP Final Evaluation Report September 2015 Page 992 Inadequate staffing at health center to oversee community activities, stock outs for RUTF and soya supplements, inability of patients to pay for hospitalizations, resulting in low compliance to referrals Health Center Teams Support to the Projec:; Training, supervision, visits to ICG and CHW home visits, assist in development of BCC education materials, establishing monitoring systems. Collaboration and linkages for HCT, ITN distribution, FP, BCC, GMP and ANC services were mentioned as some of the important health system strengthening and capacity building activities. Perception on Project Value and Contributions; Aware of project strategies and ICG, and reported participation in community health activities in the past 6m, visited ICG, NW demonstrations, and provided technical support and appreciated the integrated package of interventions. Reported reductions in prevalence of under nutrition, deaths caused by poor hygiene and sanitation, improved referrals, prompt care seeking for sick children, improved immunization, increased ANC visits especially in the first trimester, reduced home deliveries. Although they could not provide the exact figures, they reported that almost all referrals were by ICG and CHWs. Teaching on balanced and affordable diet and hygiene was particularly appreciated as it resulted in health improvements, increased use and construction of latrines appreciation of the 1000d interventions, and use of water purification gadgets. One informant indicated that based on clinic records number of MN children declined from 35 to 10. Improved collaboration between health center and CHWs was a major accomplishment by the project, and they participated in the supervisory and management oversight of CHWs. Community ownership to the NW cooking demonstrations emerged as a key finding, as they brought their own supplies and appreciated the importance of a balanced meal and including fruits and vegetables in the diet. Savings associations were created to generate income for acquiring the supplies for the NW. Changes in market commodities were also reported as now vendors began selling more fruits, vegetables, and small fish. As screening and triaging for counseling and treatment occurred in the community by CHWs, they believed that access and utilization had improved. Increase in mutelle enrollment was also reported as a result of project efforts. Some also remarked about an increase in utilization of formal healthcare versus traditional doctors, and others said increase in family planning uptake has resulted in lower maternity cases in the hospital. In comparison to other projects, they had good collaboration with the project staff who facilitated the achievement of their goals. The project addressed issues from bottom up and evidence of peer to peer learning and increased trust in health providers. Challenges: Some community members are still not enrolled in mutelle, large catchment area population, staff working overtime with no additional compensation, no provision for cell phone minutes to provide supervision for community activities, distance of HC from communities, need for health posts, need for transport or budget to rent motorcycles, neglected care for unwed teen pregnancies, polygamy, inadequate transport or too many responsibilities for regular supervisory visits, due to extreme poverty some mothers sell the food commodities provided by the HC to buy other essential commodities for the home. Propose to distribute water purification gadgets to community members. Some remarked that though mosquito nets were distributed there was a rise in malaria cases and need to further explore. Sustainability: Believed that there was now a critical mass of community members and trained CHWs that could continue with interventions, when project ended, savings groups can improve and sustain the economy, as they are now empowered. Cooking demonstrations in other days, and not just NW and continued investments in hygiene training, including triangulating the messages in schools, increase capacity of ICG. Contributions of the ICG was perceived as another key community capacity mechanism, and though they may not be fully functional post project, they could be sustained through the rotating savings scheme but supervision by the district teams need to be ensured. Integration of NW and ICG in district performance plan. Capacity building efforts for community and religious leaders. Other interventions could be integrated in the ICG model, for NCD prevention, helminthes eradication, community clean up, address poverty, provide seeds for gardening, repair of roads, water pipes, prevent unhygienic local brewery etc. They suggested that the DHMT could support the ICG with technical training, essential supplies, offer mutelle for vulnerable groups, construct and equip health posts and provide water pumps. Income generation activities to address poverty, was considered a key strategy to improve health status. Community Sector and Cell Leaders Project Awareness and Contributions: All participants were aware of the key health and nutrition objectives of the project and its capacity building motivation of community entities. Support to ICG training, oversight, problem solving, savings initiatives, were mentioned by most. A majority of them remarked that health status of their communities improved, with reduced MN, improved hygiene practices, handwashing, balanced diet, increased use of pit latrines, increased ANC, facility deliveries, decreased maternal and child deaths, increased participation in NW, kitchen gardens, livestock rearing etc. Contributions of the ICG were considered to be