The NicaSalud Network:
 Restoring Community Health Activities in Nicaragua
 after Hurricane Mitch
 A Final Evaluation (December 1999-October 2001)
Fernando Campos, MPH, MD
Joseph Valadez, PhD, MPH, ScD
William Vargas Vargas, MA, MPH
NICARAGUA, NOVEMBER, 2001
(Translated April 2002)
This document was prepared
by NGO Networks for
Health and NicaSalud, under
Cooperative Agreement
HRN-A-00-98-00011-00
signed by NGO Networks
and USAID.
Copyright © [Click here and type year] by NGO Networks for Health. All rights reserved.
Additional copies may be obtained from:
NGO Networks for Health
2000 M Street NW, Suite 500
Washington, DC 20036
Tel. 202-955-0070
Fax 202-955-1105
www.ngonetworks.org
info@ngonetworks.org
Results of NicaSalud Final Evaluation Survey 1
Contents
CHARTS.................................................................................................................................................................................2
TABLES..................................................................................................................................................................................2
SUMMARY.............................................................................................................................................................................4
INTRODUCTION...................................................................................................................................................................9
GEOGRAPHIC AREAS...................................................................................................................................................10
METHODOLOGICAL DESIGN.........................................................................................................................................13
SAMPLE DESIGN.................................................................................................................................................................14
PREPARATION OF QUESTIONNAIRES...................................................................................................................................15
STAFF TRAINING ...............................................................................................................................................................15
DATA PROCESSING AND ANALYSIS....................................................................................................................................15
RESULTS.............................................................................................................................................................................17
DEMOGRAPHIC CHARACTERISTICS ........................................................................................................................17
SAFE MATERNITY AND CARE OF NEWBORNS......................................................................................................18
Maternal Health Card ..................................................................................................................................................18
Prenatal Care ...............................................................................................................................................................18
Tetanus Toxoid Vaccine ...............................................................................................................................................19
Iron during Pregnancy .................................................................................................................................................19
Knowledge of Pregnancy Danger Signs.......................................................................................................................20
Delivery ........................................................................................................................................................................20
Post Natal Care ............................................................................................................................................................22
Newborn Care ..............................................................................................................................................................23
Child Spacing ...............................................................................................................................................................23
CHILD SURVIVAL .........................................................................................................................................................26
Growth Monitoring .....................................................................................................................................................26
Immunization................................................................................................................................................................26
Breastfeeding and Complementary Feeding ................................................................................................................30
Diarrhea Case Management ........................................................................................................................................34
Acute Respiratory Infections ........................................................................................................................................36
HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS.........................................................................................38
Awareness and Transmission of HIV............................................................................................................................38
HIV Prevention.............................................................................................................................................................39
Other STIs.....................................................................................................................................................................40
Condom Use .................................................................................................................................................................41
BIBLIOGRAPHY..............................................................................................................................................................42
ANNEXES:...........................................................................................................................................................................44
ANNEX 1: LQAS METHODOLOGY. A BRIEF HISTORY AND DESCRIPTION OF LQAS...........................................................44
Steps for using LQAS................................................................................................................................................44
Interpretation of the LQAS data...............................................................................................................................45
ANNEX 2. LQAS TABLE ....................................................................................................................................................48
ANNEX 3: TABLE SUMMARIZING INDICATORS FOR PVOS AND NGOS WITH CONFIDENCE INTERVALS FOR BASELINE AND
FINAL EVALUATION SURVEYS ...........................................................................................................................................49
Results of NicaSalud Final Evaluation Survey 2
CHARTS
Figure 1. Map of Nicaragua showing departments where NicaSalud members are located. ......................11
Chart 1. Person who attended the birth: A Comparison of PVO and NGO Baseline and Final Evaluation Results
.............................................................................................................................................................20
Chart 2. Place of Birth of Mothers with Children 0-11 Months: A Comparison of PVO and NGO Baseline and
Final Evaluation Results......................................................................................................................21
Chart 3. Vaccination Coverage among Children 12-23 Months: A Comparison of PVO Baseline and Final
Evaluation Results...............................................................................................................................28
Chart 4. Vaccination Coverage among Children 12-23 Months: A Comparison of NGO Baseline and Final
Evaluation Results...............................................................................................................................29
Chart 5. Exclusive Breastfeeding by Monthly Cohort of Infants 0-5 Months in PVO Catchment Areas: A
Comparison of Baseline and Final Evaluation Results.......................................................................32
Chart 6. Consumption of Foods and Liquids by Children 0-11 months in PVO Catchment Areas: A Comparison
of Baseline and Final Evaluation Results............................................................................................32
Chart 7. Continuing Breastfeeding. Mothers with children 12- 23 months: A Comparison of PVO and NGO
Baseline and Final Evaluation Results................................................................................................33
Chart 8. Treatment Practices of Children 0-23 Months with Diarrhea: A Comparison of PVO and NGO Baseline
and Final Evaluation Results...............................................................................................................34
Chart 9. Knowledge and Preparation of ORS and Knowledge of Dehydration Danger Signs among Mothers
with Children 12-23 Months: A Comparison of PVO and NGO Baseline and Final Evaluation Results 35
TABLES
Table 1. Departments and municipalities covered by NicaSalud Network partners...................................10
Table 2a. Interventions by the PVOs..........................................................................................................12
Table 2b. Interventions by the NGOs..........................................................................................................12
Table 3. Areas of Supervision and Interviews by organization and population group ...............................14
Table 4. Maximum Sample Sizes in Baseline and Evaluation Studies of PVOs and NGOs ......................16
Table 5. Prenatal Care. Comparison between baseline and final evaluation studies...................................19
Table 6. Delivery Related Behavior and Knowledge: A Comparison of PVO and NGO Baseline and Final
Evaluation Results...............................................................................................................................21
Table 7. Post Natal Care Behavior and Knowledge: A Comparison of PVO and NGO Baseline and Final
Evaluation Results...............................................................................................................................22
Table 8. Newborn Care: A Comparison of PVO and NGO Baseline and Final Evaluation Results..........23
Table 9. Family Planning Knowledge and Behavior: A Comparison of PVO and NGO Baseline and Final
Evaluation Results...............................................................................................................................24
Table 10. Monitoring of Growth: A Comparison of PVO and NGO Baseline and Final Evaluation Results 26
Table 11. Doses of Polio and Pentavalent among Children 12-23 Years: A Comparison of ENDESA 98, and
NicaSalud PVO Baseline and the Final Evaluation Results................................................................28
Table 12. Immunization of Children 12-23 Months: A Comparison of PVO and NGO Baseline and Final
Evaluation Results...............................................................................................................................30
Table 13. Exclusive Breastfeeding and Complementary Feeding: A Comparison of PVO and NGO Baseline
and Final Evaluation Results...............................................................................................................33
Table 14. Knowledge and Practice about Diarrheic Illnesses: A Comparison of PVO and NGO Baseline and
Final Evaluation Results......................................................................................................................36
Table 15. Knowledge and Practice about Acute Respiratory Infections: A Comparison of PVO and NGO
Baseline and Final Evaluation Results................................................................................................37
Results of NicaSalud Final Evaluation Survey 3
Table 16. Knowledge of Ways HIV Is Transmitted among Women: A Comparison of PVO and NGO Baseline
and Final Evaluation Results...............................................................................................................38
Table 17. Knowledge of Ways to Prevent HIV Transmission among Women 15-49 Years: : A Comparison of
PVO and NGO Baseline and Final Evaluation Results.......................................................................39
Table 18. Knowledge about HIV/AIDS/STI among Women 15-49 Years: : A Comparison of PVO and NGO
Baseline and Final Evaluation Results................................................................................................40
Table 19. Use of Condoms among Women 15-49 Years: A Comparison of PVO and NGO Baseline and Final
Evaluation Results...............................................................................................................................41
Results of NicaSalud Final Evaluation Survey 4
SUMMARY
The NicaSalud Network began in September 1999, as a USAID funded project that combined the
efforts of a group of national and international organizations present in the country to restore and
protect the health of the population affected by Hurricane Mitch.
Currently, the organizations making up the NicaSalud Networks are grouped in three sub networks: 1)
Pacific (León and Chinandega): Asociación para el Desarrollo de los Pueblos (ADP), PLAN,
Fundación Hablemos de Nosotras, Save the Children y Centro de Mujeres Ixchen; 2) Las Segovias
(Madriz, Estelí y Nueva Segovia): CARE, ADRA, CEPS, INPRHU Somoto, FUNDEMUNI; and 3)
Jinotega: CRS, Project HOPE, Wisconsin Partners of the Americas, PCI, Alistar de Nicaragua y
Compañeros de las Américas.
NicaSalud’s members implemented health projects for high priority populations (women of
childbearing age, children under 5, and adolescents). The projects were located in 31 municipalities
in 8 departments of the country, giving coverage to a population living in 736 communities and/or
barrios.
This document reports the results of the final evaluation carried out in September 2001 and compares
them with the baseline studies of 1999 for the PVOs and in 2000 for the NGOs.
The methodology used for the evaluation was the same one used for the baseline studies: Lot Quality
Assurance Sampling LQAS. NicaSalud coordinated refresher training and standardized the
questionnaires.
The geographic area for each project was divided into Supervision Areas (SA) and a systematic
random sample of 19 observations was collected in each SA for each group defined by each
organization: children from 0 to 11 months, mothers with children from 12 to 23 months, women from
15 to 49 years old who were not pregnant, men from 15 to 49 years old, adolescents, and youth 15-
24 years old. All data were entered into a computer database using EPI INFO, Version 6.04d.
SAFE MATERNITY AND CARE OF NEWBORNS
Prenatal Care
In NicaSalud (PVOs and NGOs) 59.7% of mothers presented their maternal health card to the
interviewer. Of the remaining mothers, 10.5% had lost their card, 3.6% had it in another household,
12.1% mentioned they had never had a card, and the remaining 14% had given their cards to MINSA.
For all NicaSalud, 55.7% of mothers had at least one antenatal care visit (ANC) by a qualified health
staff. Mothers with maternal health cards in NicaSalud had on average 4.5 visits with a median of 5.
The data for PVOs shows an increase in the proportion of mothers having had at least one ANC visit:
46% at baseline and 61% in the evaluation. No significant variation was detected for NGOs.
According to the maternal health card, only 1.1% of the women in NicaSalud were vaccinated against
tetanus toxoid, which included 5% and 0.6% for PVOs and NGOs, respectively. These results are
lower than at the baseline, which were 10% and 22%, respectively. The 90.7% of women with
children 0-11 months mentioned that the vaccine protects the newborn. For PVOs, the percentage
Results of NicaSalud Final Evaluation Survey 5
was 94%, a significant increase over the baseline (47%). NGOs had a similar percentage (86%) to
the baseline result.
For PVOs only, 86.4% of mothers with children 0-11 months said they had received iron during their
most recent pregnancy, a significant increase from the baseline (71%).
A third of the women 15-49 not pregnant (33.1%) mentioned at least two danger signs during
pregnancy that require immediate referral to a health facility. The proportions for PVOs and NGOs
respectively were 33% and 33.6%. With respect to the baseline, PVOs show a significant increase of
12% while NGOs had a 5.4% reduction.
Delivery
For all of NicaSalud, 62.8% of the deliveries of mothers with children 0-11 months were attended by
qualified health staff. PVOs display an increase of 18.5% while NGOs had an increase of 16.2%.
In the final evaluation, in PVO areas, the proportion of deliveries attended by TBA did not change
(24.2%) . However, in NGO areas, the TBAs attended 50% of deliveries.
For NicaSalud, 60.6% of the births were attended in a health institution, while 39.2% occurred at
home. The PVOs showed an increase over the baseline of 13% of deliveries occurring in a health
institution. By contrast, NGOs displayed a smaller proportion of institutional births both in the baseline
and in the evaluation (35% and 39% respectively. In NicaSalud, 32.6% of the women mentioned at
least two delivery danger signs.
Post Natal Care
Postnatal care increased in 36.8% for PVOs and 42.3% for NGOs. PVOs also asked the mother if
she had received information about family planning during the post-natal visit. 77.9% responded
affirmatively, this result represents a significant increase when compared with the baseline result of
40%. Results for PVOs show a statistically significant increase in the proportion of mothers who said
they received Vitamin A after giving birth (28% to 40.8%).
Care of Newborns
The 88% of mothers with children 0-11 months reported that in the first week of life, their child
showed no signs of complications with the umbilical cord. Both PVOs and NGOs had similar results.
PVOs reveal an 10.4% increase above the baseline (77% vs 87.4%) while NGOs did not (91.5% vs
86.4%).
In NicaSalud mothers with children 0-11 months reported that 82.6% of the newborns had a
consultation with qualified health staff. PVOs (85.9%) realized an increase over the baseline of
15.9%, while NGOs (78.7%) increased the proportion by 35.7%. Both results are statistically
significant.
Results of NicaSalud Final Evaluation Survey 6
Child Spacing
The 61.1% of women 15-49 not pregnant said they used a contraceptive method. Among women
residing in the PVO areas, 69.4% used a contraceptive method, which is an increase of 13.4% over
the baseline result. 96.8% of those women knew mentioned at least three contraceptive methods. For
PVOs, 98.2% knoew 3 or more methods which represents an increase of 35.2%.
The main contraceptive methods mentioned were: pills 90.1%, injections 87.6%, and condoms
79.9%. With respect to knowledge of where to obtain contraceptive methods, 90.7% of women
mentioned at least one place. The places mentioned most frequently were: Health Center (53.3%),
Health Post (41.6%), and pharmacies (12.4%). Of the women who did not use an FP method, 13.7%
signaled that it was difficult to obtain them, and 6.8% did not know a single method.
CHILD SURVIVAL
Growth Monitoring
For NicaSalud, 89.1% of mothers with children 0-11 months showed their child’s card, which indicate
that these children were taken to a MINSA health facility at least once for growth monitoring. PVOs
and NGOs exhibited increases over their baselines (78% to 89.1%, and 81.7% to 89.6%,
respectively). The 73.6% had had their growth monitoring session within the last two months. The
PVOs maintained their baseline percentage of 73%, while the NGOs achieved a significant increase
of 21%.
Immunization
A high percentage (94.6%) of all mothers interviewed with children from 12 to 23 months old showed
the vaccination card for their child, which represents a significant increase over the baseline for PVOs
and NGOs.
