IMPROVING THE HEALTH OF MOTHERS
AND CHILDREN OF RURAL JINOTEGA,
NICARAGUA:
An Integrated Approach in Partnership with the Public
and Private Sector Providers in Coffee-Growing Areas
Cooperative Agreement No. HFP-A-00-02-00026-00
Final Evaluation Report
Project Duration:
September 30, 2002 – September 29, 2007
Submitted to:
Jill Boezwinkle
Child Survival and Health Grants Program
Attn: Aimee Rose, Program Assistant
UDAID/GH/HIDN/NUT/CSHGP
Room 3.7-74
Washington, DC 20523-3700
Attn: Deborah Kumper, Administrative Assistant
ORC Macro-Child Survival Technical Support Plus Project (CSTS+)
11785 Beltsville Drive
Calverton, MD 20705
Submitted by:
Project HOPE – The People-to-People Health Foundation, Inc.
Millwood, Virginia 22646
Tel: (540) 837-2100
Fax: (540) 837-1813
December 2007
Project HOPE HQ Contact person: Field Contact Person:
Ruth Madison, MPH Silvia Coronado
Technical Advisor, Health of Women and Children Country Director, Project HOPE Nicaragua
Prepared by:
Marguerite Joseph, Consultant
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ACRONYMS
AMAS MOH Health Facility Supervision System
AMATE Animation, Motivation, Appropriation, Transference, Evaluation educational
approach
ARI Acute Respiratory Infection
BCC Behavior Change and Communication
BF Breastfeeding
CDD Control of Diarrheal Diseases
CHW Community Health Worker
CM Community Mobilization
CORU Community Oral Rehydration Unit
CRS Catholic Relief Services
CSP Child Survival Project
CSHGP Child Survival Health Grant Program
CSTS+ Child Survival Technical Support Project
DIP Detailed Implementation Plan
DPSV Life Saving Skills (Destrezas Para Salvar Vidas)
ECMAC Community Based Distribution of Family Planning Methods
EPI Expanded Program of Immunizations
FP Family Planning
GIK Gift-In-Kind
GM Growth Monitoring
HC Health Center
HIS Health Information System
HP Health Post
HQ Headquarters
IDRE Introduction, Development, Reflection, Evaluation educational approach
IEC Information, Education, and Communication
IMCI Integrated Management of Childhood Illnesses
KPC Knowledge, Practice, and Coverage Survey
LQAS Lot Quality Assurance Sampling
M&E Monitoring and Evaluation
MCH Maternal and Child Health
MOH Ministry of Health (MINSA in Spanish)
MSH Management Sciences for Health
MTE Mid Term Evaluation
NID National Immunization Day
NGO Non-Governmental Organization
NICASALUD Network of PVOs in Nicaragua
ORS Oral Rehydration Solution
PCI Project Concern International
PCM Pneumonia Case Management
PDA Personal Digital Assistant (Handheld PC)
PROCOSAN MOH integrated community health program, similar to AIN
PVO Private Voluntary Organization
SICO Community Information System
SILAIS Sistemas Locales de Atención Integral en Salud-Departmental level of MOH
TA Technical Assistance
TBA Traditional Birth Attendant
TQM Total Quality Management
UNICEF United Nations Children’s Education Fund
USAID United States Agency for International Development
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TABLE OF CONTENTS
A. Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
B. Assessment of progress made in achievement of program objectives
1. Technical Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
a. General Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
b. Progress report by intervention area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
c. New tools or approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2. Cross-cutting approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
a. Community Mobilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
b. Communication for Behavior Change . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
c. Capacity Building Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
i. Strengthening the PVO Organization . . . . . . . . . . . . . . . . . . . . . . 28
ii. Strengthening Local Partner Organizations . . . . . . . . . . . . . . . . . 28
iii. Health Facilities/Health Worker Strengthening . . . . . . . . . . . . . 29
iv. Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
d. Sustainability Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
C. Program Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
1. Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
2. Staff Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3. Supervision of Program Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
4. Human Resources and Staff Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
5. Financial Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
6. Logistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
7. Information Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
8. Technical and Administrative Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
9. Mission Collaboration…………………………………………………………. 44
D. Conclusions and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
E. Results Highlight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
ANNEXES
A. Evaluation of Team Members and their titles
B. Evaluation Assessment methodology
C. List of persons interviewed and contacted
D. Attached diskette or CD with electronic copy of report
F. Special reports
G. Project Data Sheet form
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Executive Summary
Project HOPE has been implementing a five-year Jinotega Child Survival Project (JCSP) since 2002,
aimed at improving the health status of children under five and women of reproductive age in the
Department of Jinotega, Nicaragua. The focus has been on rural populations, including those working on
coffee plantations. The main partners in implementation are the Ministry of Health (MOH) at the
Departmental level (SILAIS), Health Centers/Posts, and private sector coffee growers.
Specific program health interventions and level of effort include the following: maternal and newborn
care (30%), nutrition/micronutrient deficiencies (13%), breastfeeding promotion (10%), control of
diarrheal disease (15%), pneumonia case management (10%), immunization (7%), child spacing (10%),
and HIV/AIDS/STIs (5%). The proposed interventions focused on the MOH’s PROCOSAN initiative,
which is a program based on community growth monitoring. This initiative incorporates IMCI;
community-based family planning, Life Saving Skills training, Birth Planning for health facility staff
and community volunteers, and strengthening the Health systems and quality of care.
The project focus was to strengthen the SILAIS and all health units within the department. The target
population was identified as the entire population of Jinotega, totaling 62,451 children under five and
67,461 women of reproductive age living in approximately 750 villages (129,912 total beneficiaries).
All MOH health facility staff have been involved in institutional strengthening activities, but the CSP
selected 80 priority communities where the project would provide more direct support to community
based activities on a monthly basis.
Main Achievements of the Project:
1. Mobilization and capacity building in the form of training community based resource persons
(282 CHWs, 88 TBAs and 759 Community committee members).
2. Development and support of Jinotega MOH strategies, training manuals, guides, supervision
checklists in child health promotion, maternal and newborn care, and community based
family planning strategies.
3. Creation of 43, 18, and 36 training facilitators in community based GM, CBD and Birth
Planning respectively in the SILAIS and municipalities of Jinotega.
4. Institutional strengthening of the Department of Jinotega in its quality of services and in
M&E through the training of 20 key management personnel at SILAIS and municipality
levels.
5. Development of linkages between 36 MOH health facilities and 80 communities through
community based services, community health data collection, monthly reporting,
monthly/bimonthly meetings, references, and counter references.
6. Mobilization of $1,208,006 in direct funds, and $27,286,110 in medicines and supplies to
compliment those provided by the child survival project received from PROSIC, FamiSalud,
ProSalud, in addition to Gift in Kind (humanitarian assistance) from Project HOPE in support
of infrastructure.
7. Involvement of 23 coffee plantation owners in the improvement of health service provision
in the plantations and the development of linkages with the MOH for follow-up and
monitoring.
8. The support of construction of a Maternity Home in WanBlan, managed by the community
health committee.
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9. Contribution of technical project staff at the national level to training methodologies and
materials.
Conclusions
Quantitative results for the final KPC show the project as having reached only 6 of the 19 targets set.
These dismal results do not reflect what was heard during qualitative interviews in the project
communities during the final evaluation. It is important to note that this project involved direct and
indirect communities as well as direct and indirect beneficiaries. The survey results were obtained from
a large geographical area of communities not receiving direct support from the project. A lesson learned
for all involved was that it is unrealistic for a project to expect to have a demonstrable impact on
knowledge and behavior change in communities where only minimal training has been provided to
CHWs and where there were limited health facility strengthening activities. The CSP had requested
USAID to survey only the 80 direct intervention communities for the final evaluation and not the 750
total communities of the department, but this request was denied. Fortunately, the project was able to
conduct a separate KPC for the 80 direct intervention communities, which can be found in Annex D.
Nevertheless, the results for Maternal and Newborn Care were quite strong, with the project achieving
all of the three indicators (prenatal visits, birth attended by trained attendant and postnatal visit), and
remarkable progress showing from baseline to final. The project saw a dramatic decrease in the
percentage of children with low weight for age in Nutrition, but since child weights obtained at the
community level are not recorded on the child health card and this information is collected on the final
KPC to determine if the indicator has been achieved, this lack of complete data makes it appear that the
project has not achieved it’s target. To include community weights on children’s health card would be a
more accurate indicator of progress in the nutrition intervention. Details are provided in the nutrition
section of this report.
The prevalence of anemia increased rather than decreased during the life of the project. In the case of
breastfeeding, the project witnessed improvement in immediate breastfeeding from the baseline, but no
change in exclusive breastfeeding by the final evaluation. Neither objective seems to have been met.
Immunization coverage saw a great deal of progress from the baseline. None of the five objectives were
achieved in the CDD component, and only 2 out of 5 saw a slight improvement from the baseline. There
was a slight improvement in recognition of danger signs of pneumonia, but care seeking results
decreased from what they were at the time of the baseline. In the area of FP, the project saw an increase
in use from the baseline, but the child spacing indicator decreased rather than increased. The indicator
for knowledge of HIV was achieved and increased substantially from the time of the baseline to the final
evaluation.
The Jinotega CSP dedicated a substantial amount of effort to strategy development, launching of
training manuals, and supervision and IEC tools, in addition to the implementation of these strategies.
Various strategies began at different points during the course of the program; therefore some have been
implemented longer than others. As an example, the CBD program for FP and Life Skills Training for
maternal health started early in the project whereas the Integrated Community-Based Growth
Monitoring (PROCOSAN) and Birth Planning initiatives at the community level started later. Additional
time needs to be dedicated to strengthening the more recent activities launched, including counseling
and follow up done by CHWs in the area of anemia as prevalence levels are still high. In addition,
information and key messages for child care during illness have not been shared with community
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resource entities through training. Community committees interviewed did not appear to be very
dynamic in the area of health, although they were organized, enthusiastic, and prepared for emergency
obstetric evacuation. These entities could benefit from additional capacity building and empowerment
efforts. On the other hand, the CHWs and TBAs are very empowered and dynamic and are leading the
community committees in many cases. Linkages with the health facilities at this end point in the project
are fairly strong and relationships are established well enough to continue beyond the life of the project.
MOH resources in terms of support to community activities are limited and there will be challenges in
maintaining the elevated level of support and supervision provided by the project. Health services have
improved with the support of the project in terms of MOH staff technical skills in MCH case
management, data collection and reporting, and planning and community based services. Unfortunately,
quality of care is challenged by high staff turnover, staff shortages, and logistical and financial
constraints at the SILAIS and municipality levels.
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B. Assessment of Results and Impact of the Program
1. Results: Summary Chart
Please Note: The methodology used for each of the below surveys was LQAS where results were
adjusted for the population as recommended. The results are from a sample of 750 communities
Jinotega-wide and thus do not accurately measure the changes in the 80 communities benefiting from
direct project support and interventions. A mini KPC was conducted in the 80 intervention communities
and the results appear throughout this report and in Annex D.
Baseline
March
2003
Midterm
March
2005
Final
Evaluation
March
2007
Final
Evaluation
June 2007
80
Communities
Indicator (for the entire project area)
Adjusted
Coverage
Rates
Adjusted
Coverage
Rates
Adjusted
Coverage
Rates
Adjusted
Coverage
Rates
TARGET
Maternal and Newborn Care Maternal and Newborn Care
1. % of mothers of children aged 0-23 months who
report having had at least one prenatal visit with
a doctor or nurse.
89% 94% 95% 95% 94%
2. % of children aged 0-23 months whose birth
was attended by a doctor or nurse. 51% 54% 71% 61% 65%
3. % of mothers of children aged 0-11 months who
report having had at least one postpartum visit. 32% 33% 51% 52% 45%
Nutrition and Micronutrients
4. % of children aged 0-23 months weighed in the
last four months according to growth monitoring
card.
68% 86% 75% 96% 90%
5. % of children aged 0-23 months with low
weight (Weight-For-Age) (<2Z). 8% 8% 1% n/a 8%
6. % of children aged 0-23 months with anemia
(hemoglobin level < 11mg/dl). 42% 47% 47% n/a 30%
Breastfeeding Promotion
7. % of mothers of children aged 0-23 months who
report having breastfed within the first hour
after birth.
69% 82% 77% 82% 80%
8. % of infants aged 0-5 months who received only
breast milk in the past 24 hours. 56% 52% 56% 74% 70%
Immunization
9. % of children aged 12-23 months with all
recommended vaccines at the moment of their
first birthday according to the growth
monitoring card.
69% 81% 78% 87% 80%
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Baseline
March
2003
Midterm
March
2005
Final
Evaluation
March
2007
Final
Evaluation
June 2007
80
Communities
Indicator (for the entire project area)
Adjusted
Coverage
Rates
Adjusted
Coverage
Rates
Adjusted
Coverage
Rates
Adjusted
Coverage
Rates
TARGET
Control of Diarrheal Diseases
10. % of mothers of children aged 0-23 months with
a diarrheal episode in the last two weeks who
report giving as much or more food to their
child.
46% 45% 31% 59% 60%
11. % of mothers with children aged 0-23 months
with a diarrheal episode in the last two weeks
who report giving as much or more liquids or
breast milk to their child
69% 71% 65% 85% 80%
12. % of mothers of children aged 0-23 months who
report having sought assistance or counseling
from a health unit or CORU during the child’s
last diarrheal episode.
36% 53% 40% 54% 50%
13. % of mothers of children aged 0-23 months who
report washing their hands with water and soap
before the preparation of meals, before feeding
children, after defecation, and after tending to a
child that has defecated
19% 11% 7% 24% 35%
14. % of mothers of children aged 0-23 months that
know at least two signs of dehydration due to
diarrhea. 27% 17% 31% 73% 40%
Pneumonia Case Management
15. % of children aged 0-23 months with cough and
fast breathing in the last two weeks taken to a
health unit.
60% 55% 53% 30% 75%
16. % of mothers of children aged 0-23 months that
can identify fast breathing as a danger sign for
pneumonia.
76% 78% 83% 90% 90%
Child Spacing
17. % of children aged 0-23 months that were born
at least 24 months after the previous surviving
child.
84% 86% 77% 90% 86%
18. % of mothers of children aged 12-23 months
who desire no more children in the next two
years, who are using some type of modern child
spacing method.
65% 90% 100% 66% 85%
HIV/AIDS
19. % of mothers of children aged 0-23 months who
know at least one way to prevent STIs￾HIV/AIDS.