paramount to these achievements and participants felt that this model ought to be integrated into the district program. They proposed educating adolescent boys and not just focus on girls Rwanda ICSP Final Evaluation Report September 2015 Page 993 about reproductive health. Discouraging polygamy and infidelity, training on adult education, construction of health posts, rearing live stock for the vulnerable were some of the distinguishing services reported. Challenges: Poverty was mentioned as one of the biggest challenges to development. Additional supervision and training reinforcement was recommended. Integrated CG Role and Contributions: ICGs are comprised of CHWs, a religious leader, and a representative of the hygiene club. Reports are compiled and shared with the health center and with the cell leader. They meet once a month for 1-2h, their roles range from health education, NW, GMP, community mobilization, household visits, referrals, community health information systems etc. They were also supported by the savings groups. Reduced illness incidence and deaths due to malaria, pneumonia, diarrhea and malnutrition were reported. Improved knowledge on health, nutrition, handwashing, kitchen gardens, balanced food, increased utilization of health services, compliance to health advice, registration in mutuelle, increased involvement of men in child rearing and feeding, animals are no longer kept in the home, were all mentioned by the ICG participants. They are proud to be a model to the community and enhance community solidarity. Regular supervision oversight was reported, including visits from the health center staff. The most powerful incentive was witnessing communities adopt the practices and supporting them in community based efforts like contribution of ingredients to NW and building toilets for the vulnerable households, aside from the support received from leaders and pastors. Shared responsibility, problem solving skills, friendship within the ICG and increased self-confidence and skills were other factors mentioned by the ICG members. Challenges: major reported challenges were lack of training, lack of participation by some male community members, meeting expectations of the health center staff, competing priorities and weather conditions. However despite the challenges, the ICG members were enthusiastic about continuing their contributions as they felt valued and appreciated by the communities. Village Nutrition Committee Project Awareness and Contributions: Reports on knowledge gains was impressive; balanced meals, hygiene, sanitation, hand washing, 1000 days, weaning recipes, micronutrient powders, drinking safe water, sleeping under ITN, value of breast feeding, age appropriate feeding, creating and maintaining kitchen gardens, family planning etc were mentioned by most participants. The greatest achievements were reduced malnutrition and improved hygiene and they believed the committee members were now a role model to the communities. Latrines were constructed, kitchen gardens created, many families had a rubbish pit, and men participate in child feeding. Importance of refresher training, savings associations, reinforcement of messages, communication from pastors, sufficient stock and supplies for NW demonstrations, and engagement of local leaders were emphasized as sustainability measures. Challenges: Initial disinterest of fathers and grandmothers for NW interventions, no direct donations to the project, were demotivators, but eventually their mindset was transformed when they witnessed the evidence of the health outcomes. Some parents arrive at NW without bringing any ingredients and this created a problem for other families as they had to share their scarce resources and others arrived late due to the long distances. Pastors and Religious Leaders Project Awareness and Contributions: There was a unanimous response from all the participants, as all vouchsafed about the project, the value of ICG, CHW and NW interventions and subsequent health outcomes. Observations of increased households consuming balanced diets, enhanced communication between community groups and solidarity, increase in men’s participation and in parenting responsibilities, Support to Project Activities: Triangulation of health messages provided by CHW and ICG in churches and during pastoral visits, community mobilization for improved hygiene and balanced diet, enrollment in mutuelle, assistance with savings and other economic development programs, financial and technical support to ICG and CHWs, and encouraging household and community hygiene. Challenges: practice of witchcraft prevented some families from adopting the BCC messages and poverty were perceived as some of the main challenges. Economic development and self reliance was considered a key element for any community empowerment activity; gardens, rearing small animals, especially for the vulnerable households. Mothers Project Awareness and Contributions: a majority of the participants were aware of the project purpose and contributions; promotion of hygiene and sanitation, kitchen gardens, community mobilization for savings and cooperatives, child health and nutrition, micronutrient powder, etc were mentioned. Many of them reported seeking care in health clinics, though some said they also seek advice from other mothers in the community. Treatment for sick children by CHWs was mentioned by most, and they also reported visits from CHW and CG members in the past 3m. The mothers exhibited extraordinary knowledge on all the danger signs for seeking care immediately for both pregnant women and children, prevention of diarrhea, handwashing practices, water treatment, importance of