In NicaSalud, the coverage with BCG was 91.1%, for PVOs the coverage was 91.7%, which is a
significant increase over the baseline of 82%. Coverage also increased among NGOs (86% to
90.3%).
The coverage with Pentavalent was 89%. When it is compared with DPT, the vaccine used during the
baseline, both PVOs and NGOs show an increase of 13.1% and 5.9%, respectively.
MMR coverage for all NicaSalud was 83.9%. PVOs had an increase of 9.8% while NGOs increased
by 4.9% over the baseline.
To be considered as fully vaccinated a child needs to have had the complete basic regime, including
one dose of BCG and at least three doses of polio and three of pentavalent. The coverage with this
criteria was 88%. PVOs realized an increase over baseline of 17.2%, while the NGOs increased the
proportion by 11.8%.
Breastfeeding and Complementary Feeding
The 76.4% of PVO mothers with children 0-11 months reported having begun breastfeeding in the
first hour after giving birth, which is a statistically significant increase of 13.4% over the baseline.
NGOs did not report data for this indicator.
The 61.1% of children 0-5 months were exclusively breastfed. In PVO areas exclusive breastfeeding
increased by 27.4% from a baseline value of 35%. Exclusive breastfeeding declined as the child
grows older. In addition to breastfeeding, a greater proportion of children tend to consume other
liquids and solids, especially when they are 3 months old.
Results of NicaSalud Final Evaluation Survey 7
In NicaSalud, 64.8% of mothers with children 12-23 months were still breastfeeding. The PVOs had
an increase of 13% over the baseline, while in NGO areas a 13.8% increment occurred.
Diarrhea Case Management
In NicaSalud, 24.6% of mothers with children 0-23 months reported that their child had diarrhea in the
previous two weeks to the interview. PVOs reported 24.6% and the NGOs 24.7%, which are
significantly smaller diarrhea prevalences than reported during the baselines.
When mothers were asked what kind of treatment they gave their children for diarrhea, 59.4% said
they used oral rehydration salts. PVOs displayed a significant increase from the baseline (19% to
60%). NGOs also displayed an increase although it was not significant.
The 38.8% of the mothers interviewed had ORS in their home at the time of the interview. Also, when
the mothers were asked where they got this product if needed, the responses in order of frequency
were the following: Casa Base or Community Oral Rehydration Units-UROCs (44.6%), Health Center
(44.1%), health promoters (33.7%), and health posts (17%).
For the baseline, the PVOs considered preparation correct when the mother mentioned and carried
out three steps (use of one envelope of salts, use of one liter of water, and mixing until completely
dissolved). In the evaluation, PVOs showed a significant increase in the proportion of mothers
preparing the oral salts correctly (43% to 77.9%)
NGOs required the mother mentioned five steps (wash hands, boil or chlorinate the water, use one
envelope of salts, use one liter of water, and mix until dissolved completely). In the evaluation, 53.8%
explained using the 5 steps, which is an increase of 45.8% over the baseline of 8%. When behavior
was assessed, 72.2% of mothers prepared the ORS correctly, which is an increase of 61.2% from the
11% baseline.
The 78.8% of mothers interviewed for NicaSalud mentioned at least two danger signs. For PVOs,
77.8% of mothers knew two or more danger signs, a significant increase over the baseline of 43%.
Acute Respiratory Infections (ARI)
Almost half (48.2%) of mothers with children 0- 23 months reported that their children had had a
respiratory infection (cough and rapid breathing) in the two weeks prior to the interview. For the PVOs
and the NGOs, the prevalence of respiratory ailments was similar: 50.4% and 47.3%, respectively
Mothers with children 0-11 months were asked about ARI danger signs in a child that would have her
urgently visit a health unit. PVOs considered three danger signs (rapid breathing, intercostal in￾drawing, and not being able to drink or breastfeed) and obtained an increase of 30% over the
baseline (5% to 35%). For NGOs a reduction of 39% was found.
In NicaSalud, 71% of mothers with children with respiratory infections sought help or treatment in a
health facility. At the baseline, PVOs had 32%, which increased to 71.5% in the evaluation. While
PVO increase is significant, there was no significant difference for the NGOs, with 70.8% in the
baseline study and 65.9% in the evaluation.
HIV/AIDS and other Sexually Transmitted Infections (STIs)
For PVOs, 97.6% of women stated that they had heard about HIV/AIDS. The main transmission way
mentioned was sexual relations with 91.2%. Less than half of informants mentioned other
transmission ways.
Results of NicaSalud Final Evaluation Survey 8
The 65.9% of women mentioned at least two ways that a person can prevent HIV transmission.
These percentages represent an increase over the baseline: PVOs (47.4%) and NGOs (26.6%). All
forms of prevention involved sexual relations. The most frequently mentioned was the use of
condoms (73.9%). The other forms mentioned for preventing HIV transmission range from 2.9% to
35.2% in the evaluation.
Sexual Transmitted Infections (STI)
In NicaSalud, 74.9% of the women 15-49 years not pregnant, mentioned knowing other infections, in
addition to HIV, that are transmitted through sexual relations. The PVOs had an increase of 18% over
the baseline while the NGOs achieved an increment of 36.4%. The sexually transmitted infections
most commonly mentioned were gonorrhea (67%), syphilis (63.4%), condilomatosis (24.1%),
pediculosis (9.4%), and tricomoniasis (8.4%).
For all NicaSalud, 83.5% of the women mentioned locations where they can obtain condoms.
However, only 6.49% of them used condoms in the last sexual contact.
Results of NicaSalud Final Evaluation Survey 9
INTRODUCTION
In September 1999, USAID/Nicaragua approved funds to implement health projects aiming to help
the Nicaraguan population located in the north and northwest of the country that had been affected by
Hurricane Mitch one year earlier. These funds were channeled through the as NGO Networks for
Health Cooperative Agreement. They supported the initiative to form the NicaSalud Network in
Nicaragua.
The NicaSalud Network began as a project that combined the efforts of a group of national and
international organizations present in the country to restore and protect the health of the population
affected by Hurricane Mitch, according to the USAID guidelines and objectives.
NicaSalud’s members implemented health projects for high priority populations (women of
childbearing age, children under 5, and adolescents). The projects were located in 31 municipalities
in 8 departments of the country, giving coverage to a population living in 736 communities and/or
barrios.
The duration of PVO projects was two years and a little more than one year for the NGOs.
This document reports the results of the final evaluation carried out in September 2001 and compares
them with the baseline studies of 1999 for the PVOs and in 2000 for the NGOs.
PROJECT OBJECTIVES
The USAID/Nicaragua post-Mitch reconstruction plan is summed up by its Special Objective (SpObj)
of Rapid Reconstruction and Sustainable Recovery in Areas Affected by Hurricane Mitch. The
specific intermediate result (IR) in public health proposed by the SpObj is “Health Situation of families
affected by Hurricane Mitch maintained or improved.”
According to what USAID/Nicaragua requested, NicaSalud proposed to work under IR1.1: Increased
access to health services in areas affected by Hurricane Mitch. Thereby, the planning of the work of
NicaSalud set out to restore primary health services in the components of immunization, infant
survival, and reproductive health in small communities and rural areas affected by Hurricane Mitch.
The USAID Mission asked that emphasis be put on “health education, monitoring, prevention and
treatment of malaria, dengue, cholera, leptospirosis, and other infectious diseases.”
Results of NicaSalud Final Evaluation Survey 10
GEOGRAPHIC AREAS
The organizations making up the NicaSalud Network are located in the departments in the north and
northwest of the country, as shown in Table 1. (See map on following page).
Table 1. Departments and municipalities covered by NicaSalud Network partners
Department Organization Municipalities
ADRA Totogalpa, Yalagüina, San Lucas, Palacagüina Madriz INPRHU Somoto San José de Cusmapa
CARE Pueblo Nuevo, La Trinidad, Condega, San Juan de
Estelí Limay, San Nicolás, Estelí
Ixchen* Estelí
CEPS Ocotal Nueva Segovia FUNDEMUNI Quilalí
CRS Wiwilí
Project HOPE Wiwilí, Pantasma, Jinotega Rural
Partners of the
Americas Jinotega Rural
PCI Yalí, La Concordia, San Rafael del Norte, Pantasma
Jinotega
Compañeros Peri-urban Jinotega
PLAN Puerto Morazán, Tonalá
Save the Children** Posoltega, Chinandega, Chichigalpa, El Realejo
ADP Villa Nueva
Fundación Hablemos
de Nosotras El Viejo
Chinandega
Ixchen Chichigalpa
Save the Children Malpaisillo, Quezalguaque, Telica León Ixchen Malpaisillo
Matagalpa Ixchen San Isidro
RAAN Alistar of Nicaragua Waspán
* Ixchen is present in 4 different zones.
 ** Save the Children is present in two departments in the northwest of the country.
Except for the projects of CEPS and Partners of the Americas, all projects were executed in rural
communities. CEPS executed its project in the urban area of the municipality of Ocotal and Partners
of the Americas executed theirs in the peri-urban area of the municipality of Jinotega.
Though the table shows some municipalities as being shared among the partner organizations, they
intervened in different communities.
Results of NicaSalud Final Evaluation Survey 11
Figure 1. Map of Nicaragua showing departments where NicaSalud
members are located.
Lago de
Nicaragua
O
C
E
A
N
O
P
A
C
I
F
I
C
O
H O N D U R A S
C O S T A R I C A
O
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A
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O
A
T
L
A
N
T
I
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Madriz, Estelí 
y 
Nueva Segovia
León y 
Chinandega
Jinotega
Sub Network Jinotega
CRS, Project HOPE,
Compañeros, PCI, Alistar of
Nicaragua, Partners of the
Americas
Sub Network Las Segovias,
Madriz, Estelí and Nueva
Segovia
CARE, ADRA, CEPS, INPRHU
Somoto,
FUNDEMUNI, Ixchen Women’s
Center
Sub Network Pacific, León
and Chinandega
ADP, PLAN, Fundación
Hablemos de Nosotras, Save
the Children, Ixchen
Women’s Center
Results of NicaSalud Final Evaluation Survey 12
PROGRAM INTERVENTIONS
Tables 2a and 2b list the interventions implemented by each organization.
The interventions listed below reflect the objectives of each organization as stated in their proposals.
Table 2a. Interventions by the PVOs
Type of intervention ADRA CARE CRS PLAN PCI HOPE Partners SAVE
Breastfeeding and Infant
Nutrition
* * * *- * * *
Care of sick children:
diarrhea/ARI
* * * *- * * *
Prenatal Care * * - ** * * *
Care during delivery and
of newborns
- * - ** * * *
Postnatal care - * - ** * - *
Child Spacing * * - ** - - *
Immunization * - * *- * * *
STDs/HIV/AIDS * * - -* - * *
* = Intervention made
Table 2b. Interventions by the NGOs
Type of intervention Hablemos ADP INPRHU CEPS Ixchen FUNDEMUNI Compañeros Alistar
Breastfeeding and
Infant Nutrition
* ** -- - * -
Care of sick children:
diarrhea/ARI
* ** -- * * -
Prenatal Care * ** * * - *
Care during delivery
and of newborns
* ** -* * - *
Postnatal Care * ** -* * - *
Child Spacing - - - ** - - *
Immunization * ** -- * * -
STDs/HIV/AIDS * - - ** - - *
* = Intervention made
Results of NicaSalud Final Evaluation Survey 13
METHODOLOGICAL DESIGN
The tool used for the evaluation was the same one used for the baseline studies: Lot Quality
Assurance Sampling LQAS (Wolfe and Black 1989; Valadez 1991; Robertson, Anker et al. 1997;
Valadez et al. 2000). LQAS is a simple quick method that uses small sample sizes to determine the
initial situation, coverage, and quality of projects or interventions. It can be applied on different levels
and in different areas of work like: Health Posts, Casa Base, Barrios, etc., enabling quick and
accurate identification of the priorities within the Supervision Area (SA). The data can be easily
analyzed and used for making immediate managerial decisions in the Supervision Areas. It also
allows for adding the data obtained from the SAs for calculating averages. (See Annex 1)
There are three main advantages of the LQAS sample over cluster sampling, another method often
used by organizations and institutions.
1. Besides allowing for calculating a conventional average coverage for a program area, the
program managers can also determine the performance relative to the different areas of
supervision making up the whole area of influence. For example, a typical program area of an
organization can include hundreds of communities with a total population of several thousand
persons. To manage the implementation of the program, the entire area of influence is divided
into Supervision Areas (SAs). Each SA is managed by a supervisor who may be a nurse, a
midwife, an experienced health promoter, or any other individual. With LQAS, each supervisor
can determine the relative performance of these in order to arrive at a point of reference for
annual performance.
2. LQAS allows for a smaller sample size than cluster sampling in order to make judgments. With a
sample of 19 individuals, one can judge whether a target has been reached in a given SA. To
calculate a coverage proportion, the individual samples of 19 from each SA are added together
and the average is calculated. In the conventional application for cluster sampling, a sample size
of 300 is required.
3. Since LQAS needs a small sample in order to judge whether the performance of a health worker
or another indicator in the population is reaching a preset standard, data collection does not
compete seriously with the time the staff have allotted for other activities of providing health
services. Health workers in developing countries often have too much work and they need
management tools that are easily understood within their particular cultural context.
Results of NicaSalud Final Evaluation Survey 14
Sample Design
The geographic area for each project was divided into Supervision Areas (SAs). The SAs are defined
according to the particular characteristics presented in each project using criteria like number of
communities, population, geographic location, but above all, the administrative-managerial flow of the
project. That is why it is called an Supervision Area. For all NicaSalud, the total number of SAs is 70.
A systematic random sample of 19 observations was collected in each SA for each group defined by
each organization. Table 3 shows the number of interviews per organization per population group.
Interviews were conducted in the randomly selected household so long as people from the defined
population groups were found there: mothers with children from 0 to 11 months, mothers with children
from 12 to 23 months, women from 15 to 49 years old who were not pregnant, men from 15 to 49
years old, or adolescents. If no one from these population groups was found, a visit was made to the
closest house, and thereon successively until the set of questionnaires was completed.
If more than one person from the same population group was found in the same household, the
informant was selected randomly. A special case is when there are two children from the defined
population groups (0 to 11 months and 12 to 23 months) in the same household, in this situation a
random selection was made of one of them. Never was the same mother interviewed twice, and
never was the same type of interview conducted with two persons in the same household.