6% 14% 20% 62% 15%
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2. Results: Technical Approach
a. Project Overview
Project HOPE has been implementing a five-year Child Survival Project aimed at improving the health
status of children under five and women of reproductive age in the Department of Jinotega, Nicaragua
since 2002. The partners are the Ministry of Health (MOH) at the Departmental level (SILAIS), Health
Centers/Posts, and private sector coffee growers.
Specific program health interventions and level of effort include: maternal and newborn care (30%),
nutrition/micronutrient deficiencies (13%), breastfeeding promotion (10%), control of diarrheal disease
(15%), pneumonia case management (10%), immunization (7%), child spacing (10%), and
HIV/AIDS/STIs (5%). The proposed interventions focused on the MOH’s PROCOSAN initiative; a
child health promotion program that includes community growth monitoring and community IMCI;
community-based family planning; Life Saving Skills training for health workers and TBAs; Household
Birth Planning; Health systems strengthening and quality of care.
Key strategies include:
 Building the service-delivery capacity of health facility staff and improving the quality of care;
 Strengthening cooperation among public, private, and community stakeholders;
 Empowering consumers, particularly women, to take greater responsibility for personal and
family health maintenance decisions;
 Improving timely care-seeking behaviors through recognition of danger signs, system of referral
and counter-referral, and the formation of emergency evacuation committees;
 Improving the knowledge and skills at the target population by strengthening the capacity of
community health workers (Brigadistas) and Traditional Birth Attendants (TBAs);
 Development/Strengthening of the Community Information System.
With the project focus on strengthening the SILAIS and all health units within the province, the target
population was identified as the entire population of Jinotega, totaling 62,451 children under five and
67,461 women of reproductive age living in approximately 750 villages (129,912 total beneficiaries).
All MOH health facility staff has been involved in institutional strengthening activities, but the CSP
selected 80 priority communities where the project provides more direct support to community based
activities on a monthly basis.
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b. Progress report by intervention area
Maternal and Newborn Care (MNC)
Maternal and Newborn Care
B MTE FE KPC 80
Communities Target
1. % of mothers of children aged 0-23 months who report
having had at least one prenatal visit with a doctor or nurse. 89% 94% 95% 95% 94%
2. % of children aged 0-23 months whose birth was attended by
a doctor or nurse. 51% 54% 71% 61% 65%
3. % of mothers of children aged 0-11 months who report
having had at least one postpartum visit. 32% 33% 51% 52% 45%
The Jinotega CSP MNC strategy focused on several things: life savings skills training of all eligible
health facility staff in Jinotega and at least one traditional birth attendant in each project community (see
training section); and birth planning. TBAs were trained to target pregnant women and their households
to plan where they would give birth, plan for savings, and emergency transportation, among other things
in collaboration with the HF. The birth planning booklet, developed with the assistance of the CS
project, was key to the implementation of this strategy and served as a tool to guide TBAs and families
under the supervision of the health facility.
The CSP did well in the MNC component, as demonstrated by the results achieved for the targeted
indicators above. All targets were attained or surpassed, with a notable impact between the baseline and
final results. With the first indicator concerning mothers having at least one prenatal visit, the target had
been achieved by the time of the midterm. In regards to the additional two indicators, per the above
table, a great deal of progress was made during the second half of the project.
In the 80 direct intervention communities, the results of the KPC were similar to results found in the
survey of all communities, with the exception of the percentage of mothers interviewed whose birth was
attended by a doctor or nurse. In the 80 intervention communities, 61% of births of children 0-23
months were attended by a medical professional. This was slightly less than the target of 65%.
Achievement of the maternal and newborn care objectives was facilitated by the fact that the Ministry of
Health (MOH) identified maternal mortality as a priority problem for the Jinotega MOH and that a
multi-partner approach involving all of the INGOs operating in the department was in effect. Given this
priority, the level of effort afforded this component by Project HOPE (30%) was very appropriate. Two
large strategies contributed to the achievement of these objectives: 1) Life Saving Skills training for
health providers and traditional birth attendants; and 2) Birth Planning for pregnant women and the
household. A third strategy also contributing to this effort was Community Based Programming for
Family Planning (locally known as ECMAC, Entrega Comunitaria de Metodos Anti-Conceptivos). The
development of emergency evacuation committees from within existing community health committees
in all 80 project communities was an important component of this work. These committee members are
on call, committed and ready to assist with the transportation of a woman needing to be taken to the
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hospital in cases of obstetrical emergencies. Trained TBAs have been encouraged to promote facility￾based deliveries and both they and the health facilities report that this is indeed being done. The effort to
train TBAs and develop those linkages with the Health Facilities (HF) has resulted in an evolution of the
TBA role into more of supporting the HF with follow-up and referral, attention to danger signs, and less
of a primary service provider for deliveries. Nevertheless, many women report that they still prefer to
deliver at home because of the privacy and quality of care they receive from the TBAs. Distance and
costs involved are other barriers to facility-based deliveries.
The effort devoted to each of the above strategies by the project staff included the development of
training manuals, technical guidance, and supervision checklists for every level. This facilitated the
training of trainers/facilitators, the implementation, supervision, and monitoring of these interventions.
Another strategy to promote facility-based deliveries was the construction of a Maternity Home where
pregnant women from distance villages come to wait for labor to commence so the delivery can be
assisted by a trained health care provider. Project HOPE received funding from the Japanese Embassy
to construct and equip a Maternity Home in the Municipality of Wiwili which is attached to the local
Health Post. With the support of the Japanese, Project HOPE also provided the health post with solar
panels, a water pump, surgical and other clinical equipment. The Maternity Home is being managed by
members of the health committee who received training and technical support from the JCSP. With
sustainability and cost-recovery in mind, the project supported the start-up of a pharmacy in which
income goes towards helping with basic costs incurred in the running of the Maternity Home. Another
source of income is the availability of a meeting/training area that can be rented by NGOs, along with
food catering for these occasions. The Health Committee also conducts fundraising in the community to
support minor costs. Between 2002 and 2006, 16% of all births in the catchment area took place in the
Maternity House. Over the years, use of the Maternity House has increased from 11% to 20% of total
deliveries. The Japanese also supported needs identified in the Municipality of El Cua, which included
living quarters for staff, a new spacious clinic, as well as equipment and materials needed for the
running of the clinic. MOH staff in Wiwili report a sizeable reduction in maternal mortality in the last
few years as evidenced by the maternal mortality data below:
Year Number of maternal
mortality cases
Maternal Mortality
Ratio
1999 29 cases 316/100,000
2000 10 cases 88.6/100/000
2001 16 cases 199/100,000
2002 9 cases 115/100,000
2003 23 cases 226/100,000
2004 23 cases 224/100,000
2005 15 cases 165/100,000
2006 16 cases 163/100,000
Source: MOH data.
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Success
 The support and development for of the Maternity House in WanBlan, Wiwili.
 The partnership between the MOH and the NGO members of NicaSalud was notable in
the development of the Birth Plan strategy. Each partner took on a different element of
the strategy based on their skills and experience.
 The development and use of a Birth Planning booklet with the leadership of the CSP has
facilitated getting families to agree and commit to birth planning. The planning booklet
includes many illustrations and is also useful for illiterate mothers. It includes a section
on prenatal care checkups, identification of who will accompany the expectant mother at
the time of delivery, who will attend the delivery, where the delivery will take place,
funds needed, emergency transport preparation, and family planning post delivery. The
back of the card also contains illustrations of danger signs during pregnancy, delivery,
postpartum and in the newborn. One illiterate couple in a community, who had reportedly
seen the illustration of bleeding during pregnancy in a larger poster distributed by the
project, said that this illustration is what prompted them to rush to the hospital when the
pregnant wife started bleeding. It may have saved her life and that of her child.
Lessons Learned
 Project success can be enhanced when activities support an MOH priority and when a
multi-partner approach is employed. This approach contributed to advancing the
priorities outlined in the program DIP.
Special Outcome
 During the life of the program, the Department of Jinotega succeeded in reducing
maternal mortality. This is no doubt due to multiple efforts and strategies, but it is very
probable that the JCSP ’s effort to support birth planning and life saving skills training of
health personnel and traditional birth attendants (with an emphasis on emergency
evacuation and identification of danger signs) contributed to this reduction in MMR. The
latter is something that according to a source at NicaSalud, has only happened in
Jinotega.
Constraints
 Frequent MOH staff rotation and staff shortage are issues mentioned by both the MOH
staff and project staff which negatively impacted each intervention of the project. Many
of the doctors who provide services in the department are fulfilling their social service
requirements and are only present for one year. This staff is trained and supported by the
project and once they leave, the project is obligated to train the new personnel. In
addition to this, health posts are also understaffed, many with only one staff person who
is left with no recourse but to actually close down the facility if they need to attend
meetings at the municipality level, training events, or community-level vaccination
campaigns and MCH outreach activities.
 Staff shortages and large patient loads make it difficult for health workers to always
follow the protocols and norms for quality of care. As a result, clients are not always
satisfied with the services provided and the care given.
13
These lessons learned are being applied to smaller projects currently being implemented by Project
HOPE in Nicaragua. This includes a one year project in the municipality of Yali to support the health
information system (HIS) through the situation rooms (Salas de Situacion) funded by Proctor and
Gamble and a FamiSalud maternal child health project covering 46 communities, funded by
NicaSalud.
There is a tremendous amount of potential for scale-up of this intervention. The Life Savings Skills
and Birth Planning strategies have been adopted as priority MOH strategies and are being
implemented by several different NicaSalud partners in Jinotega as well as in the neighboring
department of Matagalpa (CARE, Caritas, Wisconsin Partners for the Americas, and PCI). As a
national strategy, this approach can continue being replicated in other communities when funds are
available to support training of health providers who subsequently train TBAs, and to mobilize
community health workers (CHWs) and health committees for emergency evacuation.
Nutrition and Micronutrients
Nutrition Indicators B MTE FE Target
1. % of children aged 0-23 months weighed in the last four
months according to growth monitoring card. 68% 86% 75% 90%
2. % of children aged 0-23 months with low weight (Weight￾For-Age) (<2Z). 8% 8% 1% 8%
3. % of children aged 0-23 months with anemia (hemoglobin
level < 11mg/dl). 42% 47% 47% 30%
Under the nutrition component, the Jinotega CSP focused primarily on supporting the PROCOSAN
(Community Health and Nutrition Program) including growth monitoring activities. The project
activity included the training of CHWs to promote good child feeding practices, iron supplementation,
and Vitamin A during monthly GM, counseling and education sessions. CHWs also provided referrals
for sick children. Community based vaccination services delivered by health facility staff was
combined with the above community based activity whenever possible. At the start of the project, the
MOH was promoting the AIN (integrated child health strategy or IMCI), and later adopted
PROCOSAN (previously mentioned), which resulted in some changes and delays in the child health
intervention. Training CHWs on care during childhood illness is still pending. CSP staff provided
technical support with the development of training manuals and IEC materials for HF and community
levels as well as supervision tools.
As one can see from the above table, the Jinotega CSP succeeded in achieving only one out of three
objectives that they set out to achieve (#2 above). The decrease in malnourished children – one of the
more difficult changes to effect - was dramatic, with a drop from 8% at the baseline to only 1% at the
end of the project. On the other hand, the first indicator above based on child GM cards, does not show
the results expected, but rather a decrease from mid-project. Likewise, the prevalence of anemia seems
to have increased rather than decreased. The target was not met: 1) because the project did not put
specific effort into this area; and 2) distribution of iron folate and follow-up was not assured.
In the KPC conducted in the 80 direct intervention communities, the results were significantly better.
Ninety six (96%) percent of children 0-23 months had been weighed in the last 4 months, according to
the growth monitoring card. The anemia indicators were not included in the KPC conducted for the 80
communities.
14
The decrease in malnutrition could be attributed to several reasons: 1) the promotion of growth
monitoring and nutrition counseling at the community level in the form of the PROCOSAN strategy;
and 2) the distribution of food to a large portion of the population in the Department of Jinotega, by
various organizations working in food security (PCI, Caritas, WFP). Mothers interviewed during the
final evaluation stated they are happy to participate in the growth monitoring activities and that those
not participating in this available service are rare. It was quite clear in discussions with the mothers
that they understood the importance of participating in these activities and that they are attentive to
their child’s growth and progress. Some mothers mentioned that having these services in the
community helped them because they no longer had to travel to the health facility to receive this
service (combined with the fact that vaccination services are also provided every two months during
the GM sessions).
Strangely enough, the development of Growth Monitoring (GM) activities at the community level is a
likely explanation for the fact that the project did not achieve its first objective under this component
(per growth monitoring card), since according to the PROCOSAN strategies, CHWs do not record
weights on the GM card. According to the PROCOSAN strategy, CHWs were trained to fill their child
registry and to note progress in growth or lack thereof. A child’s weight has always been plotted by
health providers in Health Facilities. As children receiving these services in the community are no
longer being brought to the HF unless sick, there is no record in the child’s card that they have been
weighed. So although the number of children weighed in the last 4 months appears to have gone down
from 86% at the time of the MTE to 75% at the time of the final, this is unlikely to be a reflection of
the real percentage of children being weighed. On the contrary, it is very likely that if a survey based
on mothers reports or CHW registries was taken, it would show an increase in percentage of children
weighed.
According to the different interviews, the moderate increase in prevalence of anemia in children is
likely due to the fact that: 1) the availability of iron in the Jinotega department communities was not
directly under the control of the project; 2) compliance is a challenge because of side effects of taking
iron pills can include discoloration of teeth; 3) it is traditional practice for both adults and children to
drink coffee with meals and thus contribute to iron absorption problems. A striking comment
reportedly made by a woman in the project area was that in view of her economic difficulties and the
fact that she did not have a lot of access to food, she had to stop taking iron because it stimulated her
appetite. Although the problem of anemia is clearly not something new in the country, the program
result highlights the fact that raising awareness for Iron Deficiency Anemia alone is inadequate and
there is a problem in the area of service provision. The MOH has had large supplies of iron available
in the country, but it would appear that due to a lack of coordination between health divisions at the
central level and lack of commitment and initiative on the part of various parties to see this happen,
that this micronutrient has not always reached the health post level (they stay at Municipal health
center level). Many mothers are familiar with iron supplements given to children and can speak to the
dosage and form of prescribing it. It is not clear that iron supplementation is given consistently to all
children as some mothers report not having received it and those who do have received it for different
durations.