ANC, SBA, essential newborn care (ENBC), EBF, IYCF, causes and prevention of malaria, causes and prevention of malnutrition (though one woman remarked that men who eat green leafy vegetables become stupid). Reasons for home delivery were primarily due to long Rwanda ICSP Final Evaluation Report September 2015 Page 994 distances, lack of transport, lack of health insurance, rudeness of providers, and lack of awareness of signs. They mentioned supporting the ICG members by providing ingredients for NW, informing other community members about NW, and supporting community mobilization activities, and reported on the educational and supportive activities of the ICG members. All educational interventions, especially those related to nutrition were highly appreciated. Mothers who participated in NW: In addition to those mentioned above, the mothers from the NW also mentioned kitchen gardens, tippy taps, balanced diets, constructing a dish drying rack, use of micronutrient powder, ITN use and vaccination calendars. The exciting aspects of NW interventions were learning to prepare a balanced diet, engagement of husbands in food preparation, and their assistance in home chores, visits from ICG and CHWs and exchanging best practices and experiences with the other women. Mothers also mentioned contributing food commodities, purifying the water used for cooking demonstrations, singing songs about nutrition, praying together, and caring for children of mothers participating in the NW, food exchanges, etc. Most mothers reported practicing the messages provided and trying the recipes learnt. However some mothers were more vulnerable and could not afford the more expensive ingredients, like fish meat etc. all reported owning kitchen gardens and support received from husbands. Additional income generating schemes were proposed to sustain the NW interventions. The support provided by pastors and religious leaders especially to the vulnerable households was mentioned as an important contribution. Role of CHWs for preventive and curative care for children, immediate access to care, assistance in referrals, health information were reported to be valuable services for improving the health status of the communities. Project outcomes included reduction in disease, reduced mortality of women and children, improved hygiene, increased contributions for mutuelle , etc. All mothers who participated affirmed that they would continue to meet and continue with the activities. Fathers – NW participants Learning from Project Interventions: improved knowledge on nutrition, importance of multigrain porridge, balanced meals, including fruits and vegetables in their diet, handwashing, 1000 days, GMP (one father remarked that since the onset of NW, none of his children were MN), facility deliveries, kitchen gardens, fathers no longer keep their money but contribute to family meals, fathers taking initiative to go to the market and shop for food, retain some of the home produce to feed their children, meal preparation, child feeding, etc. Previously they believed child rearing was the role of women, now they are involved. They felt they should become advocates to engage other men in the interventions and change their mind set. Support from leaders, savings groups was seen as an important motivational factor for their engagement. Perceived quality of care and service utilization for ANC, referral, timely care seeking, facility delivery, reduced MN, etc were mentioned. Some remarked that farmers ceased to grow tobacco and began planting vegetables. Distance to health center was considered a major challenge for some. Role of pastors and religious leaders was also emphasized as they supported the income generating schemes and supported health insurance for vulnerable families, and also advocated health messages and provided training. They were committed to continue their contributions and advocate for behavior change, but also felt retraining and support from leadership was essential. Fathers - Non NW Participants Awareness about NW: all aware about NW strategy, knew about kitchen gardens, wives knowledge about balanced meals, using tippy taps, using ITN, sanitation, important times for handwashing Gender equity: Men now involved in child feeding, especially when mothers are absent, support animal rearing and making nutritious porridge flour, help in establishing kitchen gardens Reasons for non-participation: occupied with business or farms in distant sites. Challenges and suggestions: poverty and availability of foods for balanced meals, soil and weather - unconducive for farming, But continue to mobilize men house to house, create men’s savings groups, encourage reluctant participants Excerpts from Formative Evaluation Participants Rwanda ICSP Final Evaluation Report September 2015 Page 995 “I was there during the project KPC baseline and I know the type of food people in community were preparing and their hygiene status, so I can testify that there is significant improvement now” In-Charge of nutrition, Kaduha Hospital “[The] CG model was a new approach for us, we were not used to it, but we have found it invaluable. I would wish to have strong cooperatives of CG, which would ensure sustainability” Hospital Director A Presbyterian Church leader noticed a single mother with many children resisting behavior change (she did not take care of her youngest child who kept losing weight, and her intent was to let the child die due to poverty instead of being treated). The church leader encouraged her to take her children to hospital for follow up, to the extent that he constantly visits her to ensure that she is taking her children to the health facility for help. “In