Table 3. Areas of Supervision and Interviews by organization and population group
Population Group Interviewed Total
Organization interviews # AS
Mothers,
children 0-11
Mothers with
children12-23
Women 15-49
Not pregnant
Men
15-49
Adolescents
15-19
Adolescents
15-24
ADRA 4 X X X - - - 228
CARE 6 X X X - - - 342
PCI 4 X - X X - - 228
Partners 4 X X X - - - 228
HOPE 4 X X X - - - 228
CRS 4 X X - - - - 152
PLAN 6 X X X - - - 342
SAVE 7 X X X - - - 399
ADP 4 X X - - - - 152
Hablemos 4 X X X X - - 304
Ixchen 4 - - - - - X 228
INPRHU 4 X X X - - - 228
CEPS 4 - - - - X - 228
FUNDEMUNI 3 X X X - - - 171
Compañeros 4 X X - - - - 152
Alistar 4 X - X - - - 152
TOTAL 70 1178 1026 950 152 228 228 3762
Data collection was carried out from September 17 to October 2, 2001. On average, each
organization took five days to collect the data in the community. The time taken depended on the
complexity and number of questionnaires that each organization used. The project technical team,
made up of project managers, supervisors, and promoters took part in this process, and the
NicaSalud technical team participated as accompanying supervisor.
Results of NicaSalud Final Evaluation Survey 15
Preparation of Questionnaires
Four questionnaires were used. Together, they make up a set. Each one corresponds to a particular
sample universe. These are:
! Mothers with children, 0-11 months
! Mothers with children, 12-23 months
! Women of childbearing age, 15-49 years old, not pregnant
! Men of reproductive age from 15-49 years old
The questionnaires used for the baseline studies were used as a basis for designing the evaluation
questionnaires. To standardize these instruments for all the organizations, the questionnaires were
shared with all the organizations who revised and vetted the contents, first independently through
working sessions between the members of the NicaSalud technical team with each organization, and
lastly, in a training workshop, the content was finalized.
The organizations CEPS and Ixchen used questionnaires directed at their special client populations:
male and female adolescents from 15 to 19 years old and 15 to 24 years old, respectively.
Staff Training
NicaSalud organized four workshops to train 116 members of the technical teams of the projects on
methods for gathering data. The workshops were facilitated by the NicaSalud M&E Specialist, the
Senior Advisor for M&E of Networks, and a professional specialized in the use of the LQAS
methodology. Training was organized so that seven members of the NicaSalud partner organizations
participated as trainers. They had received training in previous workshops and had experience in
applying the methodology, making them ready to facilitate the training on this occasion. There was
also support from the NicaSalud technical team for the training process.
The schedule and distribution of the 116 participants in the training was as follows:
September 10-12, 2001 Nueva Segovia 33 participants
September 17-18, 2001 Jinotega 23 participants
September 17-18, 2001 Jinotega 23 participants
September 19-20, 2001 León 37 participants
Given the number of participants in the Jinotega sub-network, the group was divided in two, with
simultaneous training on the same day. The topics covered in all the training sessions focused
especially on the management of basic principles and concepts of the LQAS method, validation and
standardization of data collection tools.
Data Processing and Analysis
All questionnaire data were entered into a computer database using EPI INFO, Version 6.04d. Each
questionnaire was double entered to identify data entry errors. Range tests were also carried out as
part of data cleaning.
Results of NicaSalud Final Evaluation Survey 16
The data were weighted by the population size of the Areas of Supervision, using the direct
adjustments method. Although weighting is not necessary when making LQAS judgments in an
Supervision Area, it is used when the data are added together in order to calculate the coverage for
all the areas of NicaSalud, a geographic area, or an area of influence of an organization. Without
weighting, a sample of 19 may either overestimate or underestimate the coverage for an organization,
depending on the population sizes of the different Supervision Areas. The weighting of the data
allowed for this distortion to be eliminated.
For these aggregate analyses, the total population interviewed formed the denominator. However not
all organizations measured every indicator. This is because the interventions they implemented
differed amongst them.
The PVOs’ baseline study was carried out in December 1999 while the NGOs carried out theirs in
August 2000. Both kinds of organizations used the LQAS method. In both baseline studies, four
population groups were used (mothers with children from 0-11 months, mothers with children from 12
to 23 months old, women from 15 to 49 who were not pregnant, and men from 15 to 49 years old).
The sample sizes of informant groups are presented below.
Table 4.Maximum Sample Sizes in Baseline and Evaluation Studies of PVOs and NGOs
Baseline 2001 Evaluation Informant Group PVOs NGOs PVOs NGOs
Mothers of children 0-11 months 532 361 665 361
Mothers of children 12-23 months 532 361 665 361
Women (not pregnant) 15-49 years 532 531 665 285
Men 15-49 years 532 76 76 76
In the evaluation, the sample sizes changed among PVOs and NGOs as noted in the above table.
The reasons for these changes are that either PVOs or NGOs increased the number of SAs they had
(which resulted in more data being collected) or they decided to reduce the number of activities they
were to implement. This latter change suggests the basic difference between the baseline and
evaluation datasets. Not all of the variables that PVOs/NGOs measured in the baseline, did they
continue to measure in the evaluation. The reason is they were no longer relevant to their programs.
The dramatic example of this is in the male informant group. Although PVOs sampled 532 men in the
baseline, they sampled only 76 in the evaluation since activities focusing on men were no longer
included in their programs.
Unless an indicator is reported by a group of PVOs or NGOs, it is not included in this report. There
would be little validity in comparing a national baseline data with evaluation data that are not
representative of the NicaSalud catchment area. For the purposes of this report, indicators with
sample sizes less than n=200 are not reported. There are a few exceptions to this rule. Other
exceptions to this rule are analyses of sub-samples. As a result of this decision, indicators
concerning men 15-49 are not included in this report.
Results of NicaSalud Final Evaluation Survey 17
RESULTS
The results are presented for NicaSalud as a whole. The data include information from 8 international
organizations (PVOs) and 8 national organizations (NGOs). However, as the projects of PVOs were
implemented in 2-years versus 1-year, stratified analyses were carried out of these two organizational
groupings.
Results are presented in four sections:
! Safe motherhood and newborn care
! Child Spacing
! Child Survival
! HIV/AIDS and other STIs
Tables are presented showing baseline and evaluation results for each organizational grouping (PVO
vs NGO). There is also a column indicating whether the difference between the baseline and
evaluation measures is a statistically significant improvement. When evaluation sample sizes are very
small, no comparison of baseline and evaluation data are carried out.
DEMOGRAPHIC CHARACTERISTICS
The average age of women 15-49 years not pregnant was 28.1 years. 79.4% of the women had a
stable partner. Marital status was as follows: common law, 44%; married, 35.4%; single, 17.6%, and
other categories, 4%.
The project implemented by the Center for Social Studies and Promotion (CEPS) focused on
adolescent males and females from 15 to 19 years old. The average age for males was 17 and 16.8
for females. 10.7% of females said they had a spouse (3.9% married and 6.8% common law); 3.9%
of the men stated they had a common law wife.
The project implemented by the Ixchen Women’s Center focused on adolescents and young adult
men and women between the ages of 15 and 24.
The average age of the mothers with children from 0-11 and 12-23 months of age was 24.5 and 25.7,
respectively. The average age of the children in the first group was 5.3 months and in the second, it
was 17.3 months.
Results of NicaSalud Final Evaluation Survey 18
SAFE MATERNITY AND CARE OF NEWBORNS
This section presents the results of interviews with mothers of children 0-11 months. Indicators
concern antenatal care, delivery, post-partum care.
Maternal Health Card
In NicaSalud (PVOs and NGOs) 59.7% of mothers presented their maternal health card to the
interviewer. Of the remaining mothers, 10.5% had lost their card, 3.6% had it in another household,
and only 12.1% mentioned they had never had a card. This latter percentage may approximate the
number of women who did not have access to health care. The remaining 14% had given their cards
to MINSA.
Among PVOs the proportion of card holders increased from 56% to 63.1%. During the PVO baseline
study, interviewers stated that some women said they had no card because they had given it to the
MINSA health unit. In the evaluation this information was included as an option response in the
questionnaire.
Among the NGOs the proportion found in the baseline (45.3%) did not change substantially during the
evaluation (46.1%). Of all the mothers not presenting the maternal control card, 37.8% said it was
because they had given it to MINSA.
Considering the high percentage of mothers without a maternal health card, NicaSalud has proposed
to MINSA an initiative to create and develop a maternal card for community use.
Prenatal Care
About half of the mothers (55.7%) in the NicaSalud evaluation attended at least one antenatal care
visit (ANC) by a qualified clinician. According to the records from the 1998 ENDESA (Nicaraguan
Demographic Health Survey), 84% of the pregnancies in the five years prior to the survey had at least
one ANC visit, a higher percentage than in the NicaSalud catchment area. The data, however,
collected by NicaSalud and ENDESA used different standards. NicaSalud used the information on the
maternal health cards, and ENDESA 98 used not only those cards but also mother’s verbal reports.
Therefore, the results are not comparable. Moreover, the ENDESA sampled all of Nicaragua and
NicaSalud sampled its intervention areas.
The data for PVOs shows an increase in the proportion of mothers having had at least one ANC visit:
46% at baseline and 61% in the evaluation. No significant change was detected for NGOs as the
proportion of mothers with at least one ANC visit had increased by 2.4%.
As MINSA’s recommendation is that women have at least 4 ANC visits, the data were analyzed for
this indicator. Mothers with maternal health cards in NicaSalud had on average 4.5 visits with a
median of 5. This latter result is similar to ENDESA 98 which reported a median of 5.1 ANC visits.
The significant increases in ANC may be attributed to the formation of pregnant women clubs and
development of birth plans. PVOs promoted these activities in coordination with community networks
and the network of health services of the local MINSA. In both activities, emphasis was put on
promoting healthy behavior, especially, looking for timely care. The success of these activities can be
attributed to trained midwives and health brigades, who searched for pregnant women and referred
them to MINSA health units.
Results of NicaSalud Final Evaluation Survey 19
Table 5. Prenatal Care. Comparison between baseline and final evaluation studies
PVOs NGOs
Indicator Baseline Final Eval Differ. Baseline Final Eval Differ.
%n%n % Significant %n%n % Significant
Mothers with children, 0-
11 months, showing ANC
card
56% 532 63% 662 7% NO 45% 360 46% 359 1% NO
Mothers with children 0-11
months, who received iron
during pregnancy
71% 532 86.4% 305 15.4% YES 83.8% 228 NA NA NA NA
Mothers with children 0-11
months, who received at
least one ANC visit during
pregnancy
46% 532 61% 573 15% YES 44% 318 46% 359 2% NO
Mothers with children 0-11
months vaccinated with
TT, according to maternal
card
10% 532 5% 662 -5% YES 22% 324 0.6% 359 -21.4% NO
Mothers with children 0-11
months who mentioned
that TT protects the baby
47% 532 94% 399 47% YES 85% 190 86% 282 1% NO
Women (15-49 years, not
pregnant) who know 2 or
more signs of danger
during pregnancy
21% 532 33% 665 12% YES 39% 646 33.6% 285 -5.4% NO
NA= Not Applicable
Tetanus Toxoid Vaccine
The criterion for judging adequate tetanus toxoid vaccination is at least two vaccinations during
pregnancy or five doses during their lifetime. Vaccination had to be recorded on the maternal health
or a vaccination card. Using this standard, only 1.1% of the women in NicaSalud were vaccinated,
which included 5% and 0.6% for the PVOs and NGOs, respectively. These results are lower than at
the baseline, which were 10% and 22%, respectively. However, there is a marked under-recording of
the data for this indicator. The ANC card does not have space to record all the doses applied before
and during pregnancy. There is only space to note one dose, which is normally applied during ANC
visits. This result emphasizes the need to develop a strategy to guarantee that information about
maternal health is contained in a document managed by the woman herself, in the community.
The 90.7% of women with children 0-11 months mentioned that the vaccine protects the newborn.
For PVOs, the percentage was 94%, a significant increase over the baseline (47%). For NGOs, it was
86%, a similar percentage to the baseline result.
Iron during Pregnancy
This indicator was measured by PVOs only. 86.4% of mothers with children 0-11 months said they
had received iron during their most recent pregnancy, a significant increase from the baseline (71%).
This increase can be attributed to the health units that distribute this micronutrient to pregnant
women. It also reflects the health education and referral of pregnant women by community health
workers.
Results of NicaSalud Final Evaluation Survey 20
Knowledge of Pregnancy Danger Signs
One third of the women 15-49 not pregnant (33.1%) mentioned at least two danger signs during
pregnancy that require immediate referral to a health facility. The proportions for PVOs and NGOs
respectively were 33% and 33.6%. With respect to the baseline, PVOs show a significant increase of
12%. However, NGOs had a 5.4% reduction.
Delivery
For all of NicaSalud, 62.8% of the deliveries of mothers with children 0-11 months were attended by
qualified health staff. While the percentages vary between the two kinds of organizations, the
differences between baseline and final evaluation values are significant. The PVOs display an
increase of 18.5% while NGOs had an increase of 16.2%.
Chart 1. Person who attended the birth: A Comparison of PVO and
NGO Baseline and Final Evaluation Results
The proportion of deliveries by traditional birth attendants (TBAs) did not change over this period in
PVO areas, accounting for approximately a fourth of the total (24.2%) in 2001. However, in the zones
attended by NGOs, TBAs attended 50% of all births. The increase in deliveries by qualified health
staff is probably due to a decrease in births attended by the mother herself or by a relative. For
example, the PVO baseline of 11% of deliveries by the mother herself or by a relative dropped to
4.9%.
For NicaSalud, 60.6% of the births were attended in a health institution, while 39.2% occurred at
home. The PVOs showed a substantial increase over the baseline, going from 56% to 69% of
deliveries occurring in a health institution. By contrast NGOs displayed a smaller proportion of
institutional births both in the baseline and in the evaluation (35% and 39% respectively), while the
proportion occurring at home decreased slightly (65% and 61%, respectively). These results may be
due to the high percentage of births attended by TBAs. In the ENDESA 98, 63.6% of births were
institutional and 34.8% were at home.