15
Successes
 The launching of the PROCOSAN strategy strengthened community based services in
Jinotega. This initiative has forged linkages between community health volunteers and
facility health providers in a way that had not existed before, as health providers have
become involved in the supervision and monitoring of these activities and now bring
immunization services to the community level as well. The project supported monthly
meetings with CHWs and TBAs by providing refreshments and a transportation stipend
for those volunteers who live far from the health facility. The CS project also regularly
provided health workers with transportation to communities for community mobilization,
service provision, or supervision visits. Although the financial support provided for
monthly meetings was phased out at the beginning of year 5, per the reports from CHWs
and health providers alike, these meetings are still taking place and attendance is good.
Lessons Learned
 For an accurate reflection and evaluation of growth monitoring activities, it is important
for the data collection method to take the existing protocol into consideration. (Measured
by CHW registers if that is where the data is; and explore the issue of training of CHWs
to plot child weights on child GM cards as well).
 Projects should be careful in establishing objectives that are related to commodities the
project does not control, i.e. iron supplements.
Constraints
 Due to limited logistical resources of the MOH, MOH management and health facility
staff have difficulty linking and supporting communities without the logistical support of
the project.
 The MOH in the department of Jinotega is also faced with limited human resources. The
development of the community based PROCOSAN strategy has increased the work of
providers in terms of introducing regular community services and supervision
responsibilities. In a health post staffed by only one health worker, this requires that the
worker close the health facility while they are out. (The HF has to be closed if the
provider is participating in training or has to go to a meeting at the municipality level).
Thus this shortage of staff results in reduction of community access to services;
something mentioned by mothers during the final evaluation.
The PROCOSAN child health strategy is an MOH strategy that has been supported by the project and is
an initiative already being implemented country-wide with the support of various NGOs. Scaling-up is
simply a matter of the MOH (or NGOs) obtaining funding to support complete roll out of the strategy.
16
Breastfeeding Promotion
Breastfeeding Indicators B MTE FE KPC 80
communities Target
1. % of mothers of children aged 0-23 months who report
having breastfed within the first hour after birth 69% 82% 77% 82% 80%
2. % of infants aged 0-5 months who received only breast milk
in the past 24 hours. 56% 52% 56% 74% 70%
The project support of the BF component has mainly been through encouraging the breastfeeding
support groups being implemented at the health posts by the provider. In addition, breastfeeding
messages are disseminated by project trained CHWs and TBAs during monthly PROCOSAN activities,
as breastfeeding is a component of the strategy as well as during occasional follow-up home visits. Per
the KPC results shown in the above table, this component was not as successful as other components
discussed previously. While neither of the two objectives was reached, the CSP made a lot of progress in
the first indicator for immediate breastfeeding. At the time of the midterm, the project had already
bypassed its objective by several points (82%), and then went down thereafter (Although this difference
is not statistically significant). The indicator for exclusive breastfeeding (EB) shows absolutely no
progress from the time of the baseline, and thus was quite far from reaching its target.
Although the immediate breastfeeding indicator did not quite reach its target, it was very close to
reaching it at 77% verses 80%. According to mothers interviewed, all trained birth attendants now have
the practice of giving the mother her newborn to breastfeed immediately after delivery. The fact that a
large percentage of mothers are now delivering at the health facility (approximately 71% per program
results) has contributed to the progress seen between the baseline in 2003 and the final in 2007. During
focus group discussions with mothers, they reported that trained TBAs are also encouraging them to
breastfeed soon after delivery. Mothers mentioned the following barriers to breastfeeding within an
hour: sometimes the infant needs immediate medical attention; the mother has undergone a C-section
and/or needs medical attention herself; the baby is not able to suck properly; or (in home deliveries) if
the baby is sleeping the TBA won’t wake them up to breastfeed. With the continued upward trend
towards facility-based deliveries as well as the continued linkages and support of TBAs, it is expected
that the practice of immediate breastfeeding will continue to increase.
Results from the KPC conducted in the 80 communities reveal stronger results which exceeded both
targets. Eighty-two (82%) percent of mothers of children aged 0-23 months report breastfeeding within
hour of the birth of their child. Additionally, the exclusive breastfeeding indicator shows that 74% of
infants 0-5 months received only breast milk in the past 24 hours, surpassing the established target of
70%.
Unlike the above indicator, the project found that behavior change in exclusive breastfeeding is a
significant challenge because of the influence of old habits and traditional feeding behaviors, in addition
to advice from elders such as mother-in-laws. From a knowledge standpoint, it was clear during focus
group discussions that mothers in project communities knew the advantages of exclusive breastfeeding
and many said they practiced it (approximately 56% per the above KPC results). Probing during
interviews revealed that many mothers who had heard the messages did in fact give their infants a small
17
amount of water within two to four months of birth, and many started “getting the child accustomed to
food” at about three to four months of age. This was perceived as important for the child’s growth and
development, and is a perfect example of knowledge not leading to practice. With the common idea that
it is okay to start feeding around four months of age, it is likely that this comes from the old health
message which promoted EB until 4-6 months of age. A study was organized by the project to obtain
more information on the barriers to exclusive breastfeeding, which is detailed in the Operations
Research section.
Lessons Learned
 The Jinotega CSP experience has shown through strength and influence that traditional feeding
practices inhibit the adoption of exclusive breastfeeding. As grandmothers seem have a
negative influence on EBF, they, as well as young breastfeeding mothers, should be targeted
for all EBF promotion activities.
Constraints
 With the limitations of the CSP budget, Project HOPE was not in a position to provide direct
support to knowledge, practices and service delivery to more than 80 communities in the
department of Jinotega, even though per the DIP, they planned on measuring impact on
knowledge, practices and coverage across the population of 750 communities. Project HOPE
Nicaragua had counted on match support from other institutions to deliver MCH/FP services in
additional Jinotega communities and contribute to those results. Unfortunately, institutional
policy changes at Project HOPE headquarters prevented the team from being able to benefit
from this funding and consequently, the team was unable to increase program coverage. Due to
the ambitious nature of this program and expectations with regard to the level of
complementary funds, the CSP selected the entire department population for its quantitative
KPC measurement of progress from the baseline, MTE and FE, rather than limiting this to just
the 80 communities targeted to receive direct support from the CSP funds. As mentioned
before, the project was supporting the entire department in the following: 1) human resource
capacity building with a focus on quality of care for service providers in particular; and 2)
facilitating the inclusion of all functional CHWs from non-project communities in meetings
and technical updates with the health facility during the initial part of the project.
Again, conducting the KPC survey in both the direct and indirect communities does not
accurately reflect the true results of the project as they relate to knowledge and behavior
change. When this request to USAID was declined, the project found additional funding to
conduct the KPC in the 80 direct intervention communities so as to compare results from the
750 community sample. Across the department, there are communities where other NGOs
were intervening (152 total), and communities where there was no NGO presence (518
communities, until the recent start-up of the Project HOPE FamilSalud project which covers 46
additional communities). The results of the KPC can be found in Annex D.
Because immediate and exclusive breast feeding are already MOH-accepted practices, this and other
NGO-implemented projects are part of an existing scale-up process that was initiated in 1995 by
UNICEF. When health providers, including TBAs, are trained, the breastfeeding messages need to be
emphasized and facilities that have been certified as baby friendly will need to be recertified.
18
Control of Diarrheal Diseases (CDD)
CDD Indicators B MTE FE KPC 80
Communities Target
1. % of mothers of children aged 0-23 months with a diarrheal
episode in the last two weeks who report giving as much or
more food to their child.
46% 45% 31% 59% 60%
2. % of mothers with children aged 0-23 months with a
diarrheal episode in the last two weeks who report giving as
much or more liquids or breast milk to their child.
69% 71% 65% 85% 80%
3. % of mothers of children aged 0-23 months who report
having sought assistance or counseling from a health unit or
CORU during the child’s last diarrheal episode.
36% 53% 40% 54% 50%
4. % of mothers of children aged 0-23 months who report
washing their hands with water and soap before the preparation
of meals, before feeding children, after defecation and after
tending a child that has defecated.
19% 11% 7% 24% 35%
5. % of mothers of children aged 0-23 months that know at least
two signs of dehydration due to diarrhea. 27% 17% 31% 73% 40%
The project strategy for this intervention was supporting the MOH in developing and launching the
integrated child health promotion (PROCOSAN), which included community based GM, counseling and
referral for the sick child. This strategy was a change from the previous focus on AIN (IMCI) and time
was lost in this MOH strategy change. Much of the project time went to the new PROCOSAN strategy
development (including training manuals, guidelines, supervision tools), and subsequently the launching
and start-up implementation. At this end point in the project, CHWs have not yet received specific
training on the sick child component (which normally includes counseling on household management of
childhood illness and feeding during illness to decrease duration and severity of diarrheal disease and
ARI). In addition, the project did not envision specific support to the community ORS corners. As a
result of the above, inadequate effort went into the achievement of the CDD behavior change indicators.
Per the above table, the results of the CDD component were far from what the project had originally
anticipated. The project did better overall at the MTE but results deteriorated after that. It was suggested
by program staff that this is in all likelihood due to the fact that the MTE survey was undertaken in the
middle of a multi-month Rota virus epidemic campaign, during which time many people were attending
the health facilities to get checked, and health messages for child care, feeding, rehydration, and hygiene
were being disseminated through radio programs. Thus it was a time when people were being mobilized
to consult health providers in the case of any kind of symptoms affecting them or their children, be it a
cold or a mild case of diarrhea. It would appear that this may have had a positive influence on the MTE
survey results, but these were not behaviors that were sustained much beyond the period of the crisis.
Thus in the case of the third objective (% of mothers who sought assistance) the project appeared to
have reached its target at the time of the midterm (showing a dramatic improvement from the baseline),
but it went down subsequent to that. The most disappointing results were in the case of the first and
fourth indicators which fell very short of reaching their targets. In both cases, figures were better at the
time of the baseline. At the midterm there was either no improvement, as was the case with the first
objective, or there was evidence of a reduction in the health behavior (in the case of the fourth and fifth
indicators).
19
The results from the KPC in the 80 communities showed dramatically better results for indicators related
to the Control Diarrheal Disease intervention. Fifty nine (59%) percent of mothers of children 0-23
months reported giving as much or more food to their children during a diarrheal episode and 85% of
these same mothers report giving as much or more liquids to their child during diarrhea. Fifty four
percent (54%) of these same mothers reported seeking care at CORUs. Twenty four (24%) of mothers
report washing their hands as indicated and 73% of mothers knew at least two signs of dehydration. It
would appear that gains achieved during the midterm that were attributed to the Rotavirus campaign
were sustained in the 80 direct intervention communities.
During focus group discussions conducted for the final evaluation with mothers in the community, the
evaluation team spent time discussing CDD and challenges that mothers encounter related to feeding
and providing fluid during episodes of diarrhea and the issues around care-seeking for cases of diarrhea.
Overall, mothers generally find that it is difficult to either feed children the same amount or more food
when children are sick. The most common reasons given were that the child is vomiting, (or caretakers
fear the child will vomit), the child is too sick and doesn’t want to eat, or feeding him while she/he is
sick will cause discomfort or harm (common cultural belief). On the positive side, several mothers said
that they manage to continue feeding by giving the child small quantities from time to time and thus they
were able to take in at least the same amount of food. Continued breastfeeding did not tend to be as
much of a problem as infants sought comfort from this, but again, there were no efforts to increase the
amount during episodes of illness. Giving liquids, including ORS, is an orientation that mothers have
been given and tends to be somewhat easier for them to practice than feeding during illness. Again, there
is much concern around the issue of vomiting and thus some mothers are very cautious. The project
needed to spend more effort on teaching mothers how to feed a sick child.
After the MTE (prior to the reduction seen at the time of the FE), the Jinotega Child Survival Program
conducted operations research to try and understand the barriers to use on the ORS corners established
in previous community programming supported by the project. In interviews with CHWs managing
these corners, it was mentioned that they did not always have a stock of ORS packets and Clorox tablets
or pain medication as in times past, and this was de-motivating to them. Other challenges included the
distance to health facilities (in the case of certain municipalities like Wiwili), and lack of support and
supervision from health providers. Mothers interviewed said that they were aware of these ORS corners
and knew the volunteers, but many of them stated they preferred going directly to the HF because they
could be sure to get proper care in case of a serious case of diarrhea, or the child has fever as well as
diarrhea – as the community volunteer would usually refer them to the health facility anyway in such
cases. Some mothers are very comfortable with the home case management of diarrhea already and
don’t feel the need to go to the ORS corner for help. On the positive side, other mothers mentioned the
fact that having the ORS corners right in the community was very convenient and was much quicker
than going to the health facility where there is a long waiting time.
Although the project shared results of the special study with project partners, it was not able to put any
specific resources into the above.
Lessons Learned
 In the case of a new project, program staff has learned that it would be better to prioritize
two or three indicators for a CDD component (as opposed to 5), and put the necessary
20
level of effort in those areas with focused messages and strategies that address the
challenges and barriers identified.
Constraint
 As mentioned above, some ORS corners in program communities are not functioning as
well as they could, or are not functioning at all because of lack of motivation of the
volunteer, distance to the health facility for re-supply, and lack of supervision from the
health providers who often have logistical problems reaching communities (as previously
discussed).
 Cultural beliefs and practices with regard to feeding and care during illness such as the
belief that it’s best not to feed a child when she/he is ill are hard to overcome especially
when it is common for the child to have lost his/her appetite and refuse to eat.
The community ORS corner strategy is an intervention that is already being implemented country￾wide with varying degrees of success and impact. In the program area, per the KPC results and some
of the qualitative information provided by the operations research activity, it is an activity that needs to
be revitalized and expanded on before contemplating scale-up in communities that do not have this
service. The project was not involved in supply or specific support to these ORS corners, but rather
revitalizing community based integrated child health promotion.
Immunization
Immunization Indicator B MTE FE KPC 80
communities Target
1. % of children aged 12-23 months with all recommended vaccines
at the moment of their first birthday according to the growth
monitoring card.
69% 81% 78% 87% 80%
The main project strategy for immunization was to support the MOH with the integration of vaccination
services into community based service strategies developed and implemented with the support of the
project, and to give the MOH logistical support with both routine immunization and with bi-annual
national immunization days. Although the CSP did not quite reach the immunization indicator, it was
close to doing so. In fact, this target was reached at the time of the MTE and is showing a slight
reduction, although not significant.
The KPC in the 80 communities revealed that 87% of children aged 12-23 months had all of their
recommended vaccinations by their first birthday, surpassing the target of 80%.