Mushubi village, mothers formed a savings group called Turere neza where every mother gives 100 RWFs every week. They now have 60,000 RWFs saved. These funds help them to buy NW ingredients and recently, every mother received one chicken and guinea pig from the group savings.” VNC member “My child didn’t have appetite before, but now when he meets with others in the NW, he eats with a lot of appetite, so I now use what I have learned to prepare his food.” Mother from Mushubi village “ The first time I did not feel concerned but I have learnt to prepare a balanced meal made of energizers, vitamins, and proteins and I can do it and feed my kids when my wife is not around ” “Before joining a care group I did not have dish dryer in my house, my toilet was not covered nor clean, I was not drinking clean water nor did I know importance of drinking water, but now I do have all of these, and I eat a balanced diet in my home” Village leader in charge of social affairs “The meeting in NW helped us to know many things about health. We are no longer fearful, instead we have opened our mind. We no longer stay at home the whole week but we feel proud to get out” NW participant “NW helped a lot in transforming the mindset of many men (fathers) who used to misuse the households’ assets instead of caring about the good nutrition of their children. They believed that nutrition and food preparation were only women responsibilities. But today, when we discuss with them about nutritional issues, they tell us that they have understood that they have to spend enough money to feed their children. The statistics on malnourished children in out sector has greatly reduced, and this is mostly due to NW” Executive Secretary, Mugano sector Project sustainability “We will continue to work as a group. We will not be discouraged.” Meetings, savings, and visiting of households will be continued” “Friendship will keep us together.” “We have sufficient skills, we will continue.” “We understand the importance of what we do, we will continue for the benefit of our people.” “Prayer will keep us together.” Rwanda ICSP Final Evaluation Report September 2015 Page 996 ANNEX 19. SUMMARY OF PROJECT ACTIVITIES Major Activities Timeline Personnel Build MOH and Sector Social Affairs –in-Charge capacity to train and supervise BCC activities. Year 1, Refresher Year 3 Tangiraneza ICSP CM Staff, MOH Train CHW Cell Coordinator and In charge of Social Affairs at cell level to supervise CG in Interventions and BCC. Year 1, Refresher Year 3 Tangiraneza ICSP CM Officers, Community Health in-Charge, Sector Social Affairs in-Charge Quarterly meeting for Care group leaders and supervisors Start Q4 Year 1, ongoing quarterly Tangiraneza ICSP CM Officers, In charge of Social affairs at cell level Quarterly meeting with Local Leaders and Religious Leaders on BCC Start Q4 Year 1, ongoing quarterly Tangiraneza ICSP CM Officers, In charge of Social affairs at cell level Care Group Leaders lead monthly Integrated CGs Start Q4 Year 1, ongoing monthly Care Group Leaders BCC (household level health education) Start Q4 Year 1, ongoing monthly Care group Members: CHW, Village Leaders Follow up Care Group BCC activities Start Q4 Year 1, ongoing monthly Tangiraneza ICSP CM Officers, In charge of Social affairs at Cell, CHW Cell Coordinator Distribute annual incentives to CG members End of Yrs 2 & 4 Tangiraneza ICSP CM Officers Mobilize churches to assist vulnerable households with kitchen gardens & tippy taps. Start Q4 Year 1, ongoing Tangiraneza ICSP CM Officers Nutrition Activities Participate in Nutrition Technical Working Group; Solicit input and share findings. Start Q4 Yr 1, ongoing ICSP Manager, HO Tech Unit; ICSP Nutrition Officers Conduct TOT on CBNP Q3 Year 1 ICSP Nutrition Officers, MOH Train CHWs on CBNP Q3-4 Year 1 ICSP Nutrition Officers, MOH Develop Nutrition Week Curriculum Q3-4 Year 1 ICSP Team, MOH/NTWG, HO Tech WG Train MOH trainers and In Charge of Social Affairs on NW Q4 Year 1 ICSP Nutrition Officers, MOH Train Village Nutrition Committees on NW Q4 Year 1, Q1-3 Years 2-4 ICSP Nutrition Officers, MOH Mobilize Sector Nutrition Committees through quarterly Meeting Q4 Year 1, ongoing quarterly Tangiraneza ICSP Nutrition Officers, Hospital Nutrition Supervisors Participate to DPEM semi annually meeting Q1 & Q3 Years 2- 4 ICSP Manager, ICSP Nutrition and Community Mobilization Officers Implement and follow up Growth Monitoring sessions Q4 Year 1, ongoing monthly CHWs; HC In charge of CH activities Implement and follow up Kitchen Garden and assist vulnerable Families Q1-3 Year 2-4 CHWs, In Charge of Social affairs at cell level, Sector Agronomist Implement Nutrition Weeks Innovation/ OR activities Q4 Year 1, Q1-3 Years 2-4 Village Nutrition Committee, ICSP Team.In charge of Social Affairs and HC in charge of Nutrition OR to compare CBNP, ‘Nutrition Week' Innovation, and control communities, prior to district level scale-up Q4 Years 1-3, Q3 Year 4 UBC, MOH, ICSP Officers, HO Technical Unit Maternal & Newborn Care Build HC and Hospital staff capacity to train ASM on MNC and Rapid SMS Q3 Year 1, Refresher Q1 Yr 3 ICSP MNC Officers; MOH Support HC trainers to train ASM on MNC and Rapid SMS Q4 yr 1, Refresher Q1 Yr 3 ICSP MNC Officers ; HC Support HC to follow up ASM providing Newborn and post partum care Q3 Year 1, ongoing ICSP MNC Officers , HC; ASM Community Case Management Community Case Management Refresher training Q1 Year2 ICSP CCM Officers, MOH Support HC staff to supervise CCM activities Q1 Year 2, ongoing ICSP CCM Officers, HC Rwanda ICSP Final Evaluation Report September 2015 Page 997 U.S. Agency for International Development 1300 Pennsylvania Avenue NW Washington, DC 20523