0.52
0.7
0.29
0.45
0.29
0.23
0.55
0.5
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Baseline Evaluation Baseline Evaluation
PVOs NGOs
Percentage
Qualified health staff TBA
Results of NicaSalud Final Evaluation Survey 21
Chart 2. Place of Birth of Mothers with Children 0-11 Months: A
Comparison of PVO and NGO Baseline and Final Evaluation Results
With respect to knowledge of danger signs during delivery, there was a slight increase in the
recognition by women (15-49 years) of at least two danger signs. In NicaSalud, 32.6% of the women
mentioned at least two danger signs. There was no difference among PVOs and NGOs. These
proportions represent a statistically significant 14% increase for PVOs. Among NGOs a 2% increment
occurred. These results signal the need to continue the work, but while applying new improved
activities.
Table 6. Delivery Related Behavior and Knowledge: A Comparison of PVO and NGO Baseline and
Final Evaluation Results
PVOs NGOs
Indicator Baseline Final Eval Differ. Baseline Final Eval Differ.
%n%N % Significant %n%n % Significant
Deliveries by mothers with
children 0-11 months,
attended by a qualified
health personnel
52% 532 70.5% 586 18.5% YES 29% 342 45% 228 16% YES
Women (15-49 years, not
pregnant) who know 2 or
more danger signs during
delivery
18% 532 32% 589 14% YES 30% 646 32% 285 2% NO
Birth attended by TBA 29% 532 24.2% 586 -4.8% NO 56% 342 50% 228 -6% NO
Institutional birth 56% 532 69% 586 13% YES 35% 342 39% 228 4% NO
Birth at home 42% 532 31% 586 -11% NO 65% 342 61% 228 -4% NO
0.56
0.69
0.35 0.39 0.42
0.31
0.65 0.61
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Baseline Evaluation Baseline Evaluation
PVOs NGOs
Percentage
Institutional birth Birth at home
Results of NicaSalud Final Evaluation Survey 22
Post Natal Care
In the PVO baseline study, 51% of mothers with children 0-11 months reported receiving postnatal
care. Among NGOs, 37% of mothers did so. The final evaluation data indicate that 84.7% of mothers
in NicaSalud report they received postnatal care. Significant increases in this behavior took place in
both the PVOs (87.8%) and NGOs (79.3%) catchment areas.
PVOs also asked the mother if she had received information about family planning during post-natal
visit; 77.9% responded affirmatively. This result represents a significant increase when compared with
the baseline result of 40%. NGOs did not include this indicator in their projects.
Results for PVOs show a statistically significant increase in the proportion of women who said they
received Vitamin A after giving birth (28% to 40.8%). The increased coverage for Vitamin A suggest
two things: (1) during the project period Vitamin A was available in the health units, and (2) NicaSalud
members were effectively promoting that mothers take Vitamin A. One reason why supplements were
available is that Wisconsin Partners of the Americas delivered several lots of Vitamin A to MINSA
health units. They also distributed it through a network of promoters in communities where their
project was working.
With respect to knowledge of post natal danger signs, in NicaSalud 55.6% could cite 2 or more
danger signs requiring them to visit a health facility immediately. In PVOs areas 53.7% cited 2 or
more danger signs. This result represents a 27.7% increase over the baseline. In NGO areas 57%
could cite 2 or more danger signs, which is a 16% increase over the baseline. Both effects are
statistically significant increases.
Table 7.Post Natal Care Behavior and Knowledge: A Comparison of PVO and NGO Baseline and Final
Evaluation Results
PVOs NGOs
Indicator Baseline Final Eval Differ. Baseline Final Eval Differ.
%n % n % Significant %n%n % Significant
Post natal care received
by mothers with children
from 0 to 11 months from
qualified health staff
51% 257 87.8% 156 36.8% YES 37% 323 79.3% 169 42.3% YES
Mothers with children from
2 to 11 months who
received Vitamin A in the
first two months after
giving birth
28% 462 40.8% 316 12.8% YES NA NA NA NA NA NA
Mothers with children from
0 to 11 months who
received FP information at
the post natal visit.
40% 532 77.96% 205 37.96% YES NA NA NA NA NA NA
Women 15 to 49 years,
not pregnant, who know 2
or more signs of danger
after giving birth
26% 532 53.7% 665 27.7% YES 41% 551 57% 285 16% YES
NA= Not Applicable
Results of NicaSalud Final Evaluation Survey 23
Despite the increases in the proportion of women knowing pregnancy, delivery, and post natal danger
signs, the percentages are low (half or less of the women interviewed). Substantial work is still
needed. Programs should focus more effort on males since in Nicaragua, men tend to make
decisions about the care seeking behavior of woman and children.
Newborn Care
In NicaSalud 88% of mothers with children 0-11 months reported that in the first week of life, their
child showed no signs of complications with the umbilical cord. Both PVOs and NGOs had similar
results. However, PVOs reveal an 11% increase above the baseline (77% vs 87.4%), where the NGO
results show no significant change (91.5% vs 86.4%). In NicaSalud mothers with children 0-11
months reported that 82.6% of the newborns had a consultation with qualified health staff. PVOs
realized an increase over the baseline of 15.9%, while NGOs increased the proportion by 35.7%.
Both results are statistically significant.
Table 8. Newborn Care: A Comparison of PVO and NGO Baseline and Final Evaluation Results
PVOs NGOs
Indicator Baseline Final Eval Differ. Baseline Final Eval Differ.
%n%n % Significant %n%n % Significant
Mothers with children 0-11
months who reported a
clean umbilical cord during
the first week after birth
77% 532 87.4% 323 10.4% YES 91.5% 323 86.4% 152 -5.1% NO
Mothers with children 0-11
months who report
newborn visit with qualified
health staff
70% 263 85.9% 323 15.9% YES 43% 259 78.7% 150 35.7% YES
Child Spacing
In the NicaSalud sponsored projects, no funds were used to support family planning activities.
Nevertheless, some organizations made use of the final evaluation as an opportunity to measure their
family planning activities financed with non-Mitch funding sources. Those results are reported here.
Knowledge of child spacing is measured in NicaSalud by asking the women 15-49 years (not
pregnant) how long a woman should wait before getting pregnant after giving birth. In NicaSalud
95.5% of women said that women should wait 2 or more years. PVOs realized an increase of 7.5%
over the baseline – a statistically significant result. NGOs realized a significant increase of 20.3%.
Some PVOs measured actual spacing of births. In this assessment of mothers with children 0-11
months, 46.6% spaced their last two births by at least 24 months; and 31.6% spaced them by at least
36 months. The baseline values for spacing these two intervals was 42% and 21%, respectively.
These results suggest that Nicaraguan woman increased birth spacing intervals in 2001 as compared
with 1999. In the ENDESA 98, 68% and 39.8% of mothers had a spacing of at least 24 and 36
months, respectively.
Two PVOs and one NGO asked women whether they used a contraceptive method. However, as
multiple geographical areas of NicaSalud are included in the sample, the results are presented as
NicaSalud, where 61.1% of women said they used a contraceptive method. This situation is similar to
the finding in ENDESA 98 (61.7%).
Results of NicaSalud Final Evaluation Survey 24
Among women residing in the PVO areas, 69.4% used a contraceptive method, which is an increase
of 13.4% over the baseline result. As only one NGO measured this variable no results are presented.
As family planning interventions could not be financed with Mitch funds, the results can be attributed
to work carried out by PVOs and NGOs with financing from other sources.
Women were also asked their knowledge of contraceptive methods. In NicaSalud, 96.8% knew three
or more methods. For the PVOs, 98.2% of the women mentioned a minimum of three methods, a
significant gain over the baseline result of 63%. Only one NGO evaluated this indicator, obtaining a
level of knowledge of 70.3%. The eight most frequently mentioned methods are listed below.
! Pills 90.1%
! Injections 87.6%
! Condoms 79.9%
! IUDs 55.8%
! Tubal Ligation 29.9%
! Rhythm 13.9%
! Vasectomy 12%
! Breastfeeding 10.2%
With respect to knowledge of where to obtain contraceptive methods, 90.7% of women mentioned at
least one place. The places mentioned most frequently were: Health Center (53.3%), Health Post
(41.6%), and pharmacies (12.4%). Other places mentioned less frequently were brigadistas,
PROFAMILIA, and private clinics. In communities of the municipality of Waspán, the most frequently
mentioned source was counselor mothers (33%). This high percentage is illustrative of the work being
done with the community network in this zone through the NicaSalud.
Table 9.Family Planning Knowledge and Behavior: A Comparison of PVO and NGO Baseline and Final
Evaluation Results
PVOs NGOs
Indicator Baseline Final Eval Differ. Baseline Final Eval Differ.
%N%n % Significant %n%n % Significant
Women 15 to 49 years,
not pregnant, who know
about spacing
pregnancies
89% 455 96.5% 209 7.5% YES 63.6% 560 83.9% 152 20.3% YES
Women 15 to 49 years,
not pregnant, who know 3
or more family planning
methods
63% 532 98.2% 209 35.2% YES 73% 585 70.3% 76 -2.7 NA
Women 15 to 49 years,
not pregnant, who use a
contraceptive method
(CPR)
56% 532 69.4% 207 13.4% YES 62% 598 42.3% 76 -19.7 NA
Ixchen and CEPS work with adolescents to educate them about issues related to Sexual and
Reproductive Health. An important topic concerns the best age for a women’s first pregnancy. A
comparison of baseline and final evaluation results indicate an increase in the proportion of
adolescents who are knowledgeable about this matter. 79% of adolescent women interviewed by
CEPS said the ideal age for a women to get pregnant for the first time, is over 24 years. This result is
22% above the baseline. Among adolescent men, the baseline value of 51% increased to 76%.
Results of NicaSalud Final Evaluation Survey 25
For Ixchen, 95% of adolescents women said the ideal age is over 24 years, a 30% increase over the
baseline. For adolescent men, the baseline proportion of 50% increased to 65% in the final
evaluation.
In the final evaluation, CEPS asked questions about practices of sexual relations. 60.5% and 21.1%
of adolescent men and women, respectively, said they had already had sexual relations. The average
age for the first sexual relation was 14 years for men and 16 years for women. These data will be
valuable to NicaSalud and its members for planning future interventions, especially those related to
pregnancies prevention and STIs/HIV/AIDS control among adolescents.
Results of NicaSalud Final Evaluation Survey 26
CHILD SURVIVAL
Most NicaSalud members implemented projects with child survival components. The exceptions are
PCI, CEPS, and Ixchen whose work did not concern children and consequently had no intervention
with this client group.
The core area of child survival work carried out by most projects concerned IMCI. Community IMCI
was implemented through a volunteer community network, and MINSA staff were trained in the clinic￾based IMCI. In addition to staff training, some projects equipped community networks and MINSA’s
health units with basic materials.
The evaluation focused on assessing knowledge, practices, and coverage of several services. To
measure specific indicators data were obtained from interviews with mothers with children 0-11
months and 12-23 months.
Growth Monitoring
Mothers with children 0-11 months were asked to show the child’s growth card. For NicaSalud, 89.1%
of mothers showed their child’s card. This result indicates that these children were taken to a MINSA
health facility at least once for growth monitoring. Both PVOs and NGOs exhibited increases over
their baselines (78% to 89.1%, and 81.7% to 89.6%, respectively). On reviewing the cards, it was
found that three quarters of the children (73.6%) had had their growth monitoring session within the
last two months. The PVOs maintained their baseline percentage of 73%, while the NGOs achieved a
significant increase (70.6% to 91.8%).
Table 10. Monitoring of Growth: A Comparison of PVO and NGO Baseline and Final Evaluation Results
PVOs NGOs
Indicator Baseline Final Eval Differ. Baseline Final Eval Differ.
%n%n % Significant %n%n % Significant
Mothers with children 0-11
months who showed the
child’s growth card
78% 532 89.1% 475 11.1% YES 81.7% 300 89.6% 133 7.9% NO
Mothers with children 2 -
11 months who weighed
their child in the last 2
months, according to the
growth card
73% 462 72.3% 361 -0.7% NO 70.6% 289 91.8% 106 21.2% YES
Immunization
A large number of organizations, and community networks worked together under MINSA to
vaccinate children. A principal means of vaccinating children was through the National Health
Campaigns (NHC). During the lifetime of NicaSalud, members have participated actively in at least
four National Campaigns, providing support in: logistics, human and financial resources, educational
materials, information, direct vaccination, and more. The results obtained in immunizing children as a
result of this effort are presented below.
A high percentage (94.6%) of all mothers interviewed with children from 12 to 23 months old showed
the vaccination card for their child. This represents a significant increase over the baseline for PVOs
and NGOs. The PVOs went from 88% to 97.8% and the NGOs from 84% to 94.5%. These
Results of NicaSalud Final Evaluation Survey 27
percentages are higher than those found by ENDESA 98, where 74.1% of Nicaraguan children had
cards. In terms of vaccination coverage, it is important to note that in the last 4 years, MINSA and
other organizations have invested considerable resources to heighten mothers’ awareness of and
commitment to childhood vaccination. Therefore, the results reported here may be attributed to these
as well as other programs.
The regime for basic childhood vaccinations in the first year of life as set by MINSA Nicaragua, is the
following:
BCG
Newborn
Polio 1
2 months old
Polio 2
4-6 weeks after the first
dose
Polio 3
4-6 weeks after the
second dose
Measles
12 months old
Pentavalent 1
2 months old
Pentavalent 2
4-6 weeks after the first
dose
Pentavalent 3
4-6 weeks after the
second dose
For this analysis, vaccinations were counted only if they were recorded on the child’s vaccination
card. The analysis did not take into account the interval between doses, nor the age at which the child
was vaccinated. There were from time to time errors in the way to record vaccination dates. These
errors were not considered in the analysis. For example, a child whose vaccination date is prior to its
birth is an obvious entry error. NicaSalud will undertake work in 2002 to try to resolve such problems
detected during the evaluation. Using these criteria, BCG coverage in NicaSalud was 91.1%, a similar
percentage to the coverage described by the ENDESA 98 (95%). Coverage among PVOs was
91.7%, which is a significant increase over the baseline of 82%. Coverage also increased among
NGOs (86% to 90.3%).
90.9% of children had had at least three doses of polio vaccine, while ENDESA 98 showed 72%.
Coverage among PVOs and NGOs was 91.1% and 90.6%, respectively. While these results
represent increases over baseline values of 77% and 85%, only the PVO result is a statistically
significant increase.
Three doses of Pentavalent replace DPT in the Nicaraguan EPI program. This vaccine immunizes
against diphtheria, pertusis, tetanus, hepatitis B, and Haemophilis influenza. Coverage for all
NicaSalud with Pentavalent was 89%, with similar percentages for PVOs and NGOs. These results
are compared with DPT, the vaccine used during the baseline. In the ENDESA 98, a coverage of
68.8% of children with three doses was reported for all Nicaragua. Therefore, NicaSalud’s results
signal an increased coverage. PVOs realized a significant increase of 13.1% over the baseline. The
increase for the NGOs was not significant.