Although the project did not meet the exact target outlined at the time of the project DIP, it did come
close to achieving its goal. There was a substantial amount of effort that went into supporting the
immunization component as part of the PROCOSAN community based initiative. Project Educators and
CHWs coordinated their schedules with that of the health facility and the CSP provided support with
logistics and transportation of health providers to communities that were located at a distance. CHWs
would often go to the HF to escort mothers back to the community location where the GM and
21
vaccination session would be taking place. Community health committees would also help with
mobilizing community members and disseminating dates for these services. With such efforts combined
with the National Immunization Day (NID) normally implemented twice a year, the results with regard
to complete vaccination coverage should have continued to get better after the MTE. According to
program staff, the MOH was unable to implement the second NID in 2006 because the country was
gearing up for the presidential elections. A closer analysis of the data shows that it was the absence of
the MMR vaccine and child vaccination cards that affected the results of the project indicator.
Successes
 Mothers interviewed in the project communities were happy about receiving childhood
immunizations at the community level. This addressed the barrier related to travel to
health facilities for this service, particularly those related to distance and transportation
costs. Thus it is fair to say that the increase in coverage from the baseline 69% to the final
78% can be attributed to this project-supported strategy of providing vaccinations in the
community.
Lessons Learned
 The slight decline in immunization coverage at the final evaluation, identified as being
mainly due to some child cards missing MMR vaccines, is an indication that the project
relied too heavily on the NID that was not implemented in 2006, rather than ensuring
complete coverage through the routine vaccination services both at the community and
health facility levels.
Constraints
 Many health workers are in the habit of going out for NIDs with an exact number
of vaccines based on census information. This often leads to them not having
enough vaccines in communities as census data is not always up to date. These
missed opportunities have also occurred during other integrated community health
activities.
 This component is also affected by the human resource limitations issue raised
earlier. If there is only one service provider at the health post, she or he may not
be able to prioritize community based vaccination services on a given day
depending on other events, such as trainings or important meetings at the
municipality level.
22
Child Spacing
Child Spacing Indicators B MTE FE KPC 80
communities Target
1. % of children aged 0-23 months born at least 24 months after
the previous surviving child. 84% 86% 77% 90% 86%
2. % of mothers of children aged 12-23 months who desire no
more children in the next two years, who are using some type of
modern child spacing method.
65% 90% 100% 66% 85%
The project strategy for this intervention was to support the development and implementation of an
MOH strategy for the community based distribution of FP (ECMAC). CBDs were trained and provided
with oral pills, injectables and condoms. Please refer to training section for numbers trained. With
respect to the first indicator, the project fell short of meeting its target. Inexplicably, the final evaluation
results show quite a decline from the mid point of the CSP where the project target had already been
achieved. In fact, the baseline for this indicator was already quite high, at 84%, not leaving much room
for improvement. The CSP was not responsible for procuring and supplying FP contraceptives, thus the
project decided not to increase the target. On the other hand, in the second indicator, the project did see a
dramatic increase from the baseline to final evaluation.
In the KPC conducted in the 80 communities, 90% of children aged 0-23 months were born at least 24
months after the previous surviving child. Only 66% of mothers of children 12-23 interviewed were
using a modern family planning method, which contrasts dramatically with the 100% result found in the
750 community sample.
The outstanding results in the areas of contraception use can be attributed to increased access to
information on Family Planning through CHWs who participated in program capacity building and
technical updates and encouragement through the monthly meetings held at the health facility. CHWs
department-wide benefited from participation in these meetings and technical updates and the MOH and
project efforts in the area of maternal health and family planning did start at the beginning of the project;
making full use of the entire program period to make gains in this area. The success of the Community
Based Distribution strategy (known as ECMAC in Nicaragua), was most likely due to the fact that it was
a focused effort that prioritized communities based on certain criteria, rather than being implemented in
all communities across the program area or department. CBD volunteers were trained only in
communities, located far from health facilities, with issues of access and communities with cases of
maternal mortality and low rates of family planning use. Thus the effort went where it needed to go, and
appears to have been amongst the reasons for the high impact.
Although the CSP appears to have contributed to the health services meeting the demand for
contraceptives as discussed above, spacing between childbirths seems to have gotten worse, rather than
better since the baseline survey (84% at baseline and 77% at final). During Focus Group Discussions
with mothers for this evaluation, several mentioned issues such as unplanned pregnancies due to their
belief that they could not get pregnant during the months after delivery; that they are amenorrheic; that
23
mothers became pregnant when they thought they were following the LAM method of family planning;
women frequently forget the date for their follow-up Depo-Provera shot and might get pregnant as a
result. Essentially, as is the case in many parts of the world, the problems encountered related to child
spacing were due to human error rather than a specific intention to get pregnant again less than 24
months after the birth of a previous child. It was also clear from talking to mothers that they had not
heard specific advice with regard to the WHO recommended 3-5 year interval between births. When
asked, the mothers cited anywhere between 3 and 8 years. It seemed to be the general consensus that
because of the effort involved in child rearing, women should wait longer rather than a shorter number
of years. What was interesting was that when asked if this was practiced, most said no.
Successes
 Project HOPE has been an integral partner in the CBD program in Nicaragua and has
been recognized by the MOH for contributing to the large increase in use of family
planning in the department of Jinotega.
Lessons Learned
 The CSP learned that it’s crucial to ensure that the target population is informed about the
importance of the birth spacing interval for effective and optimal use of FP.
The ECMAC (CBD) strategy is already being promoted by the MOH and supported by NGOs in various
parts of the country. Its apparent success where it is being implemented and supported does encourage
scale-up, although there is a concern of contraceptive availability (particularly Depo-Provera) in the
future.
Pneumonia Case Management
Pneumonia Case Management Indicators B MTE FE KPC 80
Communities Target
1. % of children aged 0-23 months with cough and fast breathing
in the last two weeks taken to a health unit. 60% 55% 53% 30% 75%
2. % of mothers of children aged 0-23 months that can identify
fast breathing as a danger sign for pneumonia. 76% 78% 83% 90% 90%
For the pneumonia case management component, the project strategy was the promotion of the
PROCOSAN integrated child health promotion strategy at the community level which included a focus
on referral of the sick child identified during monthly growth monitoring sessions by community health
workers. As previously mentioned, because of the change from AIN to the above strategy,
implementation of integrated child health activities was delayed. As indicated in the above table, the
CSP did not achieve the targets of either of the two indicators. In fact, not unlike a few other indicators
previously discussed, the first indicator (care-seeking behavior) shows a decline through the life of the
program, rather than progress. The second indicator (identification of danger signs) does show slight
progress between the baseline, MTE and FE. Nevertheless, the program objective was not reached.
It is evident that a large number of mothers recognize danger signs of pneumonia (approximately 83%)
and, according to interviews; CHWs are also doing referrals as promoted by the CSP. During focus
24
group discussions with mothers in sample communities for the final evaluation, the team tried to
investigate reasons behind the fact that so many mothers do not seek care at the health facility. Among
the main reasons given were: the HF often doesn’t have medication and mothers are just given
prescriptions to go and fill elsewhere; mothers become familiar with the medications prescribed and so
are in a position to procure them on their own the next time without consultation. When asked about the
wisdom of self-medication, mothers mentioned that since they have become familiar with what is
prescribed, they don’t feel it is necessary to travel all the way to the HF and likely lose many hours
waiting to be attended. Health facility staff interviewed stated that they do have shortages of drugs at
times, and also do not carry certain medicines that help children with cough, such as expectorant, unless
the facility receives it as a donation. Health facilities do not tend to have problems with stock-outs of
antibiotics.
The KPC conducted in the 80 communities revealed that 90% of mothers interviewed identified fast
breathing as a danger sign for pneumonia, but only 30% had taken their child with cough and fast
breathing in the last two weeks to the health post.
Lessons Learned
 Issues of distance to health facilities, time spent there and availability of drugs, both
addressing symptoms in addition to antibiotic treatment, play an important role in care￾seeking and need to be addressed for one to see improvements in this indicator.
Refer to scaling up of the PROCOSAN strategy in the Nutrition and Micronutrient section.
HIV/AIDS
HIV/AIDS Indicators B MTE FE KPC 80
communities Target
1. % of mothers of children aged 0-23 months who know at least
one way to prevent STIs-HIV/AIDS. 6% 14% 20% 62% 15%
Key messages for HIV also reached community members through MOH radio programs that received
support from the project. The program realized at the time of the MTE that they did not need to expend
effort in this intervention and though it was not officially withdrawn, they did come to an agreement on
this with USAID. As indicated in the above table, the target under this intervention was almost met at
the time of the midterm, and surpassed by the time of the final.
The percentage of mothers that knew at least one way to prevent STIs/HIV-AIDS in the 80 intervention
communities was 62%, which was significantly higher than the results of the survey conducted in the
750 community sample.
25
Conclusion on Program Intervention Results
As discussed prior, the Maternal and Neonatal Care component was very successful. All targets were
reached and surpassed. This can be attributed to the fact that the MOH identified maternal mortality as a
priority and was ready to dedicate a significant level of effort to it. The project matched this with strong
support to the two main strategies, i.e. Life Saving Skills training and Birth Planning – both reported by
all to have been successful undertakings. The important result under the Nutrition and Micronutrients
component was the dramatic change in the area of child weight-for-age, which has been attributed to the
PROCOSAN activities, and food distribution. Interviews with mothers show that they are happy to have
these services at the community level and understand their importance. With regard to children weighed
at the community level, it is important for CHWs to be trained on how to record this on the child health
cards, which would allow for more accurate monitoring of Growth Monitoring coverage. Anemia still
remains a problem and more effort needs to be expended to assuring stock distribution to health posts,
follow up, and counseling of mothers compliance with regard to iron supplements provided to their
children. The breastfeeding component was not as successful as other components as neither of the two
objectives was reached. Nevertheless, the CSP made progress in the immediate breastfeeding indicator.
Contraceptive use can be considered a success as the project saw a dramatic increase in use of FP,
although spacing seems to have seen a reduction, so more work needs to be done to ensure the effective
use of FP. Again, measuring across the entire department makes it difficult for the project to understand
some of the KPC results. In the area of pneumonia, patient waiting time and drug supply seem to have a
strong influence on care-seeking. Mothers want such things as cough syrup and cold medicine which are
not part of the essential drugs regularly available at health posts. They will often look elsewhere for
these as they have been prescribed before. There is also self-medication for pneumonia. Efforts in the
area of immunization were generally successful although it is clear that there is still a dependence on the
national immunization days (NIDs) to assure coverage. HIV/AIDS was not a significant intervention
under this project.
New tools or Approaches; Operations Research/Special Studies
Please refer to previous comments on the project support for new tools and approaches (PROCOSAN,
CBD, Birth Planning strategies, manuals, guidelines and respective supervision tools).
A special study was conducted on the barriers as to use of the ORS corners. The main issues raised are
that of supply and lack of support and supervision from the health facilities. These activities were
mainly initiated by projects that have since closed and the MOH never formally took them over.
Although many mothers interviewed frequent the ORS corner (e.g. Wiwili which offers a variety of
different services), some mothers do not attend because they expect the ORS corner to provide
medicines or advise and thus choose to go directly to the Health Facility. The recommendation that
came out of this study is that to be successful the ORS corners: 1) need to ensure the continuous supply
of ORS packets; 2) need to provide others services such as FP and anti-malarias to attract clients; 3)
CHWs need more training and capacity building to be in a position to provide other services and health
information; 4) The ORS corners need to be developed so that they are comfortable and clients can be
well received. These results were shared with the project partners.
The project conducted a special study to look at the acceptance of exclusive breastfeeding. Interviews in
the community showed that mothers receive messages from different sources and on a relatively
continuous basis. The importance and benefits of immediate breastfeeding has also been well understood
and is widely practiced. Many mothers are able to talk about the benefits of immediate and exclusive
26
breastfeeding to the mother as well as the child. The main barriers to exclusive breastfeeding found in
the study seem to be related to the lack of assistance given to mothers when the child has difficulty
breastfeeding, and cultural and traditional ideas about what an infant needs in terms of food intake to
grow and develop. Again, these results were shared with project partners (MOH and community) so that
more effort could go into counseling and support.
A special study was also undertaken to understand barriers to care-seeking for pneumonia. The study
concluded that although mothers do seek help, they often go directly to the municipal health centers or
hospitals because they expect to get more there. Reasons for not seeking care were related to age of the
mother and lack of knowledge, cultural and family habits, and service provision (particularly perception
of lack of drugs) in health posts.
The above information was used to inform IEC/BCC activities at the community level.
3. Results: Cross-Cutting Approaches
a. Community Mobilization
The approach for community mobilization used by the Jinotega CSP was effective. This began with a
step by step process including meetings with community leaders and the existing CHW (Brigadista)
network whereby project staff and MOH partners proposed potential health activities and partnerships
with communities, and allowed time for community members to reflect and consult with each other
before continuing with the dialogue. As communities in Nicaragua have a long history of collaboration
with projects, developing this partnership and community participation did not pose a problem. Existing
CHWs, TBAs and community development committees were very happy to have the chance to improve
maternal and child health through the development of community based services, revitalize and
strengthen their relationship with the health facilities, and have the opportunity to build new skills and
capacity.
Another community mobilization strategy was the revitalization of the Health Councils at the SILAIS
and municipality levels. These bodies consisted of resource persons from NGOs, the Mayor’s office,
police, MOH, public services, and emergency services who took the responsibility to address requests
and complaints. The Health Councils were able to support initiatives such as radio campaigns/programs
and sanitation. CSP staff participated in these councils. Project efforts to participate in these councils
and help make these councils more active did face some challenges, i.e. council members attendance to
meetings not always regular (as these resource persons already had commitments), and responsibilities
including travel. In addition, the regular change in SILAIS directors who lead these councils (4
directors for the SILAIS of Jinotega in the period of 4 years) interrupted continuity and level of interest
and commitment. Change in some municipal directors also did the same, i.e. Bocay had a new director
almost every year, and El Cua also experienced changes. At this time there are only 3 of the 8
municipalities that have the same directors as they did at the beginning of the project.
A third effort in mobilization for health was targeting coffee plantation owners in the municipality of
Jinotega (where most of the plantations are located) as partners in the project. During the harvest season,
the coffee growers employ hundreds of workers from across the region and need to be able to provide
27
adequate health services for these workers. Forging linkages and collaboration between the MOH and
this private sector was something that the project facilitated through meetings and inclusion of their
health workers in CSP-supported training activities and integration in the MOH data collection and
referral system. A total of twenty-three coffee plantations (19 independent and 4 who are part of a
cooperative entitled, SOPEXCCA) agreed to collaborate with the project. Efforts at linkages with the
MOH Municipal headquarters have been relatively successful and collaboration is now established
whereby clients are being referred and transferred when necessary (usually with the MOH ambulance as
farm trucks are not the most adequate for the job). These health posts on the coffee plantations are also
submitting monthly reports to the MOH. Whenever possible, these health posts are also included in the
supervision visits by the MOH, although with the constraints that they are dealing with they have not
made a commitment in this regard. Coffee growers are committed to paying the salary of a trained health
worker, and to address the issue of access and availability to drugs have collaborated with the project on
a complementary drug revolving fund project which is also working well. In addition, the coffee
plantation owners are supportive of the dissemination of health information and education messages in
their communities by the trained health workers who work in collaboration with the CHWs.
The aim of the CM component of the CSP was to have communities partner in the effort to bring health
services closer to communities. By doing so, the project expected that MCH indicators would improve
(not easy to assess due to aforementioned issue of measuring across both direct and indirect beneficiary
populations). The CM objectives were indeed met. Interviews held in 9 sample communities during the
final evaluation confirmed that CHWs and TBAs were very active in terms of implementing the MOH
community based strategies of PROCOSAN, Plan de Part, o and ECMAC (Community Health and
Nutrition Program, Birth Planning and Community Based Distribution of family planning
contraceptives), and many have been community health volunteers for five, ten or more years. There has
been a problem of dropouts and volunteer de-motivation. The overall dropout rate is approximately 29%
(119 dropouts reported of 405 CHWs initially trained by the project), which is quite high. Some of this
has been due to migration, but volunteer burnout and need to focus on a job which brings in income
have been two other reasons given for drop outs. For the most part, it has not been difficult to replace
these volunteers. The trend has been to recruit new and younger CHWs, and those interviewed seem to
enjoy the work and the CHW status in the community.
With respect to the community health committees, the level of organization and participation varies.
Some of the community committees are involved with the local government office and have received
support to undertake small development activities; some have helped with census activities, NIDs or go
from neighborhood to neighborhood to let people know dates for health activities such as vaccination
and GM sessions. Many of these committees are more focused on emergency evacuation of cases than
anything else. The establishment of an emergency evacuation system is something that the CSP put
much of emphasis on, and virtually all communities that have been participating in the Birth Plan
strategy have a committee in place and on call to evacuate mothers in obstetric emergencies or any other
type of emergency. Many groups, per guidance from the project, had mobilized resources in the
community to collect small funds to help cover transportation and other expenses in the case of an
evacuation. In some cases, funds were no longer available because money collected had not been
replenished. One community reported that the family who had benefited from evacuation did not
reimburse the community fund and for this reason people are now reluctant to make a second
contribution.
28
The community leadership in terms of health does seem to rest with the CHWs, who are also part of the
community committee, and often head the committee. The strength of the CHW system in place is that a
community does not have just one or two volunteers, but rather three or four. This is rather different
from most countries, and is a tremendous benefit in terms of spreading the responsibility and weight of
the work, sharing and support, and sustainability because when one person drops out, there are others
who can also help identify new volunteers and orient them with the work that needs to be done.
At this end point in the CSP, both the CHWs and the TBAs have a new and improved relationship with
MOH health providers. Every health facility in the department holds monthly or bi-monthly meetings
with these community resource persons. Some facilities have even invited TBAs to come and deliver
babies in the health facility (as a way to encourage deliveries at health facilities). TBAs are also very
happy with their new skills and knowledge, and very much enjoy the recognition being given to them by
the MOH personnel. Based on interviews with project staff, community members as well as health
providers, it is clear that the communication, linkages, and referrals between the health facilities and
communities have become strong as a result of the project.
Another challenge worth mentioning is the fact that with the staff rotation at the health center and health
post levels, the community resource people need to get acquainted with the new doctors and nurses
(serving their annual social service requirement) who are not familiar with the collaboration between
the community and the health facility. A CHW or TBA dealing with someone who has not been oriented
by the existing staff or the municipal educator or trainer may not be well received or the provider may
have an attitude about referrals coming from the community. This may delay future community
mobilization activities as well as program implementation.
Lessons learned
The project learned in order to cope with high CHW drop out rates it is important to invest the time
necessary for communities to ‘buy in’ to the idea of community participation and mobilization, and
participate in establishing the criteria and choice of community volunteers. In the case of Jinotega (and
Nicaragua in general) the Brigadistas already existed but many had to be replaced over the project years.
Thus it was important for the project to help the community understand the responsibilities and activities
expected of brigadistas at the community level. There is certainly clear demand in program communities
for activities to continue, as measured through discussions held during the final evaluation. In interviews
at the community level, community mothers stated it is rare for a mother not to attend the GM and
vaccination sessions. Mothers appreciate having the services close to home because it saves them having
to go all the way to the health facility. Mothers demonstrated their knowledge of health components
when asked questions, confirming the fact that they had also been attending health talks and getting
advice from volunteers and health workers during the project period. Health care-seeking behavior
overall in groups interviewed seemed quite good; notably better than is reflected in the KPC results
whose sampling included the entire department of Jinotega and not just the 80 direct program
communities.
The CSP strategy was geared towards sustainability from the very beginning as they did not work in
isolation, but rather with the MOH in this community partnership. Brigadistas (CHWs) have existed in
Nicaragua for a long time, although the degree to which they function and are active depends on the
kind of support and supervision that they receive and their degree of personal motivation and
availability.
29
Monthly or bi-monthly meetings initiated by the CSP continue to take place in each of the health
facilities without the financial support of the project. Although some disappointment and concern has
been registered regarding the termination of financial support by Project HOPE, these meetings have
been ongoing and are reportedly well attended. The meetings do serve to motivate the CHWs and TBAs,
as the Community Based Health Information reports (SICO) that they submit every month reflect the
amount of work they have done during the month, i.e. number of referrals, home visits, health talks,
children weighed etc. The CHWs are happy to discuss issues during meetings, have a close relationship
with the health facility, and are recognized for their work. As the MOH strategies supported by the CSP
are now priorities and very much community based (PROCOSAN, Plan de Parto and ECMAC), MOH
health facility staff is in fact obliged to maintain contact with communities even if there are constraints
to supervising all of their monthly activities. HF monthly reports include information from the
community level, and thus service providers try to at least maintain the monthly meetings so that they
can include this data in their reports. These meetings benefit all involved and are an indication of an
activity that will be sustained after the project ends.
There is no doubt that the MOH will encounter challenges with regard to maintaining the level of
supervision of community activities given staff shortages and logistical problems. As motivation of
CHWs is an important issue, receiving less support, lack of small ‘motivational gifts’ such as t-shirts and
caps, boots or bags, distance to health facilities, and not receiving transportation money or refreshments
when attending meetings, is likely to contribute to continued CHW dropout or reduced attendance at the
HF monthly/bi-monthly meetings. Fortunately, not all communities are dealing with great distances to
health facilities and health providers and seem to be managing to visit many of the communities about
once every two months. In interviews with staff across the eight municipalities of Jinotega, most
mentioned that there are one or two communities that they would have trouble reaching without the help
of the CSP staff. They also mentioned that even with the communities not as hard to reach, unless they
were able to get rides from other NGO partners for example in the area, they are now going to be
dealing with increased walking time (up to two hours in some cases).
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Conclusions
Community mobilization was a success in terms of revitalizing the role of CHWs, TBAs and cementing
their relationship with the health facilities. With the establishment of linkages between health facilities
and communities at this point, it will be easier for community-based activities to continue at the end of
the project. These community resource persons are empowered, but have complained about health
providers not always keeping appointments and commitments. They have legitimate concerns about the
degree of support they will continue to receive from the MOH after the project ends and how that will
affect their activities. PROCOSAN activities are more fulfilling when the health provider can be present
to do immunizations and when micronutrients and other supplies are brought to the community.
b. Communication for Behavior Change
There were a couple of approaches used by the project to promote behavior change in the target
population - primarily mothers of children. The first was information, education, and counseling through
CHWs, health facility workers, and CSP project Educators. This was done at the community level
during monthly Growth Monitoring and vaccination sessions and health talks; at the household level
when following up a problem case; and at the HF level during case-management. The second area of
effort went into the development of a colorful and low literacy friendly maternal health poster, a birth
plan booklet (illustrating options for couples to choose and commit to), a child health flip chart and
mother reminder materials (known locally as recordatorios which are mini-posters with illustrations for
bf, child feeding, etc). Mothers are given the latter to take home to help them remember and follow the
advice given regarding their child’s weight and health status at the time of the GM session.
The combined strategies appear to have been very effective, although they are more clearly
demonstrated in the quantitative KPC results of the maternal health component than some of the other
components such as breastfeeding, CDD and Pneumonia Case Management. The qualitative data
obtained specifically in project communities (verses communities with no direct support from the
project) did show good levels of knowledge and relatively good health behavior.
Although the project has not studied the effectiveness and impact of the mother reminder materials if
affordable (please refer to recommendations section of report with regard to this), or if Ministries and
programs are able to reduce the costs by using simple black and white versions of these types of
illustration that guide mothers’ health behaviors, it is clearly a brilliant way to help mothers of every
educational level to understand, improve and manage their child’s health.
For behavior change objectives, please refer to the discussion above, including the comments on the
qualitative interviews with mothers, and the behavior change indicator results. A continued relationship
with the health facility will help to encourage CHWs and TBAs to continue their health promotion
efforts, along with the identification, referral, and follow-up of cases.
One measurement of BCC interventions was through the KPC indicators. In view of the fact that the
KPC survey covered a sample of communities from the entire department and not just from intervention
communities, it is difficult to use the KPC results alone to evaluate the impact of BCC interventions.
The complementary qualitative interviews with mothers in a sample of program communities did help to
provide a good idea of program impact.
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Conclusions
It is clear from certain KPC indicators, as well as qualitative interviews conducted in communities, that
the project has positively influenced health behavior. Working at both the health facility level and the
community level appear to be the key as mothers mention both as sources of information and advice.
Communication messages via the radio also appeared to have had an impact and the use of educational
materials (reminders and birth plans) also reportedly helped reinforce behavior change. The multiple
approaches to achieving behavior change seem to have improved the knowledge of mothers in the
project intervention areas.
c. Capacity Building Approach
i. Strengthening the PVO Organization
The implementation of the Nicaragua Child Survival Project produced many “lessons learned” that
strengthened the capacity of Project HOPE during the life of the project and will allow Project HOPE to
continue to improve its ability to design, implement, and evaluate effective child survival projects or
interventions in the future. These lessons include:
 Although there may be numerous health problems in the target area, to be
effective a project should only focus on a few of these problems. A project that
tries to work on multiple interventions reduces the likelihood of having a major
impact.
 Process indicators need to be articulated in the logical framework as they are
essential to project design and implementation. The monitoring system needs to
track process indicators as well as outcome indicators from the beginning.
 Personnel changes in the technical backstopping role can have a detrimental
impact on program implementation and management.
 At HQ, monthly meetings between Assistant Regional Director, the Technical
Advisor, and the International Accounts Manager should be routine to facilitate
monitoring of project expenditures.
 Institutional strengthening of the MOH is not best measured by the current CS
indicators of caregiver behavior change. Other indicators need to be developed.
The project should only have one group of targeted communities. Designating
communities as direct and indirect communities is confusing for project staff, the
MOH, and the communities, and does not increase program impact.
 Based on project experience with running short of funds, Project HOPE realizes
that it is important to find an efficient way of consolidating expenditures from the
field and HQ to monitor CS budgets.
These lessons have already been incorporated into the design and management of other Child Survival
and MCH projects being implemented by Project HOPE.
In terms of field operations in Nicaragua, this grant very clearly built the capacity of the country
team/staff. Although the Nicaragua Country Director, Project Manager, and technical advisors were all
seasoned Project HOPE staff, the Jinotega CSP gave them the opportunity to take some of those lessons
learned from Boaco and Chontal provinces (Central and Central South-East of Nicaragua) and
32
essentially scale up that experience; combining it with some of the strategies coming from the
Guatemala CSP. The Nicaragua team (including the 9 Educators who worked with the project over the
course of the last 5 years) had the opportunity to build on their skills as trainers and facilitators, notably
in the area of participatory learning. This project gave the technical advisors the opportunity to get
involved and support MOH and NGO trainings at the national level and work in the area of training
manual/curriculum development. Thus Project HOPE Nicaragua has continued to develop their
institutional strength in the area of training and is seen as leaders and resource persons by the MOH￾SILAIS. The CSP has also had an effect on the field team’s capacity in MCH program strategy
development, and has provided them with skills on the development of behavior change educational
materials and key messages, skills in partnering, collaboration, community mobilization, quantitative
research and analysis and monitoring and evaluation among other things.
ii. Strengthening Local Partner Organizations
In year two of the CSP, Project HOPE was assisted by CSTS to develop a Sustainability Framework. As
part of that process, assessments (via interview) were done with community health committees,
community volunteers, representatives from coffee plantations, and government partners, including
representatives from the department level and Municipal Health Center of Jinotega.
The assessment with the local government partner revealed several issues identified as areas of concern.
These include: a need to sensitize staff implementing the community based strategies; not enough
funding to cover all the needs in the area of training, materials, referral, and community mobilization;
supervision of HFs is not supportive, but rather negative; poor treatment of clients by MOH staff is
frequent and client does not receive explanation or information about the child’s health condition; the
MOH was not managing and coordinating the different NGOs working with the health strategies;
communication between the HF and communities was inadequate, there is little to no supervision of
community work; HFs break their appointments and commitments with the community and often don’t
come with everything needed to do the job; and the MOH staff is not motivated due to low salaries.
With the support of Leo Ryan from CSTS, the project and local partners engaged in a process of
visioning and planning strategically (including the development of action steps) to improve the situation
through building community and partner capacity to maintain healthy outcomes.
Assessments for health facility services have been done primarily through the AMAS evaluation system
(the results of which are discussed in the Health Facility Strengthening section). As much of capacity
building was focused on quality of services and the development, supervision, monitoring and
evaluation of community based health services, this is where the focus of assessments (via supervision
visits) and evaluations has been.
Although the local MOH is still dealing with challenges related to human resource shortages and
financial limitations, all MOH staff and facility health workers report that their capacity has increased
with the support of the project. MOH staff specified the following health strategies (including
community based) as areas of change: HIS and computer skills; basic management and administration;
and quality assurance. These project partners have attributed these changes to trainings that they have
benefited from. They also recognized and acknowledged the technical support and assistance of the
project staff through the monthly/bi-monthly meetings with community resource persons and in
33
planning meetings. Monitoring and evaluation activities have also been mentioned as capacity building
for the MOH staff.