Coverage for each polio dose and Pentavalent are included in Table 11. Results suggest an
increased coverage.
Results of NicaSalud Final Evaluation Survey 28
Table 11. Doses of Polio and Pentavalent among Children 12-23 Years: A Comparison of ENDESA 98,
and NicaSalud PVO Baseline and the Final Evaluation Results
Polio Pentavalent Survey Polio 1 Polio 2 Polio 3 Penta 1 Penta 2 Penta 3
ENDESA 98 94.6 86.2 73 92.7 84 68.8
Baseline. PVOs.
December 99 86.6 84.7 77 85.9 83.4 76
Final Evaluation
PVOs-September 2001 92.7 91.8 91.1 92.6 90.4 89.1
MMR coverage for all NicaSalud was 83.9%. Since the application of MMR began in Nicaragua after
the ENDESA 98, there is no comparative data for this antigen. However, measles vaccination
coverage according to ENDESA 98 was 70.8%. Coverage among PVOs was 85.8%, a significant
increase over the baseline of 76%. The NGOs had 80.9%, which despite being an increase over their
baseline of 76%, is not a statistically significant effect.
Chart 3. Vaccination Coverage among Children 12-23 Months: A
Comparison of PVO Baseline and Final Evaluation Results
0.89 0.858 0.88
0.82 0.77 0.76
0.71
0.76
0.91 0.92
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
BCG Polio Penta MMR Complete
Percentage
Baseline (Dec. 1999) Final Evaluation (Sept. 2001)
Results of NicaSalud Final Evaluation Survey 29
Chart 4. Vaccination Coverage among Children 12-23 Months: A
Comparison of NGO Baseline and Final Evaluation Results
To be considered as fully vaccinated a child needs to have had the complete basic regime, including
one dose of BCG and at least three doses of polio and three of pentavalent. The coverage for
complete vaccination in NicaSalud was 88%. The ENDESA 98 included measles vaccinations in
addition to those already mentioned. This is because measles vaccination had to be a part of the
vaccination regime in 1998. The application of MMR however does not occur until the child is one
year old. In ENDESA 98 the complete vaccination rate was 56.3%.
Among PVOs 88.2% of children were fully vaccinated in the final evaluation. This is a significant
increase over their baseline of 71%. Among NGOs, 87.8% of children were fully vaccinated, a
significant increase over the baseline of 76%.
In addition to support the National Health Campaigns carried out in the last two years, other activities
that helped improve immunization vaccination coverage include integral visits with MINSA, and
house-to-house visits by the community volunteer network. In both activities, children who had not
been vaccinated and who had missed an appointment for vaccination were identified and referred to
the health units for vaccination. Another activity implemented in Chinandega included nutrition fairs,
where mothers were asked to present their child’s vaccination card in order to identify and refer
children need vaccination.
0.9 0.91
0.89
0.81
0.88
0.76 0.76
0.83 0.85 0.86
0.65
0.7
0.75
0.8
0.85
0.9
0.95
BCG Polio Penta MMR Complete
Percentage
Baseline (August 2000) Final Evaluation (Sept. 2001)
Results of NicaSalud Final Evaluation Survey 30
Table 12.Immunization of Children 12-23 Months: A Comparison of PVO and NGO Baseline and Final
Evaluation Results
PVOs NGOs
Indicator Baseline Final Eval Differ. Baseline Final Eval Differ.
%n%n % Significant %n%n % Significant
Mothers with children 12
to 23 months who showed
the vaccination card
88% 531 97.8% 551 9.8% YES 84% 361 94.5% 361 10.5% YES
Coverage of vaccination
with BCG for children from
12 to 23 months, using the
vaccination card
82% 531 91.7% 551 9.7% YES 86% 341 90.3% 361 4.3% NO
Coverage of vaccination
with Anti-Polio 1-3 for
children from 12 to 23
months, using the
vaccination card
77% 531 91.1% 551 14.1% YES 85% 343 90.6% 361 5.6% NO
Coverage of vaccination
with Pentavalent 1-3 for
children from 12 to 23
months, using the
vaccination card
76% 531 89.1% 551 13.1% YES 83% 342 88.9% 361 5.9% NO
Coverage of vaccination
with MMR for children
from 12 to 23 months,
using the vaccination card
76% 448 85.8% 551 9.8% YES 76% 342 80.9% 361 4.9% NO
Complete vaccination
coverage for children 12 to
23 months old with Polio,
Pentavalent, and BCG.
71% 531 88.2% 551 17.2% YES 76% 73 87.8% 361 11.8% YES
During this study, NicaSalud identified issues that when addressed can strengthen the EPI. To gather
vaccination data, mothers were asked to show the vaccination card for their child; vaccination dates
were then copied into the survey form. On several cards, polio and Pentavalent dates indicate that
dose two or dose three was less than the 4 weeks set. This may be due to the following
a) Inaccurate entry of the date into the vaccination card by the health professional at the time the
vaccination was given;
b) A replacement card has inaccurate information transcribed on it from a medical record; or
c) Children were vaccinated with too short an interval between doses.
The third possibility is the priority concern since these children may be thought to be immunized when
in fact they are not. This should be a warning for health staff working in support of the EPI.
Breastfeeding and Complementary Feeding
This section shows breastfeeding practices (start and duration) and the use of supplementary foods.
Mothers with children 0-11 months were asked to report how soon after birth they started to
breastfeed their children and to list the food they fed to their children in the last 24 hours besides
mother’s milk. Mothers with children from 12 to 23 months old were asked how long they had
Results of NicaSalud Final Evaluation Survey 31
breastfed their child. Exclusive Breastfeeding and Complementary Feeding were measured using
sub-samples of the population (children under 5 months and children 6-11 months, respectively).
ENDESA 98 reported that 79.5% of children began to breastfeed within the first hour of birth. This
indicator was only evaluated by the PVOs, the 76.4% of mothers with children 0-11 months reported
having begun breastfeeding in the first hour after giving birth, which is a statistically significant
increase of 13.4% over the baseline. The current level approximates the percentage reported in the
ENDESA 98 for Nicaragua. NGOs were not assessed for this indicator since only one organization
included it in their questionnaire.
For all NicaSalud, 61.1% children 0-5 months were exclusively breastfed. The result among PVOs
and NGOs reveals a potential variation (62.4% and 53% respectively) although the confidence
intervals indicate there is no significant difference. In PVO areas exclusive breastfeeding increased
by 27.4% from a baseline value of 35%, a statistically significant effect. The ENDESA 98 reported for
Nicaragua that 30% of children under 4 months were breastfed exclusively. This result is similar to
the PVO baseline result. No comparative assessments are possible in NGO areas since
breastfeeding indicators were not included in their baseline assessments.
The increase observed among PVOs in this evaluation may be due to a diverse strategies
implemented over two years of the projects’ lifetime. One of the most important strategies is promoted
and developed by MINSA: Friends of Women and Children Municipalities1
, which was supported by
NicaSalud and volunteer networks. The municipalities of San Rafael del Norte, San José de
Pantasma, Jinotega, San Nicolas, and Estelí were certified. The effect noted here should be
attributed to the common effort by NicaSalud as well as by MINSA and other projects present in some
municipalities who promote breastfeeding.
Other activities NicaSalud carried out under this strategy was the creation of pregnant mothers
groups, breastfeeding mothers’ groups, maternal counselling; public talks, and household visits to
pregnant women and women with children under five years of age.
Charts five and six show the proportion of children in each month cohort exclusively breastfeeding in
both the baseline and final evaluation surveys. Both trend lines show that exclusive breastfeeding
declined as the child grows older. The evaluation results strongly suggest that significantly greater
proportions of children in the 3 and 4 months cohort are exclusively breastfeeding.
 
1 These provide information and promote recommended breastfeeding practices in order to improve
the nutrition of the children without additional costs to households. They also support mothers
interested in exclusive and complementary breastfeeding of their children.
Results of NicaSalud Final Evaluation Survey 32
Chart 5. Exclusive Breastfeeding by Monthly Cohort of Infants 0-5
Months in PVO Catchment Areas: A Comparison of Baseline and Final
Evaluation Results
Mothers tend to introduce liquids sooner than they do solids. However, as children age a greater
proportion of them tend to consume both liquids and solids. In NicaSalud 79.9% of mothers
complementary breastfeed their children 6-9 months of age. In PVOs, 79.8% of mothers with children
in this age group do so. Although this result is 10.8% above the baseline of 69% it is not a significant
effect. NGOs had no baseline measure for this indicator, however, in the 2001 evaluation its result
was similar to the PVOs (80%).
Chart 6. Consumption of Foods and Liquids by Children 0-11 months in
PVO Catchment Areas: A Comparison of Baseline and Final Evaluation
Results
MINSA recommends continued breastfeeding during the first two years of the child’s life. For this
indicator the mothers with children 12- 23 months were surveyed. In NicaSalud, 64.8% of these
mothers were still breastfeeding. Among PVOs 13% more mothers did so than at the baseline.
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
012345
Age in months
Percentage
Baseline 1999-2000 Final Evaluation-2001
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
0 1 2 3 4 5 6 7 8 9 10 11
Age in months
Percentage
Liquids-Evaluation 2001 Solids-Evaluatiion 2001
Liquids-Baseline 1999-2000 Solids-Baseline 1999-2000
Results of NicaSalud Final Evaluation Survey 33
Among NGOs 13.8% more mothers continued breastfeeding. Both increases were statistically
significant.
Table 13. Exclusive Breastfeeding and Complementary Feeding: A Comparison of PVO and NGO
Baseline and Final Evaluation Results
PVOs NGOs
Indicator Baseline Final Eval Differ. Baseline Final Eval Differ.
%n%n % Significant %n%n % Significant
Mothers with children 0-11
months who began
breastfeeding within one
hour after birth
63% 532 76.4% 654 13.4% YES NA NA NA NA NA NA
Exclusive Breastfeeding
among mothers with
infants from 0 to 5 months
35% 263 62.4% 335 27.4% YES NA NA 53% 189 NA NA
Complementary
Breastfeeding among
mothers with children from
6 to 9 months
69% 191 79.8% 233 10.8% NO NA NA 80% 120 NA NA
Mothers of Children 12-23
months who currently
breastfeed their children
50% 531 63% 587 13% YES 56% 361 69.8% 132 13.8% YES
 NA= Not Applicable
Chart 7. Continuing Breastfeeding. Mothers with children 12- 23
months: A Comparison of PVO and NGO Baseline and Final Evaluation
Results
0.49
0.56
0.63
0.69
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
OPVs ONGs
Percentage
Baseline 1999 Evaluation 2001
Results of NicaSalud Final Evaluation Survey 34
Diarrhea Case Management
In NicaSalud 24.6% of mothers with children 0-23 months reported that their child had diarrhea in the
previous two weeks to the interview. The PVOs reported 24.6% and the NGOs 24.7%, which are
significantly smaller diarrhea prevalences than reported during the baselines. At that time at least
30% of children in PVO and NGO areas had had diarrhea.
The average for mothers who gave the same amount or more liquid to their children with diarrhea had
no significant variation for either PVOs or NGOs, with an average for all NicaSalud of 70.4%. Among
PVOs, 69.9% of mothers used the same amount or more liquids. NGOs display a significant increase
as 78.1% of mothers gave the same or more liquid to their child versus 58% in the baseline.
When mothers were asked what kind of treatment they gave their children for diarrhea, 59.4% said
they used oral rehydration salts. This result is similar to what was found in the ENDESA 98, with 58%
for all Nicaragua. PVOs displayed a significant increase from the baseline (19% to 60%). NGOs also
displayed an increase, although it was not significant.
Although the percentage of mothers giving Oral Rehydration Therapy (ORT) to their children during
the diarrhea episode increased, there is still a high percentage of children with diarrhea who do not
receive proper treatment, which maintains the risk of infant mortality. Along this line, the study found
that 38.8% of the mothers interviewed had Oral Rehydration Salts (ORS) in their home at the time of
the interview. Also, when the mothers were asked where they got this product if needed, the
responses in order of frequency were the following: Casa Base or Community Oral Rehydration
Units-UROCs (44.6%), Health Center (44.1%), health promoters (33.7%), and health posts (17%).
This information is particularly relevant for defining ORS distribution policies and for instructing
mothers.
Chart 8. Treatment Practices of Children 0-23 Months with Diarrhea:
A Comparison of PVO and NGO Baseline and Final Evaluation Results
With respect to feeding practices, 46.8% of mothers gave the same or more food to their children
when ill with diarrhea. In PVOs no change was detected (53% in the baseline versus 46.8% in the
evaluation). NGO data are too few to analyze.
0.19
0.6
0.49
0.57
0.75
0.69
0.58
0.78
0.53
0.46 0.44 0.47
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
Baseline 1999 Evaluation 2001 Baseline 2000 Evaluation 2001
PVOs NGOs
Percentage
Used ORS Gave Same or More Liquids Gave Same or More Food
Results of NicaSalud Final Evaluation Survey 35
0.58
0.08
0.538
0.43
0.779
0.11
0.722
0.56
0.743
0.43
0.787 0.831
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
Baseline 1999 Evaluation 2001 Baseline 2000 Evaluation 2001
PVOs NGOs
Percentage
Explains ORT Preparation
Demonstrates ORT Preparation
Knowledge of Dehydration Danger Signs
The knowledge and skills of mothers to prepare ORT were also assessed. They were asked to recite
the steps for preparing ORS and then she was given an envelope of ORS to demonstrate she could
prepare the solution. For the baseline, the PVOs considered preparation correct when the mother
mentioned and carried out three steps (use of one envelope of salts, use of one liter of water, and
mixing until completely dissolved). In this evaluation, with the same steps, PVOs displayed a
significant increase in the proportion of mothers citing the three correct steps and preparing the oral
salts correctly (58% versus 74.3%, and 43% to 77.9%, respectively).
NGOs required the mother mentioned five steps (wash hands, boil or chlorinate the water, use one
envelope of salts, use one liter of water, and mix until the ORS dissolved completely). In the
evaluation, 53.8% explained using the 5 steps, which is an increase of 45.8% over the baseline of
8%. When behavior was assessed, 72.2% of mothers prepared the ORS correctly, which is an
increase of 61.2% from the 11% baseline.
Chart 9. Knowledge and Preparation of ORS and Knowledge of
Dehydration Danger Signs among Mothers with Children 12-23 Months:
A Comparison of PVO and NGO Baseline and Final Evaluation Results
When PVO and NGO results are compared, one notices that the proportion of mothers correctly
preparing ORS goes down when the two additional steps are included in the assessment (hand
washing and water treatment). When these two steps are eliminated from the NGO analysis, the
proportion of mothers who correctly demonstrated preparation of ORS increased from 72.2% to
82.9%, which is not significantly different from the PVO result. Knowledge of preparation increased
from 53.8% to 77.2%, which is also similar to the PVO result.
During both baseline studies, the main deficiencies of mothers when preparing ORS were: they did
not wash their hands with soap and water before the preparation, they did not boil or chlorinate the
water, and they did not always use one liter of water. Identifying these problems should help orient
future interventions. NicaSalud members develop several activities to improve this practice, including:
formation and development of mothers’ groups, public talks, distribution of one liter measuring
utensils, education of the mothers during household visits, and food fairs.
Results of NicaSalud Final Evaluation Survey 36
The other indicator related to proper and timely treatment of diarrhea in children is the mother’s
knowledge of diarrhea danger signs, especially dehydration. 78.8% of mothers interviewed for
NicaSalud mentioned at least two danger signs. For PVOs, 77.8% of mothers knew two or more
danger signs, a significant increase over the baseline of 43%. For NGOs, 83.1% of mothers were
knowledgeable, also a significant increase from their baseline of 56%.
These results indicate that mothers know how to prepare and use oral rehydration salts and also
recognize diarrhea danger signs, and that the proportion of mothers with these capabilities have
significantly increased during the two-year life of this project.
Table 14.Knowledge and Practice about Diarrheic Illnesses: A Comparison of PVO and NGO Baseline
and Final Evaluation Results
PVOs NGOs
Indicator Baseline Final Eval Differ. Baseline Final Eval Differ.
%n%n % Significant % n % n % Significant
Children 0-23 months who
had diarrhea in the last 2
weeks
30% 1063 24.6% 1329 -5.4% NO 36% 721 24.7% 721 -11.3% NO
Mothers who gave the
same amount or more
liquids to children 0-23
months with diarrhea in
the last 2 weeks
75% 307 69.9% 308 -5.1% NO 58% 183 78.1% 106 20.1% YES
Mothers who gave ORS to
children 0-23 months in
the last 2 weeks
19% 307 60% 309 41% YES 49% 175 57.8% 146 8.8% NO
Mothers who gave the
same amount or more
food to children 0-23
months with diarrhea in
the last 2 weeks
53% 307 46.8% 300 -6.2% NO 44% 182 47% 58 3% NA
Mothers with children 12-
23 months who explained
how to prepare ORS
(PVOs used 3 criteria,
NGOs used 5 criteria)
58% 532 74.3% 646 16.3% YES 8% 689 53.8% 326 45.8% YES
Mothers with children 12-
23 months who showed
how to prepare ORS
(PVOs used 3 criteria,
NGOs used 5 criteria)
43% 532 77.9% 646 34.9% YES 11% 689 72.2% 314 61.2% YES
Mothers of children 12-23
months who know 2 or
more diarrhea danger
signs
43% 531 77.8% 653 34.8% YES 56% 344 83.1% 276 27.1% YES
Acute Respiratory Infections
Almost half (48.2%) of mothers with children 0- 23 months reported that their children had had a
respiratory infection (cough and rapid breathing) in the two weeks prior to the interview. For the PVOs
and the NGOs, the prevalence of respiratory infections was similar: 50.4% and 47.3%, respectively.
These percentages vary little from the results obtained in the respective baseline studies. In the
ENDESA 98, lower percentages than those found by NicaSalud were found for all Nicaragua: 26% of
children under five years with a cough and rapid breathing, while for children 0- 23 months, it was
almost 30%.
Results of NicaSalud Final Evaluation Survey 37
Acute respiratory infections (ARI) are the first cause of illness and the second leading cause of death
among children under five years old. However, there is a wide variety of conditions classified as ARI
ranging from a simple cold to a severe case of pneumonia, moreover there may be wide variation in
mothers’ capacities to perceive rapid breathing. This variation could explain the difference detected
by ENDESA and NicaSalud.
The challenge is in aiding mothers to recognize the symptoms of pneumonia. As recognition of
pneumonia symptoms is crucial for the early referral of sick children, mothers with children 0-11
months were asked about ARI danger signs in a child that would have her urgently visit a health unit.
The evaluation for PVOs recognized three danger signs (rapid breathing, intercostal in-drawing, and
not being able to drink or breastfeed). In the baseline, 5% of mothers knew two or more danger signs,
while 35% did so in the evaluation.
NGOs exhibited a different pattern. Firstly, their baseline measure indicated that 69.5% mothers knew
two or more danger signs. However, their baseline considered four signs rather than three (rapid
breathing, intercostal in-drawing, not being able to drink or breastfeed, and difficulty noisy breathing).
These were the signs included in the IMCI manuals. The evaluation only considered the former three
signs as correct (as these are most closely associate with pneumonia). The evaluation resulted in
29.9% of mothers knowing two or more danger signs. The reduced number of option responses may
account for the difference between the baseline and evaluation results. Non-sampling error may also
account for the high percentage reported in the NGO baseline.
With respect to treatment seeking, in NicaSalud 71% of mothers with children with respiratory
infections sought help or treatment in a health facility. At the baseline, 32% of mothers in PVOs areas
sought treatment for their sick children. At the evaluation this percentage increased to 71.5%. While
PVO increase is significant, there was no significant difference for the NGOs with 70.8% in the
baseline study and 65.9% in the evaluation. The NicaSalud percentages are above those reported by
the ENDESA 98 for Nicaragua (57.8%).
Table 15. Knowledge and Practice about Acute Respiratory Infections: A Comparison of PVO and NGO
Baseline and Final Evaluation Results
PVOs NGOs
Indicator Baseline Final Eval Differ. Baseline Final Eval Differ.
%n%n % Significant %n%n % Significant
Cough and rapid breathing
present in children 0-23
months in the last 2 weeks
54% 1063 50.4% 1329 -3.6% NO 50% 720 47.3% 570 -2.7% NO
Mothers who took their
child 0-23 months with
cough and rapid
respiration to a health
facility
32% 596 71.5% 662 39.5% YES 70.8% 264 65.9% 266 -4.9% NO
Mothers who know 2 or
more danger signs of
pneumonia in children 0-
11 months
5% 532 35% 661 30% YES 69.5% 361 29.9% 356 -39.6% NO
Results of NicaSalud Final Evaluation Survey 38
HIV/AIDS and other Sexually Transmitted Infections
This section reports knowledge and practices by women 15 to 49 years (not pregnant) related to the
control or treatment of HIV/AIDS and other Sexually Transmitted Infections (STIs). As only two
organizations in NicaSalud asked questions of men, these results are not reported here since they
cannot be generalized to NicaSalud.
CEPS and the Ixchen Women’s Center focused their projects on adolescents and youths of both
sexes about these issues. These reports are presented separately since they represent a specific
part of the age distribution.
Awareness and Transmission of HIV
A high percentage of women (97.6%) in NicaSalud stated that they had heard about HIV/AIDS.
Regarding the women surveyed by PVOs, 98.3% had heard about HIV/AIDS, an increase of 11.3%
over the baseline. Among women interviewed by NGOs, no significant change was detected (94.3%
baseline vs 88.5% evaluation). These percentages indicate a high level of awareness about the
existence of HIV/AIDS.
The most frequently mentioned HIV transmission routes are presented in the table below:
Table 16. Knowledge of Ways HIV Is Transmitted among Women: A Comparison of PVO and NGO
Baseline and Final Evaluation Results
Form of transmission NicaSalud PVOs NGOs
Sexual relations 91.2% 92.6% 86.9%
Blood transfusion 44.3% 44.4% 43.8%
Use of syringes 39.3% 46.2% 18.5%
During pregnancy 3.3% 4.3% 0.0%
During birth 1.0% 1.3% 0.0%
During breastfeeding 6.9% 2.3% 20.8%
In NicaSalud, the most frequently mentioned transmission route by women was sexual relations
(91.2%). This route also is the main HIV transmission routes in Nicaragua. However, less than half
the respondents mentioned other transmission route, and less than 5% mentioned that HIV can be
transmitted to children through pregnancy, birth, or breastfeeding.
With respect to mother to child transmission, the PVO baseline revealed that more than 50% of
informants knew these transmission routes. However, these high percentages disappeared in the
final evaluation. This is probably due to the way the questions were asked. In the baseline, informants
were directly asked if they knew that HIV could be transmitted to the baby during pregnancy, birth, or
breastfeeding. In the final evaluation, informants were asked to cite ways that HIV is transmitted. It is
clear from the current data that there is not high awareness of HIV.
A considerable percentage (13.2%) of informants gave incorrect responses about how HIV can be
transmitted. Among the most noteworthy are: kissing, and the use of personal items. This result
suggests that portions of the population are still not completely clear about how HIV is transmitted.
CEPS and Ixchen’s also asked adolescents how HIV is transmitted. The results for these
organizations were as follows:
Results of NicaSalud Final Evaluation Survey 39
In CEPS, 80% of adolescent women responded correctly with two or more forms of transmission of
HIV, an increase of 19% over the baseline of 61%. Male adolescents had 82% correct responses, an
increase of 22% over the baseline of 60%.
For Ixchen, 85% of respondents correctly mentioned two or more ways that HIV can be transmitted,
an increase of 45% over the baseline (40%). 90% of the adolescent men answered correctly, an
increase of 60% over the baseline (30%).
As with the adult population interviewed for NicaSalud, adolescents mentioned sexual relations as the
main transmission route.
HIV Prevention
Over half the women (65.9%) mentioned at least two ways that a person can prevent HIV
transmission. These percentages represent a significant increase over the baseline, where
percentages of less than 50% were obtained for both PVOs and NGOs.
The most frequently mentioned ways to prevent HIV transmission are presented in the following table:
Table 17. Knowledge of Ways to Prevent HIV Transmission among Women 15-49 Years: : A
Comparison of PVO and NGO Baseline and Final Evaluation Results
Women 15-49 years Form of Prevention Baseline Evaluation
Use of condom in every sexual relation with penetration 48.0% 73.9%
Abstinence from sexual relations 11.0% 35.2%
Being faithful to sexual partner 19.0% 32.8%
Avoiding sexual relations with persons who have had a
number of partners 13. %0 22.4%
Avoid sexual relations with prostitutes 17. %0 15.9%
Avoiding blood transfusions 5.0% 11.1%
Avoiding sexual relations with drug users - 5.4%
Avoiding sexual relations with homosexuals - 2.9%
All forms of prevention mentioned involved sexual relations. The most frequently mentioned was the
use of condoms. Women exhibited a significant increase in this indicator as nearly three quarters of
women mentioned this way in the evaluation as contrasted with a baseline measure of 48%. The
other forms mentioned for preventing HIV transmission range from 2% to 35% in the evaluation. This
may be due to the priority given by projects and others institutions to condom use. The 2001
evaluation percentages for sexual abstinence are very much higher than those found for all
Nicaragua in the ENDESA 98, which may signal a growing awareness.
85% of all adolescents interviewed by Ixchen mentioned at least two ways to prevent HIV infection
(20% and 40% for males and females, respectively, in the baseline), an increase of 65 percentage
points and 45 percentage points, respectively.
The CEPS focused their HIV prevention methods on sexual contact. In the evaluation, adolescents
were asked if they know about safe sex (using a condom during every sexual relation). The baseline
results were 51% and 64% for women and men, respectively. In the final evaluation, for women, the
percentage increased to 64.6% and for men the percentage was similar to the baseline (65.8%). It is
Results of NicaSalud Final Evaluation Survey 40
important to note that the CEPS developed its intervention based on the Chain of Change Model,
which uses specific behaviors as the basis for developing the intervention.
Table 18. Knowledge about HIV/AIDS/STI among Women 15-49 Years: : A Comparison of PVO and
NGO Baseline and Final Evaluation Results
PVOs NGOs
Indicator Baseline Final Eval Differ. Baseline Final Eval Differ.
%n%n % Significant %n%n % Significant
Women 15 to 49 years
old, not pregnant who
have heard about
HIV/AIDS
87% 532 98.3% 399 11.3% YES 94.3% 525 88.5% 152 -5.8% NO
Women 15 to 49 years
old, not pregnant, who
know 2 or more ways to
prevent HIV/AIDS
30% 532 77.4% 399 47.4% YES 30% 525 56.6% 152 26.6% YES
Women 15 to 49 years
old, not pregnant, who say
they know other STIs
beside HIV
60% 532 78% 247 18% YES 32% 525 68.4% 56 36.4% NA
Women 15 to 49 years
old, not pregnant, who
know 2 or more signs of
STIs in men
11% 532 48.9% 247 37.9% YES 19% 521 34.9% 76 15.9% NA
Women 15 to 49 years
old, not pregnant, who
know 2 or more signs of
STIs in women
14% 532 55.4% 247 41.4% YES 28% 434 29% 71 1% NA
NA= Not Applicable
Other STIs
For all NicaSalud, 74.9% of the women mentioned knowing other infections, in addition to HIV, that
are transmitted through sexual relations. Among PVOs, 78% women know about other STIs besides
HIV, a significant increase over the baseline of 60%. NGOs had insufficient data to analyze.
The sexually transmitted infections most commonly mentioned were: gonorrhea (67%), syphilis
(63.4%), condilomatosis (24.1%), pediculosis (9.4%), and tricomoniasis (8.4%).
Although the percentage of women who said they know about other STIs is high, when asked how
they would recognize them, only 48.9% mentioned two or more signs or symptoms that may present
themselves in men and 55.4% in women. Regarding knowledge of signs and symptoms in men,
PVOs exhibited an increase of 37.9% over their baseline. Knowledge of signs and symptoms in
women, also exhibited a significant increase of 41.4% in PVOs. NGOs were not assessed due to
insufficient data.
Despite the significant increase, more than half of the women could not recognize persons with STIs.
This indicates that although education interventions have been successful, it is still necessary to
develop activities to improve the level of knowledge.