Lessons Learned
One of the challenges encountered with working with the government of Nicaragua was the frequent
changes in policy, sometimes depending on change in MOH leadership at central or provincial level.
The CSP learned that it was necessary to be prepared to deal with these kinds of changes and to be
flexible as program partners.
Best Practice
NGO integration in government services such that they support the development, strengthening
and implementation of MOH strategies, including community linkages, for sustainable health
programming and results.
Conclusions
The project succeeded in helping the MOH in the areas of management and implementation of their
strategies, and worked with them to find solutions to the aforementioned challenges, i.e. training a cadre
of facilitators in the department used as resources to train new staff.
iii. Health Facilities Strengthening
The approach used to achieve improved management and services in health facilities was training,
supervision, support and evaluation. This intervention began with assistance from the Child Survival
Technical Support (CSTS) team, who used the Sustainability Framework to help the CSP Jinotega team
and partners identify areas of need within the MOH. Key activities supported by the project included
department and municipal staff participation in a Total Quality Assurance course over the period of a
year; nurses, doctors, and health facility workers training in the local version of IMCI (Atencion Integral
al Nino) and maternal health (Atencion Integral a la Mujer), PROCOSAN, Plan de Parto and ECMAC.
Please refer to the training table below.
With regard to service provision, there are challenges related to staff shortages, staff turnover (new
social services doctors every year), and financial and logistical resources. A relatively new health
services evaluation tool, AMAS (Abordaje del Mejoramiento de la Atencion en Salud), initiated in 2006
showed scores for quality of service provision in the 8 municipalities of the department of Jinotega,
ranging between 64 and 97 out of 100. Four of the municipalities scored between 80 and 86, and 3
scored between 64 and 68. The municipality of Concordia stands out with 97, and according to the
supervisor the influencing factor is team work and organization. With regard to health worker efforts to
reach communities with services and support to community volunteers, the scores ranged from 72 to 95.
Again, the municipality of Concordia had the high score, while four municipalities scored between 72
and 77, one scored 85, and the municipality of Pantasma had a low 54. The latter may have been due to
frequent staff changes and changes in municipal leadership. With regard to Quality Improvement, the
municipality of Pantasma was given a score of zero, Jinotega actually scored a low 41, three
municipalities scored between 70 and 73, and two scored 80 and 85. There were no specific indicators
outlined for the above.
34
One activity that the CSP promoted was public acknowledgement of health facilities that made progress
and did well. Each month, one health facility would win the ‘facility of the month’ label and receive a
flag that was set up in front of the facility. The project sponsored a lunch for the staff of the winning
facility and this was very good for staff morale and helped to stimulate the spirit of competition between
health facilities in terms of improving quality of care.
It should be noted that the Project HOPE country office in Nicaragua made a concerted effort in the area
of resource mobilization and were able to obtain support from the Japanese Embassy to renovate and
expand the Municipal health center in El Cua. The Japanese embassy also supported the construction of
a Maternity Home and funded equipment and supplies that were instrumental in improving health
services in the project area.
The CSP supported the implementation of the AMAS participatory evaluation for quality of services.
AMAS is a set of tools that are to be used bi-annually to review every aspect of services including
infrastructure, equipment, service provision, quality improvement, community outreach, HIS, and
planning, among other things. An operational plan is developed as a result of the AMAS to deal with the
deficiencies which includes the participation of the supervisor from the department level. The use of this
monitoring and evaluation tool is an opportunity to support changes in health worker attitude and level
of commitment for improved services. In principal, this tool is very effective for measuring change.
Unfortunately, because these tools were not used in a consistent manner, it was not possible to compare
results from different years.
Lessons Learned
1. With regard to improvement in MOH health services, one lesson learned in the project
experience is that relationship-building and true partnership is the key to making progress
and achieving goals. During the life of the project, Project HOPE was held in very high
esteem by the MOH and was in a position to influence and have an impact on MOH
strategies, quality of care, and community outreach. This happened because: 1) the CSP
staff devoted their efforts to supporting the MOH in their areas of priority needs; 2) the
project leadership and staff were flexible, available and engaged when it came to
initiating and supporting health strategies for the department of Jinotega; 3) project
management was resourceful and made efforts to mobilize financial and technical
resources and link to other donors and institutions to meet identified needs.
2. A second lesson learned noted by a Municipality Director is that when conducting
evaluations and problem solving with health facilities, it is important to have some funds
available to support solutions identified. When this is not the case, staff becomes
discouraged and do not want to use the tools. In other words, the health facility staff
identified a laundry list of problems but is not in a position to correct them.
As all activities were done in conjunction with the MOH and focused on MOH strategies to be
implemented by their staff, the plans are for the MOH to continue their work even when the project
support is no longer available.
In terms of whether or not these plans are realistic per the constraints already mentioned, there will be
challenges to the MOH being able to maintain activities at the current level. With some effort and
35
resource mobilization, the MOH should be able to continue with the implementation of strategies and
use of monitoring/evaluation tools and HIS systems strengthened by the project to ensure that health
facilities are providing quality services.
As previously mentioned, linkages between health facilities and communities have been strengthened by
the CSP. At the start-up of the project existing CHWs, mainly created and trained by NGO projects in
the past, did not have a close relationship with the health facilities. At the end point in the project, they
met regularly either when CHWs submit their monthly reports, when there are monthly/bimonthly
meetings and trainings, when the providers come to the community to support community based
services (growth monitoring and vaccination), and sometimes when cases are referred or follow-up.
Conclusions
Please refer to comments in previous two sections.
iv. Strengthening Health Worker Performance
The below is a table summarizing the number of training events organized and supported by the project
for both health workers and community volunteers. The training and capacity building component
covered the entire province of Jinotega, and thus included all the health workers. At the community
level, the focus was mainly on the 80 targeted communities although the others did receive some
technical updates through initial meetings that they were invited to participate in.
CSP Jinotega Y1 Y2 Y3 Y4 Y5 Total
Health Personnel # Trained
Doctors 28 61 60 25 26 200
Nurses 26 80 114 77 19 316
Educators 6 10 9 18 20 63
Dentist 1 1 1 1
4
Others MINSA 7 12 19
Total (annual and LOE) 61 152 191 121 77 602
Community Resource Persons/Volunteers
CHWs 44 83 95 74 62 358
TBAs 14 25 30 31 100
Community Committee 117 274 313 78 2
784
CBD Agents 28 52 60 47 187
Total (annual and Life of Project) 203 434 498 199 95 1429
Training in health technical areas
Integrated Community-based Growth Monitoring 44 120 95 70 19 348
Integrated Community-based Growth Monitoring
(morbidity and early childhood development) 0 0 0 93 9 102
36
Birth Planning 117 274 481 78 116 1066
Life Saving Skills (facility based) 11 0 0 32 4 47
Life Saving Skills (community) 14 26 30 0 23 93
Family Planning (CBD facility role) 23 20 10 0 0 53
Family Planning (CBD community) 28 52 60 47 0 187
IMCI 27 95 13 0 0 135
Total (annual and LOE) 264 587 689 320 171 2031
Note: Health personnel trained of Municipal Trainers/Facilitators were the following:
Year 1: 24; Year 2: 20; Year 3: 24; and Year 4: 21.
Please refer to the previous section on effectiveness of strengthening health facility services which
overlaps with health worker performance in this project.
Per the discussions and interviews during the Final Evaluation, it was noted that challenges such as
patient load, staff shortages, and others previously mentioned sometimes limit staff abilities to perform
at the optimum level. Waiting time for clients is still long and has an impact on the use of services when
mothers consider their options. Staff in health posts have to prioritize (i.e. sick child services and
prenatal care are first priorities; women who have come from far might also be prioritized over those
living close by) and sometimes must turn clients away for that day. In one interview, men in the
community committee stated that they felt that even in the case of a serious injury or illness, they, as
men, are not considered at all because they aren’t in the priority group and this puts them at risk.
The AMAS 2006 scores, which reflect health worker and health facility performance, are mentioned
above. In terms of the CSP, the project did not have specific objectives for health worker performance
but the project did extremely well in establishing training objectives. Please see training section.
In terms of strengthening skills of community providers (particularly TBAs), interviews at the
community level, with health providers and with staff confirm that TBAs do work very closely with the
health system now, encouraging women to attend prenatal consultations, paying attention to danger
signs during pregnancy and delivery, and educating women on this, referring cases more readily and call
upon the emergency evacuation committee if need be, and in some cases even attending to their clients
at the health facilities with the blessing of the health worker. Although CHWs are referring cases to the
health facilities every month, their skills still need to be strengthened. For example, CHWs have not yet
received training in the management of childhood illness. They also need training on counseling and
behavior change communication skills.
The plan for sustaining health behaviors is related to health systems strengthening, community
mobilization, and capacity building of community volunteers and MOH personnel. At the departmental
level, the project worked within the existing system and supported strengthening of MCH strategies,
treatment protocols, training capacity, use of supervision, monitoring and evaluation tools for problem
identification and problem solving. The project also helped to plan and implement workshops in areas of
management and administration. At the municipal level, the project also worked in most of the prior
mentioned areas, specifically with the Municipal Directors, Educators, Trainers and the person
37
responsible for MCH. Strengthening management capacity, technical capacity and supporting the use of
supervision, monitoring and evaluation tools is expected to contribute to sustaining the performance of
health facility workers and quality of care received by clients. The monitoring of community health
information by the MOH will also continue to encourage community linkages and community based
health services.
The challenges to sustaining the above are real, as previously mentioned. There are issues of staff
shortages, logistical constraints, and disinterest on the part of some of the short term social services
doctors and nurses. Community volunteer de-motivation and drop-out is also a real threat, mainly due to
migration, lack of remuneration, support, and supervision. Certainly the project has revitalized health
services and health workers at every level and with some of the current new efforts in the areas of
monthly meetings between community volunteers and health providers, community referrals, data
analysis, and use of information for decision-making, monitoring and evaluation for quality of care, it is
expected that most of what the project promoted will continue to be implemented, as these are MOH￾SILAIS priorities.
In addition to the use of monitoring and evaluation tools to maintain health worker performance, it is
important to note that the municipalities in Jinotega do consider staff training as a routine activity. Some
of the municipal health centers include hours of training in their weekly and monthly activities, as they
are continuously dealing with new social services staff. Due to MOH budgetary constraints, some
training activities that require staff to leave their post and go to the municipal or department
headquarters may be difficult to implement without additional resources from NGOs or the central
MOH.
In addition to the AMAS tool which measures overall performance of health facilities and their workers,
each strategy (PROCOSAN, ECMAC and PPMS) has a supervisory checklist (or indicators) which
allow managers and supervisors to monitor and evaluate performance with regard to those strategies.
Use of these tools by project supervisors has shown progress and improvement, and that they are
sensitive enough to measure change.
Gaps are identified during supervision and evaluation activities and discussed at that time and during
staff meetings which take place weekly and monthly. The CSP helped the MOH address some of these
gaps through trainings, continuous support of health facilities in the area of administration and logistics,
as well as support and participation in the implementation of supervision, monitoring and evaluation
tools.
38
Conclusions
Please refer to section on changes in organizational capacity as it relates to staff skills
and performance.
v. Training
Training and capacity building was a large part of the Jinotega CSP. Training for health facility
strengthening and performance improvement have been discussed above. All training was aimed at
achieving the latter two objectives.
Initially the project had envisaged creating training facilitators in each municipality, along with some at
the SILAIS level to take care of the training needs in each municipality. It subsequently became clear
that all trained facilitators needed to be considered as resource persons for the whole department due to
the extent of staff turnover, thus making use of this philosophy the program was better able to handle the
ongoing training needs in multiple municipalities every year.
The program adopted a participatory learning methodology that proved to be extremely popular and
successful (previously highlighted in the MTE report and also noted under Results highlights in this
report). The methodology used in this approach is called AMATE in Spanish and consists of five
components: Animation (‘Liveliness’)—getting the audience prepared and interested in learning;
Motivation—stimulating the curiosity of the audience, introducing the topic and finding out what the
audience already knows; Appropriation—testing what the audience knows and challenging assumptions
through exchange of knowledge, ideas, experiences and the introduction of new information and
constructing/incorporating the new ideas/ knowledge; Transference—applying the theory to practical
situations, working with new knowledge and skills creatively; and Evaluation—demonstrating the
integration and connection of new knowledge and skills as evidenced by the results (products) created.
IDRE is a simplified version for shorter training sessions and includes the steps of Introduction;
Development of the topic; Reflection on use of the new information; and Evaluation.
A Regional Education Advisor from Project HOPE (US) was hired specifically to support training and
started by training 12 Project HOPE Nicaragua and 4 SILAIS staff. Subsequently an additional 12 MOH
staff were trained in this methodology, 4 staff from CARE, 10 from ADRA and 10 more from the
SILAIS in Jinotega.
Training Objective/ Indicator Number Achieved
Trainers/facilitators for PROCOSAN (child health strategy)
achieving 80% at post-test
43/43 100%
Facilitators for ECMAC (CBD for FP strategy) achieving 80% at
post-test
18/19 95%
Facilitators in the PPMS (Birth Planning Maternal Health
strategy) achieving 80% at post-test
18/19 95%
Facilitators in Life Saving Skills training achieving 80% at post-test 36/37 97%
Health personnel trained in PROCOSAN who achieved 80% at post￾Test
36/37 97%
Health personnel trained in CBD programming who achieved 80% 55/69 80%
39
at post-test
Health personnel trained in Birth Planning who achieved 80% at
post- test
117/212 55%
Health personnel trained in Life Saving Skills who achieved 80% at
post-test
4/14 29%
CHWs trained in PROCOSAN who achieved 70% at post- test 282/296 95%
TBAs trained Life Saving Skills who achieved 65% at post- test 88/93 95%
Community resource persons/volunteers trained in Birth Planning who
achieved 70% at post test
759/782 97%
Community volunteers trained as CBD agents who achieved 70% at
post test
155/187 83%
Per the above table, most of the training indicators saw extremely good results (between 95 and 100%).
Two indicators were slightly less successful at 80%, 83%, and another at 55%, while a third indicator
had limited success at only 29%. The latter is explained by the fact that the MOH decided to train only
in 3 municipalities rather than all eight. The idea of the MOH was that the people trained would then
train the individuals in the other 5 municipalities. The individuals were trained as trainers of TBAs.