Results of NicaSalud Final Evaluation Survey 41
Condom Use
For all NicaSalud, 83.5% of the women mentioned locations where they can obtain condoms. PVOs
increased knowledge of women by 17.1% over the baseline. There was insufficient data to assess
NGOs for this indicator.
For all NicaSalud, only 6.49% used condom during the last sexual intercourse. PVOs did not exhibit
any significant gains above the baseline. NGOs were not assessed due to insufficient data.
Table 19. Use of Condoms among Women 15-49 Years: A Comparison of PVO and NGO Baseline and
Final Evaluation Results
PVOs NGOs
Indicator Baseline Final Eval. Differ. Baseline Final Eval Differ.
%n%n % Significant %n%n % Significant
Women 15 to 49 years
old, not pregnant, who
know where to obtain
condoms
73% 501 90.1% 112 17.1% YES 75% 397 78.5% 76 -3.5% NA
Women 15 to 49 years
old, not pregnant, who
used condom the last time
they had sex
3% 331 6.6% 109 3.6% NO 9% 381 5.6% 75 -3.4% NA
NA=Not Applicable
Results of NicaSalud Final Evaluation Survey 42
BIBLIOGRAPHY
CSSP, C. S. S. P. (1997). Survey Trainer's Guide for PVO Child Survival Project Rapid Knowledge, Practice
and Coverage Surveys. Baltimore, Johns Hopkins School of Hygiene and Public Health.
CSTS and CORE (1999). KPC-2000: Knowledge, Practices and Coverage Survey. Calverton, MD, Child
Survival Technical Support Project and the CORE Monitoring and Evaluation Working Group.
Dodge, H. F. and H. G. Romig (1944). Sampling Inspection Tables: Single and Double Sampling. New York,
John Wiley & Sons.
Henderson, R. H. and T. Sundaresan (1982). “Cluster sampling to assess immunization coverage: A review of
experience with a simplified sampling method.” Bulletin of the World Health Organization 60: 253-260.
Global Program on Vaccine (1996). Monitoring Immunization Programmes Using the Lot Quality Technique.
Geneva, World Health Organization.
DHS y MINSA (1999). Encuesta Nicaragüense de Demografía y Salud 1998. Managua, Instituto Nacional de
Estadísticas y Censos. Ministerio de Salud. Macro International Inc.: 319.
Lwanga, S. K. and S. Lemeshow (1991). Sample Size Determination in Health Studies: A Practical Manual.
Geneva, World Health Organization.
Robertson, S. E., M. Anker, et al. (1997). “The lot quality technique: a global review of applications in the
assessment of health services and diseases surveillance.” World Health Statistical Quarterly 50: 199-209.
Valadez, J. J. (1986). Lot Quality Acceptance Sampling for Monitoring Primary Health Care Coverage.
Washington, D.C., Pan American Health Organization (WHO).
Valadez, J. J. (1991). Assessing Child Survival Programs in Developing Countries: Testing Lot Quality
Assurance Sampling. Cambridge, Harvard University Press.
Valadez, J. J. (1998). A Manual for Training Supervisors of Community Health Workers to Use LQAS: A
User's Guide. Arlington, OMIN Research.
Valadez, J. J. (2000). NGO Networks for Health Detailed Monitoring and Evaluation Plan. Washington DC,
NGO Networks for Health: 64.
Valadez, J. J. and B. R. Devkota (in preparation). Using LQAS for Regular Monitoring in a Decentralized
Integrated Health Program in Two Districts of the Terai, Nepal. Draft 7: 26.
Valadez, J.J. et. al. NicaSalud. Baseline survey Results for 8 partner organizations. ADRA, CARE,
PARTNERS, CRS, PCI, PLAN, HOPE and SAVE. November-December 1999.
Valadez, J.J. et. al. NicaSalud. Baseline survey Results for 12 partner organizations. ADP, Hablemos, FUNIC
Mujer, IXCHEN, CEPS, INPRHU, FUNDEMUNI, AMNLAE, COMPAÑEROS, ALISTAR, FUMEDNIC,
FUNISDECI, August 2000.
Valadez, J. J. and C. Leburg (2000). LQAS Tables of Sample Sizes, Decision Rules and Errors: A Program
Manager's Version and a Local Supervisor's Version. Washington DC, NGO Networks for Health.
Results of NicaSalud Final Evaluation Survey 43
Wolfe, M. C. and R. E. Black (1989). Manual for Conducting Lot Quality Assessments in oral rehydration
therapy clinics. Baltimore, Johns Hopkins University School of Hygiene and Public Health.
Results of NicaSalud Final Evaluation Survey 44
Annexes:
Annex 1: LQAS Methodology. A brief history and description of LQAS
The LQAS methodology was developed in the 1920s to control the quality of the industrial production
of goods (Dodge and Romig, 1944). The basic principle is that a line supervisor takes a small random
sample of a recently manufactured lot of goods from a production unit, like an assembly line or a
machine. If the number of defective items in the sample exceeds a preset number, then the lot is
rejected; otherwise, it is accepted. This permissible number is called the rule of decision. The
permissible number of defective items is determined statistically (Dodge and Romig 1944; LWANGA
and Lemeshow 1991; Valadez 1991) based on a production standard and the sample size. This
sample size is selected so that a manager would have a high probability of accepting lots in which a
preset proportion of the items is of high quality and a high probability of rejecting lots that fail to meet
the production standard.
In health systems, an example of a production standard is a reference point for the predetermined
coverage of a program area, such as vaccinations, knowledge of how to prepare and use SRO, birth
attended by a trained medical provider, or the use of the contraception methods. Standards (or points
of reference) can be established by the managers of the health system, either national or at the
district level. In health systems, a lot is the area of influence of a health unit or a health worker. It may
also refer to a community. In this report, a lot is an area of supervision. The production unit is the set
of health workers under a supervisor.
The LQAS judgments about field areas have a percentage of error. In the standard statistical
nomenclature, these correspond to alpha (α) and beta (β) errors. In epidemiological terms, these
errors are related to the proportion of false positives to false negatives in an evaluation. The former
are used to calculate specificity (1-α), the probability of correctly identifying areas of supervision that
achieve points of reference for execution. The latter are used to calculate sensitivity (1-β), the
probability of correctly identifying areas of supervision that cover an unacceptably low proportion of
the population. The errors associated with sample sizes for LQAS present themselves everywhere.
(Valadez 1998; Valadez y Leburg 2000) since this is a discussion of the principles of LQAS. (Dodge y
Romig 1944; Valadez 1986; Wolfe and Black 1989; Valadez 1991; Immunization 1996; Robertson,
Anker et al. 1997).
Steps for using LQAS
The steps for using LQAS do not differ drastically from the gathering of data with the sample by
conglomerate of PAI (Henderson and Sundaresan 1982) and are listed below:
Each organization organizes its area of program influence into areas of supervision (SAs). As
mentioned, an area of supervision is managed by a supervisor who may be a nurse, midwife, or other
person. Experience shows that this step helps the organizations revise and potentially improve their
management plan.
Each supervisor organizes their area into a sample framework that consists of a list of communities
and their population size within each area of supervision.
A systematic random sample of the communities is used to identify the location of 19 households.
This step is done using a standard procedure described in many places (CSSP 1997). Depending on
the number of communities in an area of supervision and the population size of each community, this
procedure often results in no more than one randomly selected locality per community. Table 4
includes a sample frame for one of the areas of supervision of CARE included in the baseline. Of the
Results of NicaSalud Final Evaluation Survey 45
13 communities in the area of supervision, 12 were selected as locations for a set of interviews in
each of them. Two communities had two sets of interviews and one had three. One community had
no interviews.
Supervision Area #2 – MUNICIPALITY: SAN NICOLAS/Estelí
No. AS Community Population Accumulative
Population
Number of
Households to
Sample
1 Quebrada De Agua 218 218 1
2 Espinito 183 401 1
3 Rodeo Grande 296 697 1
4 Santa Clara 233 930 1
5 La Puerta 144 1074 1
6 Limones # 1 283 1357 1
7 La Sirena 246 1603 1
8 Salmerón (Moyes) 329 1932 2
9 La Tijera 218 2150 1
10 Potrerillo 169 2319 1
11 La Granadía 120 2439
12 Las Tablas 194 2633 1
13 Limay 301 2934 2
14 San Nicolás 652 3586 3
15 Guingajapa 244 3830 1
16 Jocomico 133 3963 1
Total in Area 2 3,963 Total 19
Sample Interval = 208.58
Random Number = 164
A household is selected in the identified communities. Although the spin-the-bottle method or
something similar is often used for samples of 30 groups, the M&E team of Networks recommended a
different procedure for Nicaragua that had been previously proven in the field in Nepal (Valadez and
Devkota in preparation). It consisted of: 1) using existing sketch maps of the community made by the
local health worker or 2) asking local informants to divide the community into vicinities of equivalent
size and then selecting one of these at random. A combination of these methods can be used. In the
second case, the half selected is again subdivided into equivalent sections with the help of an
informant and one is selected randomly. This procedure is continued until there is a small area left in
which the households can easily be counted. Then one of these homes is selected randomly. Both
procedures worked well so that the supervisors selected one household at random.
Once a household has been selected at random, the supervisor determines whether a person with
the appropriate characteristics lives in the home. If so, and if the person agrees, then he/she is
interviewed. If not, then the supervisor proceeds to the house closest to the door of the house where
the supervisor was standing. In the section of this report on Parallel Sampling, there is more
discussion of the selection of the persons to be interviewed.
Interpretation of the LQAS data
The LQAS data can be interpreted by using a decision rule to decide whether the number of correct
responses is under the threshold or by calculating a proportion of coverage (average coverage). The
NicaSalud baseline report uses average coverages as described in the section of the report: Use of
Results of NicaSalud Final Evaluation Survey 46
LQAS for baseline surveys. In surveys that have established a threshold or goal, an LQAS judgment
is made by taking the following steps.
For each indicator, count the number of correct responses for the corresponding question. Go to the
appropriate LQAS Table and find the row for a sample of 19 (or the appropriate sample size if
different from 19). The program target is found along the header of the column. Once it is located, put
your finger on it and go down it to the cell with a value in it. This is the Decision Rule. If the total
number of correct responses is less than the decision rule, then the area did not meet the target.
The compound table used for making decisions by supervisors during the tabulation workshops is
included in Table 5 of the subsection Use of LQAS for baseline surveys in the Methods section of the
main text. This LQAS table is the most user-friendly version to date. A more sophisticated set has
also been developed and published separately (Valadez and Leburg 2000). However, a detailed table
for a sample size of 19 is included in Annex 2. It shows the errors associated with the identification of
areas of supervision that meet the preset annual targets and those that do not. As shown in Annex 2,
the α and β errors never reach 0.10. The corresponding specificity and sensitivity is always over 90%.