Although MOH staff interviewed stated that the trainings have helped them do their jobs better, this has
also been demonstrated through evaluation reports and supervision reports. Unfortunately, the AMAS
evaluations done in previous years did not produce clear information, but certainly the relatively positive
results in 2006 seem to indicate that health facilities overall are functioning reasonably well.
Best Practice
The participatory training methodology AMATE/IDRE used by the project is considered a best practice
because it has been such a tremendous success and has contributed to trainee learning and skills building
at all levels.
Lessons Learned
The project realized from the very beginning that they needed to develop a cadre of facilitators in each
municipality to ensure the continuation of training activities within the municipality. With the high
turnover of staff, they learned that they needed to take this a step further and promote all facilitators as
resources for the whole department, i.e. training facilitators in one municipality conduct trainings in
other municipalities to help cover those needs. This strategy helped to address the non-stop training
needs across the department of Jinotega.
Please refer to the discussion above on sustaining health worker performance (through training).
Conclusions
The AMATE/IDRE training strategy was an activity that was valued by both the staff as well as all
program partners. It has reportedly made training fun, very participatory, and facilitated easy absorption
of information and adoption of new skills by participants at both the facility as well as the community
levels.
40
d. Sustainability Strategy
Although the project strategy was clearly aimed at sustainability, there were no sustainability goals and
objectives articulated in the DIP. This was rectified after the MTE per the following table:
Sustainability Objectives
MOH Achieved
1. Organize and/or strengthen the departmental council of health and
municipal committees of health and development.
This was not found to be
necessary after all as it was
already in place at time of project.
2. Promote coordination through the signing of collaboration agreements
between MINSA, Coffee Plantation owners and other NGOs.
No formal agreement was deemed
necessary. Collaboration was
established.
3. Develop participative processes of Annual Operative Planning in each
of the municipalities in which the main members of the project are
involved.
Project participated and
contributed to these activities.
4. Promote coordination between MINSA’s Information System and
the information system of the coffee growers and other providers.
Done. Information is sent from
coffee areas to municipal
headquarters monthly.
Strengthen the management capacity of municipal health department. Training on adult education
(including issues around the
management of health staff)
conducted.
Coffee Plantations
5. SILAIS and other project members plan and conduct health
campaigns in the Coffee Plantations according to MINSA’s norms and
protocols.
Done.
6. Owners or Plantation Managers, municipal health directors and
personnel meet, at the least on a quarterly basis, to discuss health
issues on the plantations and to design forms of support for the actions
that must be carried out.
Support given during harvest and
planting periods.
7. Communities organized to maintain and promote both health
prevention activities and an emergency obstetric transportation
committee.
Training undertaken for health
providers in the coffee
plantations. Good support from
MOH but MOH unable to
maintain consistent supervision of
plantations or provide equipment.
As part of the phase over plan the project reduced some of the support they were giving with such things
as refreshments for monthly/bimonthly meetings between the MOH and community resource persons,
transportation for those coming from long distances, office materials, and photocopies for the MOH
41
counterparts in the SILAIS and Municipalities. During this past year, two of the four project vehicles
were returned to the office of Managua as part of the process of reducing project expenditures and
commitments. These events have made the upcoming transition more real in the eyes of the MOH.
Discussions and plans to finalize the phase-over started in February of 2007. In addition to those
activities listed previously, the project has conducted the following: transfer of information and
documentation on each community directly supported by the project to the health facility and
municipality concerned, transfer of all the tools used by the project (some were adaptations of existing
MOH tools), support of MOH to complete training for new MOH staff in the department, analysis of
KPC final results with Municipal Directors, health facility In-charges, and communities, and the formal
announcement of project close-out to local health authorities.
The FamiSalud Project will continue to provide some technical and management assistance to the MOH
through September 2008. Several of the NicaSalud NGOs located in Jinotega have also received funding
under the FamiSalud project including PCI, CRS, and Wisconsin Partners for the Americas. These
organizations will continue to collaborate with each other and the MOH to cover as many communities
as possible. They will continue supporting the MOH strategies discussed in this report and use the tools
and educational material developed during the CSP.
Efforts to build financial sustainability include the development of the public-private partnership with
the coffee growers. During the harvest season, the coffee growers employ hundreds of workers from
across the region. Having understood the cost-benefit of improving health services for these workers, a
group of plantation owners (19 independent and 4 who are part of a consortium by the name of
SOPEXCCA) agreed to collaborate with the project. The coffee growers agreed to hire qualified health
staff (nurses), and these individuals have participated in project training activities. Linkages with the
MOH Municipal headquarters were also established and a collaborative relationship has now developed
whereby clients are being referred and transferred when necessary (usually with the MOH ambulance).
These health posts are also submitting monthly reports to the MOH. Whenever possible, these health
posts are also included in the supervision visits by the MOH, although, with the constraints that the
MOH is dealing with, they have not made a long term commitment in this regard. Coffee growers are
committed to paying the salary of a trained health worker, and to address the issue of access and
availability to drugs. They have collaborated with the project on a drug revolving fund project as well.
A second example of efforts at building financial sustainability is the community management of the
WanBlan Maternity Home. Please refer to discussions under Maternal Newborn Care. The MOH at the
central level has also received a World Bank loan to support training in health promotion, which will
facilitate the ability of the MOH to support some of these activities. One challenge to financial
sustainability of services and health activities is the policy of the new government not to charge patients
for health care (i.e. cost-sharing and cost-recovery). Although decentralization has been encouraged and
municipalities are often left to manage their problems with limited resources, it is not possible for them
or any project to support these kinds of initiatives within the MOH system with the current restriction.
The program has built demand for services through the promotion of the MOH community based
services PROCOSAN, ECMAC and Birth Planning, and the training and skills building of community
health resource persons, mainly CHWs and TBAs. The health committees have become very engaged in
such issues as emergency evacuation of maternity cases, and as this initiative was developed with the
collaboration of health providers, health committees do expect a prompt response and support with this
42
initiative. Committees and CHWs have also been involved in census activities, support for NIDs in
terms of community mobilization and awareness of the activities, and involved in scheduling, organizing
and implementing the PROCOSAN growth monitoring activities. As the latter initiative was developed
with the CSP, CHWs have had the opportunity to develop a closer relationship with the health facilities
and now have expectations that they did not have before. These expectations include continued
relationship with health personnel, feedback from their monthly reports, supervision and support during
community based activities. TBAs received Life Saving Skills training under this project and likewise,
have a much closer relationship and collaboration with health workers. They communicate regularly as
cases are being referred and with counter referral as well. With the Birth Planning strategy, TBAs are
key players and have become much more involved in the health, identification of risks, and preparations
for pregnant mothers. This also brings a new element of collaboration and demand for services.
It should be noted that many community committees whose membership include CHWs and TBAs are
still in need of a lot of capacity-building in the area of health and empowerment. Although these
community committees are supporting health activities in their communities, and CHWs/TBAs
communicate with the health facilities on a regular basis, these entities are still very dependent on the
leadership of the project and the MOH when it comes to initiating health activities or solving problems.
There is more of a tendency to wait for direction, and uncertainty in some areas about whether or not the
MOH will continue to meet their commitments when the CSP is no longer around for support. The
systems put in place for community engagement during the CSP (implementing and reporting on
community activities, monthly meetings with health facilities and referrals) are all expected to continue
influencing how services are delivered.
Please refer to previous discussions on project’s support of MOH strategies and challenges that MOH is
still dealing with, i.e. without the project’s support, it is difficult for these health providers to reach
communities that are very far. Individuals interviewed foresee that the project will indeed leave a void
when it comes to a close, and that the MOH will find it challenging to reaching some of the more distant
communities in their catchment areas.
Conclusions
All the steps towards sustainable programming were taken by the project. It is clear that this will bode
well for the sustainability of some of the activities supported and facilitated by the CSP. The challenges
that the MOH deal with on a daily basis are real, and these will very likely affect the timeliness and
quality of support given by health facilities for community based services and the quality of services at
the health facility as well.
C. Program Management
1. Planning
Program planning for this project was inclusive right from the time of the project design, with Project
HOPE staff consulting at the SILAIS and Municipality levels on where program efforts should be placed
and what the needs were. This continued in the development of the DIP where meetings were held with
CSP project partners as well. The effect of this collaboration for the CSP was that the principal partner,
the MOH, really felt that Project HOPE worked alongside them in their efforts to improve maternal and
child health in the department. In interviews with the MOH at management levels and at the health post
43
levels, staff said that this had really been a model partnership because the project focused on supporting
them in developing and implementing MOH strategies, and everything the project did in terms of
developing and organizing training opportunities, supporting supervision and evaluation, supporting
community partnership and linkages efforts was discussed and coordinated with them first (the SILAIS
office is one block from the CSP office, and the project health educators assigned to each municipality
always stop in at the Municipal Health Center headquarters while working in the municipality).
The CSP Jinotega DIP was quite ambitious, in that there were plans to do many different things and
mobilize resources to complement the CSP from different sources. The plan to measure changes in
knowledge, attitudes, practices, and coverage of the entire department consisting of approximately 750
communities was not a practical one. Even if the project had been able to leverage other funding to
support additional communities, it would have been very difficult to have a strong impact across such a
large area. The project limited direct support to 80 communities, and hoped to influence others through
periodic support of community resource persons coming from those areas.
Based on program experience, it is clear that it would have been beneficial to have more support and
review in the area of M&E. Although Project HOPE did have an M&E specialist at headquarters, it
appears that his participation, and that of the technical backstop at the time of the DIP development and
review was inadequate because: 1) the above commitment to measuring the KPC across the entire
department was one issue that should have been weighed more carefully, and a commitment of this kind
from the project should not have been made; 2) the development of capacity building and sustainability
indicators seems to have been overlooked despite the fact that these were the fundamental strategies of
the CSP.
The two largest gaps in the DIP were lack of capacity building and sustainability indicators. No
other gaps were identified.
2. Staff Training
Knowledge, skills, and competencies of the program staff have grown tremendously over the course of
the project. Project Advisors and Educators were able to participate in different types of training
workshops and increased their capacity in maternal and child health technical areas, as well as in
participatory training methodology. The following is a list of workshops that they were able to benefit
from:
1. AMATE / IDRE
2. Training Management
3. Effective Counseling
4. Information Management (Salas de Situación)
5. PROCOSAN Strategy
6. Birth Planning Strategy
7. CBD Strategy
8. Health Information System
9. AMAS (Evaluation)
10. Life Saving Skills
11. Total Quality Management
44
12. Communication and Education (strategies for behavior change)
13. Transfer Process and Sustainability of Community Strategies
Job descriptions required program staff to support health facilities and services, facilitate and supervise
community based services, promote linkages between the two, and help strengthen health systems (HIS,
M&E). Thus through this project experience, all CSP staff reinforced and strengthened their capacity.
Project Educators hired were strong in community organization and mobilization, but had to develop
and strengthen leadership, management, M&E skills, and technical oversight to work with the project
partners at the municipality levels. The MOH partners at the SILAIS and Municipality levels likewise
benefited from working with the CSP, and health center/post staff strengthened their technical skills in
MCH service delivery, community based services, training, and support of community based resource
persons.
The CSP activities required that staff and partners apply the new skills. Staff has been used as resources
for other programs, and also assisted with technical trainings at the national level. The MOH SILAIS
and Municipality Directors have used new management skills in the way that they work with other
NGOs and lead and organize efforts. Several project staff members have used their new skills to initiate
community development projects outside of the project context. This is evidence that the project has left
a strong human resource capacity with the Project Educators, who are all natives of Jinotega as well as
within the MOH.
Project HOPE has been exemplary with regard to dedicating resources to staff training. With matching
funds they were able to purchase motorcycles for the field staff, and through a payment towards
eventual ownership of motorcycles arrangement with the staff they were able to collect monthly sums of
money that was put towards an education fund for staff. All staff had access to support towards
university and technical courses, towards finishing their bachelors, or their masters in public health. This
effort by the Project HOPE Nicaragua country leadership was a concrete demonstration and
commitment to staff professional development that is rare and commendable. It is not generally
something that NGOs have been able to do for their staff.
In addition CSP Jinotega staff was able to benefit from trainings. During the start-up period of the
project, the project leadership identified the need for technical assistance for education and training of
staff and partners as this was a critical component of the CSP. With the support from the Project HOPE
Regional Director of Latin America and the Caribbean, an Education Advisor position was created that
built the capacity of local staff in participatory training techniques for adults. This technical assistance
and resource person was greatly appreciated and is yet another example of the importance that project
leadership placed on dedicating resources to staff training and capacity building.
It is clear that the extra effort undertaken by the project to support staff development contributed to a
stronger team spirit and work ethic, staff dedication and minimal staff turnover during the life of the
project.
3. Supervision of Program Staff
The supervisory system that the project promoted was for every MOH level. They worked with the
SILAIS to support supervision of the 8 Municipalities and assisted with revising and implementing
45
guidelines and helped with transportation when necessary. At the Municipality headquarters, the CSP
also helped with the training and skills building in each of the MCH strategies and supervision of these
health activities at the health post and community levels. The CSP technical advisors for IEC, M&E,
Maternal Health and Child Health were also given geographical areas of supervision in addition to their
technical support responsibilities in order to ensure there would be adequate effort. In view of the efforts
that were being put into the development and promotion of health strategies, the CSP technical advisors
were quite busy and it appears that supervision was often focused more on the health facilities
themselves and less on CSP Educators.
The supervisory system is institutionalized in the department and at each of the municipalities and health
posts, who supervise community health resource persons. Unfortunately, due to limited human,
logistical, and financial resources the MOH finds it a challenge to stick to the supervisory schedule and
plans for supervision, monitoring and evaluation. Through this project and with the help of Project
HOPE, supervision checklists and systems have become part of the normal work schedule. It is expected
that the MOH will need to call upon the assistance of their other partners to help fill the gaps when the
CSP comes to a close. These issues were discussed in the phase-out plans.
Supervisory tools for some of the strategies were developed by Project HOPE and the Nicasalud NGOs
in collaboration with the MOH. CSP project staff put a great deal of effort into the supervision tools for
the Birth Planning strategy.
4. Human Resources and Staff Management
Essential policies and procedures are in place for both Project HOPE, NicaSalud partners, and the MOH
to continue program operations (Project HOPE activities funding through other sources). As mentioned
before, the issue that continues to be in question is resource limitations. Discussions around organization
of existing MOH and Jinotega partner resources are currently underway.