Results of NicaSalud Final Evaluation Survey . 47
SAMPLE SIZE= 19
19 for average coverage/coverage target and lowest likely estim ates ranging from 20-95% and 0-75%, respectively,
0.014 0.000 0.031 0.000 0.046 0.000 0.017 0.000
0.111 0.067 0.046 0.067 0.059 0.013 0.023 0.013
0.059 0.115 0.070 0.035 0.028 0.035 0.032 0.009
0.070 0.144 0.078 0.054 0.032 0.054 0.034 0.016
0.173 0.068 0.084 0.068 0.034 0.068 0.035 0.023
0.180 0.077 0.087 0.077 0.035 0.077 0.035 0.029
0.180 0.182 0.184 0.084 0.088 0.084 0.035 0.084 0.033 0.033
0.184 0.185 0.186 0.087 0.087 0.087 0.033 0.087 0.029 0.035
0.186 0.186 0.185 0.088 0.084 0.088 0.077 0.035 0.023 0.035
0.185 0.184 0.084 0.184 0.077 0.087 0.068 0.034 0.016 0.034
0.182 0.180 0.077 0.180 0.068 0.084 0.054 0.032 0.009 0.032
0.175 0.173 0.163 0.078 0.054 0.078 0.035 0.028 0.013 0.008
0.163 0.163 0.144 0.070 0.035 0.070 0.013 0.023
0.144 0.150 0.115 0.059 0.013 0.059
0.115 0.133 0.067 0.046
0.067 0.111
Decision rule for an LQAS sam ple of
with corresponding producer and consum er risks (α and β errors)
AVERAGE COVERAGE (Baselines) / ANNUAL COVERAGE TARGET (Monitoring and Evaluation)
20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95%
L
O
W
E
R
T
H
R
E
S
H
O
L
D
0%
1233
5%
3 34 4
6
15%
10%
45 5
7
20%
56 6
8
25%
77 7
9
30%
88 8
10
35%
10
8 99 9
11
40%
12
9 10 10
12
45%
10 11 11
13
50%
11 11 12 13
14
55%
12 12 13 14
16
60%
14 15 15 16
13 14 14 15
65%
15 16 16
70%
16 17
75%
17
Results of NicaSalud Final Evaluation Survey . 48
Annex 2. LQAS Table
LQAS Table: Decision rules for sample sizes from 12 to 30 and Targets or Average Coverages from 10% to 95%
Targets or Average Coverages Sample Size 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95%
12 N/A N/A 1 1 2 2 3 4 5 5 6 7 7 8 8 9 10 11
13 N/A N/A 1 1 2 3 3 4 5 6 6 7 8 8 9 10 11 11
14 N/A N/A 1 1 2 3 4 4 5 6 7 8 8 9 10 11 11 12
15 N/A N/A 1 2 2 3 4 5 6 6 7 8 9 10 10 11 12 13
16 N/A N/A 1 2 2 3 4 5 6 7 8 9 9 10 11 12 13 14
17 N/A N/A 1 2 2 3 4 5 6 7 89 10 11 12 13 14 15
18 N/A N/A 1 2 2 3 5 6 7 8 9 10 11 11 12 13 14 16
19 N/A N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
20 N/A N/A 1 2 3 4 5 6 7 8 9 11 12 13 14 15 16 17
21 N/A N/A 1 2 3 4 5 6 8 9 10 11 12 13 14 16 17 18
22 N/A N/A 1 2 3 4 5 7 8 9 10 12 13 14 15 16 18 19
23 N/A N/A 1 2 3 4 6 7 8 10 11 12 13 14 16 17 18 20
24 N/A N/A 1 2 3 4 6 7 9 10 11 13 14 15 16 18 19 21
25 N/A 1 2 2 4 5 6 8 9 10 12 13 14 16 17 18 20 21
26 N/A 1 2 3 4 5 6 8 9 11 12 14 15 16 18 19 21 22
27 N/A 1 2 3 4 5 7 8 10 11 13 14 15 17 18 20 21 23
28 N/A 1 2 3 4 5 7 8 10 12 13 15 16 18 19 21 22 24
29 N/A 1 2 3 4 5 7 9 10 12 13 15 17 18 20 21 23 25
30 N/A 1 2 3 4 5 7 9 11 12 14 16 17 19 20 22 24 26
N/A: Not Applicable, means that it cannot be used since the average coverage or target is very low for assessing an area of supervision
 : Alpha or beta errors are ≥≥ 10%
 : Alpha and beta errors are > 15%
Annex No.3
Table summarizing indicators for PVOs
Comparison between Baseline and Final 
Min Max Min Max Min Max Min Max
Population group: Mothers with children 0-11 months of age
Safe Maternity
Last pregnancy not planned 57.0 532 53.1 61.7 63.6 110 54.3 73.0 NO 23.9 74 13.6 34.2 NA
 Information about FP received during postnatal care 62.0 146 54.0 7.0 78.0 205 71.2 84.8 YES 29.0 293 23.8 34.2 49.4 49 33.6 65.3 NO
Prenatal
Mothers who showed CPN card 56.0 532 51.4 60.0 63.1 662 58.6 67.6 NO 45.3 360 40.4 50.2 46.2 359 40.3 52.1 NO
Mothers who made at least 1 CPN visit, according to 
card 46.0 532 42.0 50.6 60.8 573 56.1 65.5 YES 43.7 318 38.8 48.6 46.2 359 40.3 52.1 NO
Mothers with 5 doses of TT or 2 doses during 
pregnancy
10.0 532 7.1 12.3 5.0 662 3.0 7.1 NO 22.0 324 17.5 26.5 0.9 359 0.2 1.5 NO
Mothers mentioning that TT protects the child 47.0 532 43.1 51.8 93.5 399 90.2 96.8 YES 85.3 190 79.4 91.2 86.4 282 82.2 90.6 NO
Mothers mentioning receiving iron during the 
pregnancy
71.0 532 66.7 74.6 86.4 305 82.0 90.7 YES 83.8 228 78.9 88.7 NA
Birth, Post Natal
Mothers who had skilled personnel attend the birth 52.0 532 47.8 56.5 70.6 586 66.1 75.0 YES 29.0 342 24.2 33.8 45.2 228 38.3 52.1 YES
Mothers who received postnatal care from skilled 
personnel 51.0 257 45.0 57.5 87.8 156 83.8 91.8 YES 37.0 323 31.7 42.3 79.3 169 73.0 85.5 YES
Received Family Planning Information at Post Natal 
Visit 40.0 532 36.0 44.6 78.0 205 71.8 84.8 YES NA NA NA NA NA NA NA NA NA
Mother's Received Vitamin A after Birth 28.0 462 24.1 32.4 40.8 316 34.6 47.0 YES NA NA NA NA NA NA NA NA NA
Newborns
Care of newborn by skilled personnel 70.0 263 64.5 75.8 85.9 259 81.3 90.5 YES 43.0 324 37.6 48.4 78.7 150 72.0 85.5 YES
Newborns with clean umbilical cord in 1st week after 
birth 77.0 532 73.8 81.1 87.4 323 83.5 91.3 YES 91.5 247 85.6 97.4 86.4 152 80.7 92.2 NO
Mothers saying they vaccinate baby although he/she is 
ill 87.0 526 84.5 90.3 89.9 189 85.4 94.4 NO 87.0 246 81.1 92.9 92.2 75 86.0 98.4 NO
Breastfeeding
Under 6 months receiving exclusive breastfeeding 35.0 263 28.8 40.6 62.4 335 56.2 68.7 YES 30.1 361 24.5 35.6 NA
Change 
NGOs
Not included
EVALUATION
Not included
Not Included
IC
Change 
PVOs
BASELINE
NGOs: Sept. 2001
n
IC IC
NGOs: Sept. 2000
n %n
PVOs: Sept. 2001
%
BASELINE EVALUATION
%
INDICATOR
IC
PVOs: Dec. 1999
%n
Annex No.3
Table summarizing indicators for PVOs
Comparison between Baseline and Final 
Min Max Min Max Min Max Min Max
Change 
NGOs
EVALUATION
IC
Change 
PVOs
BASELINE
NGOs: Sept. 2001
n
IC IC
NGOs: Sept. 2000
n %n
PVOs: Sept. 2001
%
BASELINE EVALUATION
%
INDICATOR
IC
PVOs: Dec. 1999
%n
Children from 6-9 months receiving complementary 
feeding 69.0 191 62.7 76.0 79.8 233 74.7 84.9 NO 56.0 361 49.9 62.2 NA
Newborns breastfed in first hour after birth 63.0 532 59.3 67.6 76.4 654 72.6 80.3 YES 84.3 357 80.6 88.0 45.5 76 34.1 57.0 NO
Infant Survival
Mothers with card for Control of Growth and 
Development of baby 78.0 532 74.0 81.2 89.1 475 86.1 92.1 YES 81.7 300 75.8 87.6 89.6 133 83.5 95.7 NO
Children 2-11 months controlled in the last 2 months 73.0 462 68.4 76.7 72.3 361 67.6 77.0 NO 70.6 289 64.7 76.5 91.8 106 87.0 96.5 YES
Mothers who correctly explain preparation of oral 
serum (3 criteria) 58.0 532 53.8 62.4 74.3 646 70.3 78.3 YES 77.2 327 72.0 82.5 NA
Mothers who prepare oral serum correctly (3 criteria) 43.0 532 38.2 46.8 77.9 647 74.1 81.7 YES 82.9 314 77.5 88.2 YES
Mothers who know age when the baby should be 
weaned 42.0 532 37.3 45.8 64.8 662 60.4 69.2 YES 50.8 360 45.9 55.7 50.3 291 43.3 57.3 NO
Mothers who know at least 2 signs of IRA 0.05 532 0.0 0.1 35.0 661 30.5 39.5 YES 69.5 361 64.6 74.4 29.9 356 24.4 35.4 NO
Population Group: Mothers with children 12-23 months of age
Vaccines
Mothers who showed vaccination card for the baby 88 531 84.6 90.4 97.8 551 96.6 99.0 YES 84 361 80.2 87.8 94.5 361 92.1 96.9 YES
Coverage of BCG, according to card 82.0 531 78.7 85.4 91.7 551 87.2 96.2 YES 86.0 341 81.1 90.9 90.3 361 87.2 93.4 NO
Coverage of polio, according to card 77.0 531 73.8 81.0 91.1 551 86.2 96.0 YES 85.0 343 80.1 89.9 90.6 361 87.7 93.5 NO
Coverage of Pentavalent, according to card 76.0 531 72.3 79.7 89.1 551 84.0 94.2 YES 83.0 342 78.1 87.9 88.9 361 85.6 92.2 NO
Coverage of MMR, according to card 76.0 448 71.8 79.9 85.8 551 81.2 90.4 YES 76.0 342 71.1 80.9 80.9 361 76.8 85.0 NO
Coverage of complete vaccination (BCG, Penta3 and 
Polio3) 71.0 531 66.9 74.8 88.2 551 83.1 93.3 YES 76.0 73 71.1 80.9 87.8 361 84.5 91.1 YES
Not included
Not included
Not included
Annex No.3
Table summarizing indicators for PVOs
Comparison between Baseline and Final 
Min Max Min Max Min Max Min Max
Change 
NGOs
EVALUATION
IC
Change 
PVOs
BASELINE
NGOs: Sept. 2001
n
IC IC
NGOs: Sept. 2000
n %n
PVOs: Sept. 2001
%
BASELINE EVALUATION
%
INDICATOR
IC
PVOs: Dec. 1999
%n
Infant Survival
Mothers knowing 2 or more signs of danger of EDA 43.0 531 38.7 47.3 78.7 653 75.0 82.3 YES 56.0 344 50.7 61.3 83.1 276 77.9 88.3 YES
Mothers found breastfeeding their baby 50.0 531 45.7 54.3 63.0 587 58.1 67.8 YES 56.0 361 50.9 61.1 69.8 132 61.4 78.2 YES
Population Group: Children 0-23 months
Acute Diarrheic Illnesses (EDA)
Prevalence of EDA in last 2 weeks 30 1063 27.5 33.1 24.6 1329 21.8 27.4 YES 36.0 721 32.5 39.5 26.2 570 22.1 30.4 NO
Mothers who say they give more or the same amount 
of food to their child when ill with EDA 53 307 47.4 58.8 46.8 300 39.8 53.8 NO 44.0 182 36.8 51.2 47.0 58 32.6 61.4 NO
Mothers who say they give more or the same amount 
of liquids to their child when ill with EDA 75 307 69.7 79.6 69.9 308 63.8 76.0 NO 58.0 183 50.8 65.2 78.1 106 68.2 87.9 YES
Mothers who say they give more or the same amount 
of food to their child when recovering from EDA 71 307 64.9 76.8 69.5 298 63.4 75.5 NO 72.0 180 65.4 78.6 73.4 60 63.0 83.7 NO
Mothers who used ORS for children with EDA 19 307 14.4 23.3 60.0 309 53.5 66.5 YES 49.0 175 41.6 56.4 57.8 146 48.6 67.0 NO
Mothers who sought treatment for the EDA (Centers 
and other Health Unit) 16 307 11.6 20.0 53.9 307 47.3 60.4 YES 55.0 182 47.7 62.3 59.6 143 50.3 68.9 NO
Acute Respiratory Infections
Prevalence of IRA in last 2 weeks 54 1063 51.4 57.5 50.5 1329 47.3 53.7 NO 49.6 720 46.3 52.9 47.3 570 42.6 52.0 NO
Mothers who take their child with IRA to a health 
establishment 32 596 27.8 37.4 41.6 662 39.1 44.1 YES 70.8 264 64.9 76.7 2.4 266 0.5 4.2 NO
Population Group: Men 15-49 years
Safe Maternity
Men who know 2 or more signs of danger in pregnancy 10 520 7.4 12.6 7.3 76 1.1 13.5 NO 30.9 456 26.7 35.1 NO
Men who know 2 or more signs of danger during birth 11 520 8.5 14.0 3.4 76 -0.7 7.4 NO 22.0 456 18.2 25.8 NO
Men who know 2 or more signs of danger after birth 17 520 14.0 20.0 10.0 76 3.1 16.9 NO 29.0 456 24.8 33.2 NO
Men who know where to take a woman with maternity 
complications 94 520 92.0 96.0 96.2 76 91.2 101.2 NO 54.0 456 49.4 58.6 NO Not included
Not included
Not included
No included
Annex No.3
Table summarizing indicators for PVOs
Comparison between Baseline and Final 
Min Max Min Max Min Max Min Max
Change 
NGOs
EVALUATION
IC
Change 
PVOs
BASELINE
NGOs: Sept. 2001
n
IC IC
NGOs: Sept. 2000
n %n
PVOs: Sept. 2001
%
BASELINE EVALUATION
%
INDICATOR
IC
PVOs: Dec. 1999
%n
HIV/AIDS/STDs
Men who have heard about HIV/AIDS 95.0 520 92.6 96.6 96.6 76 91.7 101.5 NO 42.6 399 38.7 46.5 98.7 76 96.2 101.2 YES
Men who know of 2 or more ways to prevent 
transmission of HIV 42.0 520 37.6 46.2 42.9 76 30.6 55.2 NO 41.0 394 36.1 45.9 71.1 76 60.9 81.3 YES
Population Group: Women 15-49 years, not pregnant
Safe Maternity
Women who know 2 or more signs of danger during 
pregnancy
21.0 532 17.9 25.0 32.7 665 28.5 37.0 YES 39.0 646 35.2 42.8 33.6 285 27.1 40.1 NO
Women who know of 2 or more signs of danger during 
birth 18.0 532 14.6 21.3 32.0 589 27.3 36.7 YES 30.0 646 26.5 33.5 32.4 285 26.0 38.8 NO
Women who know of 2 or more signs of danger after 
giving birth 26.0 532 21.7 29.3 53.7 665 49.1 58.2 YES 41.0 551 36.9 45.1 57.0 285 50.3 63.7 YES
Women who know where to go if they have maternity 
complications 97.0 532 96.1 98.8 99.1 665 98.2 100.0 NO 82.0 552 78.8 85.2 95.7 209 93.2 98.3 YES
Women under 24 years who had their 1st birth after 
reaching 20 12.0 122 6.5 17.5 11.3 70 4.0 18.5 NO 2.9 18 -2.8 8.6 NA
Women who know about appropriate birth interval 89.0 455 84.5 93.6 96.5 209 93.8 99.2 YES 63.6 560 60.7 66.5 83.9 152 76.7 91.1 YES
Family Planning
Women who use some form of contraception 56.0 532 52.1 60.7 69.4 207 62.5 76.4 YES 62.0 598 58.1 65.9 42.3 76 29.9 54.8 NO
Women who know about 3 or more family planning 
methods 63.0 532 58.5 66.8 98.2 209 96.5 99.9 YES 78.0 585 74.6 81.4 70.3 76 58.9 81.8 NO
HIV/AIDS/STDs
Women who have heard about HIV 87.0 532 84.3 90.0 98.3 400 98.2 98.4 YES 94.3 437 91.4 97.2 88.5 152 83.3 93.7 NO
Women who know 2 or more ways to prevent HIV 
transmission 30.0 532 26.0 33.9 77.4 399 72.9 82.0 YES 30.0 525 26.1 33.9 56.6 152 48.8 64.4 YES
Women who know about other STDs 60.0 532 55.2 63.7 78.0 247 72.3 83.7 YES 68.4 56 55.1 81.7 YES
Women who know 2 or more signs and symptoms of 
STDs in men 11.0 532 8.0 13.4 48.9 247 42.1 55.7 YES 19.0 521 15.7 22.3 34.9 76 23.0 46.9 YES
Women who know 2 or more signs and symptoms of 
STDs in women 14.0 532 10.9 16.9 55.4 247 48.7 62.2 YES 27.6 434 23.7 31.5 29.0 71 17.3 40.7 NO
Women 15-49 years, not pregnant who used a condom 
with their partner during the latest sexual relation 3.0 331 1.4 5.5 6.6 109 1.4 11.8 NO 9.0 393 6.2 11.8 8.0 75 1.1 14.9 NO
Not included
Not included