At the time of the final evaluation, the entire CSP team of approximately 17 people, including non￾technical staff, had excellent moral, organizational loyalty, and team spirit. Staff spoke of the personal
benefits of having worked in this project and its contribution to their professionalism and professional
preparedness for new jobs and career opportunities as the project comes to a close. Staff satisfaction
with the organization and their work was also something that was discussed in the MTE report. It is very
clear that the positive working environment, facilitated by the character and personality of the Project
Manager who is a Project HOPE Nicaragua veteran, and the support of the Country Director, had an
extremely positive impact on program implementation and partner relations. All partner staff
interviewed mentioned this as well.
Where local staff turnover was a little problematic was with the technical advisors. The main problem
was in relation to the technical advisor for Maternal Health because the individual holding this position
left the project in September 2003. After an extended period of time of not being able to replace her, the
other advisors and the project manager eventually took over the task of supporting this component and
did not continue expending time and effort to identify someone new. Areas of geographical supervision
were divided amongst the remaining staff. From a technical point of view, as maternal health was one of
the bigger components of this project, this did indeed put more pressure and work on the other technical
advisors. From all reports and evidence of achievements, it did not have a negative impact on program
46
implementation. Other departures from technical staff did not occur until February and August of 2006
(Technical Advisor for Child Health, and for Health Information System). At this point in the project
there were issues of funding shortages and preparation for phase-over of the project to the MOH and
Jinotega partners, so this staff was not replaced. This put a much bigger load on the project manager and
remaining two technical advisors (IEC and M&E), but at that point in the project it was not critical.
One Educator was replaced in 2006, as each of the 8 municipalities being supported by the project
needed to have a field staff person present to support activities in the communities and continue to
support and strengthen the health facility-community relationship. One of the two drivers also left the
project in 2005 and was not replaced, but the project does use the services of an extra driver for hire
during field activities as needed.
Project HOPE has made it clear to their staff that they have not been able to secure funding to retain
activities at this level. They have been very supportive of its staff, recommended them to other
organizations such as Save the Children, who is starting a new project in the department. They have also
facilitated time for staff to go on interviews, and have kept an eye open for staff opportunities with other
projects.
1. Financial Management
Budget expenditures for this project were done at three different levels: headquarters, country office in
Managua, and project office in Jinotega. Following the activities outlined in the DIP and based on
proposed activities for every month, the Jinotega accountant would develop a budget in collaboration
with the project manager. Although budget expenditures and remaining balance per line items were
monitored regularly within Nicaragua through the use of a spreadsheet, there seems to have been less
communication with regard to the expenditures being made at the headquarters level. Reconciling
information was difficult. As a result, although it is clear that the program implementers had adequate
budgeting skills to be able to accurately estimate costs and elaborate budgets, there came a point in 2005
when there was a concern about the depletion of funds. Project HOPE was forced to plan for an early
reduction of certain types of support (previously mentioned), and an early close-out of the project (June
rather than September 2007).
As mentioned before, the MOH has relatively limited resources, although the health strategies supported
by the program are theirs and institutionalized. Project HOPE, through smaller projects, will continue to
be able to support select interventions such as the HIS (Salas de Situacion), and FamiSalud.
Furthermore, other NicaSalud NGOs will also continue to support health strategies in the department.
The project received technical support from CSTS to reflect on and plan for sustainability. The MOH
will be working with its other partners when the CSP comes to a close to try and mobilize adequate
resources to support key activities. Unfortunately, the MOH expects that there will continue to be issues
of financial limitations.
47
2. Logistics
The project was well supported logistically. Project HOPE provided four vehicles from previous
projects, considered as match contribution to the project, until the last year when they intentionally
reduced project running costs and took the vehicles back to the country office in Managua. Motorcycles
procured by Project HOPE were kept in good condition by their users due to the fact that the employees
were paying for eventual ownership of the motorcycles. The project was also able to support health
facilities with equipment and supplies through their Gifts in Kind program. This logistical support was
very helpful and beneficial to the department and municipality and to program implementation.
Logistics are limited and without NGO support at the SILAIS and Municipality level it is a continuous
challenge for the MOH to support all their operations and activities, but there is a commitment to
continue supporting key health strategy and activities.
3. Information Management
The project conducted KPC surveys at the baseline, midterm and final evaluation using the Lot Quality
Assurance methodology. The project planned for the field staff to conduct surveys with the use of
Personal Digital Assistants (PDAs) on an annual basis, but after conducting the first one survey, the
team decided to discontinue because of concern about bias. Other project indicators for the different
health strategies were monitored during supervision and health facilities were evaluated through the use
of an assessment (AMAS already mentioned), which helped measure progress towards program
objectives. Project staff also did an annual supervision of CHWs in Jinotega communities not supported
directly by the CSP. These did indicate that many of these CHWs were not very active, but because the
project was not in a position to give concrete assistance beyond initially supporting their participation in
meetings and technical updates, nothing could be done. The capacity-building and sustainability
indicators developed at the time of the midterm evaluation and measured thereafter also helped to
monitor progress.
It must be noted that the progress seen in the KPC results at the time of the midterm evaluation was
short lived because in several cases there was either no more progress after the midterm or a change for
the worse after the MTE. It was later realized that a health education campaign to fight against a specific
epidemic (rotavirus) across the entire department of Jinotega, may have influenced the KPC results as
people were being bombarded with health messages on the radio at the time, and in seeking advice and
consulting on the problem, were benefiting from other health services as well.
The program promoted community health strategies and assisted with the training of health providers
and community resource persons in data collection and reporting for the SICO (Community Based
Health Information System). Prior to the start-up of the project, any community health information
obtained was collected by the health providers themselves when they visited the communities. With the
revitalization of CHWs and expansion of their work, this data is now being collected and submitted by
CHWs and TBAs every month. This information forms part of the agenda for discussion during the
monthly or bimonthly meetings held between these community volunteers and the health workers.
Weekly disease surveillance reporting is also being conducted. Per interviews with the health facilities,
the regular meetings and health service data has helped the MOH to identify health priorities and
48
potential health epidemics. The SICO data is required by the municipality, and this keeps health workers
attentive to the collection of this data. The SICO data is combined with other monthly health data, and
reported to the municipality health center headquarters every month.
Program staff and partners at all levels are sufficiently skilled to continue collecting data. As previously
discussed, data collection is part of the health information system and routine at this point. With regard
to special assessments, the program pre-tested the mother reminder educational materials
(recordatorios) prior to final development. They also conducted a sustainability assessment, as well as
studies on CDD, EBF and pneumonia. Please refer to the previous discussions on the sustainability
assessment and the aforementioned studies. Although the CSP collected some data that was not
routinely part of the MOH (KPC and additional indicators for some of the health strategies), the main
emphasis was helping the MOH develop and launch the indicator checklist supervisory tools program.
Both program and headquarters staff, local level partners, and the community have a clear understanding
of what the program has achieved. Health facility assessments have been participatory and included
partners and staff; post tests results given after project trainings have been shared; partners, staff, and
community members interviewed during the midterm and final evaluations were very clear about how
the program had contributed to strengthening systems, capacity, and the development and
implementation of MOH health strategies. Despite the uncertainty of the KPC results because of the
choice to sample across both direct and indirect communities, the MOH considers their relationship and
achievements with the Project HOPE CSP partnership as exemplary, and is using those lessons learned
in their relationships with other NGOs.
In addition to sharing, analysis and discussion with the SILAIS and Municipalities of Jinotega, the
program’s monitoring and impact data has been shared with the NicaSalud partners and USAID/
Nicaragua. The CSP has been using the SigHope HIS program to produce graphics to show program
results per municipality. The LQAS methodology used by the CSP for the KPC baseline, midterm and
final evaluations facilitated this process, and has enabled them to pinpoint problem areas and locations.
Planning with the MOH took this data into consideration.
4. Technical and Administrative Support
The program received technical backstopping from Project HOPE headquarters which included
assistance with the DIP. The project team was able to take advantage of training on LQAS as part of the
NicaSalud partners. They found this to be very useful and adopted it as their methodology for all three
KPC surveys that they conducted. The Child Survival Technical Support or CSTS, also provided
technical assistance by helping the team examine the issues of program and partner sustainability using
the sustainability framework. This exercise enabled them to identify sustainability indicators and
develop work plans that focused on strengthening management and quality of care. Based on the MTE
recommendations, the project team also received technical assistance from the M&E and Health of
Women and Children units at Project HOPE headquarters in the development of a two year work plan,
training/capacity building, and sustainability indicators.
The regional staff had close involvement in the project and specifically hired a technical advisor for
participatory training and facilitation to build the capacity of CSP staff in participatory training
methodologies.
49
The Nicaragua country office and field staff had many expectations in terms of technical support and
participation from Project HOPE headquarters because at the time of project start-up there was a large
health team there of 4 people, and communication and consultation was frequent. When staff at Project
HOPE headquarters was significantly reduced to one person in 2004, this high level of support changed.
Thus, the overall sentiment from field staff is that technical assistance during the life of the project was
not always timely or adequate. HQ staff was only able to visit the project once following the MTE, and
as a result of reduced communication between the offices, the field team implemented key activities
such as operations research without the involvement of headquarters.
There should have been more guidance from Project HOPE HQ at the time of the DIP in the area of
indicators and measurements. The project identified 23 KPC indicators and planned for these to be
measured across an entire department consisting of 750 communities, even though direct CSP support at
the community level was only in 80 villages. As mentioned earlier in the report, community resource
persons in communities not directly supported by the project also benefited from a little training and
linkages with health facilities. But the process and capacity indicators identified more accurately reflect
this effort than the KPC indicators. It was overly ambitious to expect notable changes in the area of
knowledge and practices of mothers in communities not receiving direct supervision and support of
CHWs by the project.
Organizations often go through changes and staff turnover. When this occurs, it inevitably has an impact
on the degree of technical assistance given to the field projects (including timeliness of assistance, as
gaps and problems are often only identified at the time of the MTE). It might be a good idea if key
technical guidance and assistance could be made available to field staff via regional workshops in the
first months of the projects as they go into the DIP preparations. This direct TA to field project
managers and staff could be an extension of CSTS support, and ensure that projects are realistic and
practical in terms of choice of KPC indicators (even while being ambitious), and that they are also
thorough with regard to planning in the area of training/capacity building and corresponding indicators
as well as sustainability. As all projects need to focus on sustainability, they should all have access to
TA on the sustainability framework early on in the process as well.
Project HOPE HQ and Regional Staff (including a Regional Director based in Costa Rica and an
Education Advisor based in Peru) spent from 20% to 50% of their time backstopping this project over
the project years.
5. Mission Collaboration
The project had a very good collaboration with the USAID mission, whose primary partner in health and
child survival is the NGO network NicaSalud (of which Project HOPE is a leading member). The CSP
and the NicaSalud partners’ objectives were in line with that of the USAID Mission. The CSP program
complemented projects and funding available through the mission. Project staff met with USAID for
planning and updates on a regular basis and the CSP had the opportunity to present project activities in
these partner meetings as well. The USAID mission has been extremely supportive of the CS activities
in Jinotega and visited the project on several occasions as well. The Mission is very interested in the
project experience and lessons with community based programming in particular for use by other
partners.
50
6. Management Lessons Learned
Please refer to the list of lessons learned by the PVO under Capacity Building of the Organization.
D. Other Issues Identified by the Team
None
E. Conclusions and Recommendations
Quantitative results for the KPC show the project as having reached only 6 of the 19 targets set. These
dismal results do not reflect what was seen during qualitative interviews in the project communities. It is
important to note that this project had direct and indirect beneficiaries, and the results were measured
across a large geographical area of communities not receiving direct support from the project. It is thus a
lesson learned in M&E for the project, i.e. the project could not expect to have a real impact on
knowledge and behavior change in communities where they only gave limited training to CHWs and
strengthened health facility services. It should be noted that at the time of the MTE they made a request
with regard to this, but USAID did not agree to this. Nevertheless, the results for Maternal and Newborn
Care were excellent with the project achieving all three of the three indicators (prenatal visits, birth
attended by trained attendant and postnatal visit), and showed remarkable progress from baseline to
final. Under Nutrition, the project saw a dramatic change in percent of children with low weight for age,
but the measurement method for number of children weighed did not reflect the reality and thus falsely
appears not to have achieved the objective. The prevalence of anemia increased rather than decreased
during the life of the project. In the case of breastfeeding, the project saw a lot of improvement in
immediate breastfeeding from baseline, but no change in exclusive breastfeeding at all. Neither
objective seems to have been met. Immunization coverage saw a lot of progress from baseline. In the
CDD component none of the five objectives were achieved, and only 2 out of 5 saw very slight
improvement from the baseline. There was a very slight improvement in recognition of danger signs of
pneumonia, but care seeking results went down from what it was at the time of the baseline. In the area
of FP, the project saw use shoot up by a huge percentage from baseline, but the spacing indicator
decreased rather than increased. The indicator for knowledge of HIV was achieved and increased
substantially from the time of the baseline.
The Jinotega CSP put a lot of effort into strategy development and launching (including training
manuals, supervision and IEC tools), in addition to the implementation of these strategies. The various
strategies started at different points during the course of the program so some have been implemented
longer than others, i.e. the CBD program for FP, and Life Skills Training for maternal health started
early in the project whereas the Integrated Community-based Growth Monitoring (PROCOSAN) and
Birth Planning initiative at the community level started later. More time needs to be dedicated to
strengthening some of the more recent activities launched, including counseling and follow up done by
CHWs in the area of anemia as prevalence levels are still high, and key messages and information on
child care during illness, which community resource persons have not yet been trained in. Community
committees interviewed did not appear to be very dynamic in the area of health, although they were
organized and prepared for emergency obstetric evacuation. These entities need to benefit from more
capacity building and empowerment efforts. The CHWs and TBAs, on the other hand, are very
empowered and dynamic and in many cases are the ones leading the community committees. Linkages
51
with the health facilities at this end point in the project are fairly strong and relationships are established
enough to continue beyond the life of the project. MOH resources in terms of support to community
activities are limited and there will be some challenges to maintain the high level of support and
supervision that the project was providing. Health services have improved with the support of the project
in terms of MOH staff technical skills in MCH case management, data collection and reporting,
planning and community based services. Unfortunately, quality of care is challenged by high staff
turnover, staff shortages, logistical and financial constraints at the SILAIS and municipality levels.
52
Main Achievements of the Project:
1. Mobilization and capacity building of community based resource persons (282 CHWs, 88
TBAs and 759 Community committee members).
2. Improvement in knowledge, involvement in health, and health behavior of mothers in
communities directly supported by the project.
3. Development and support of Jinotega department MOH strategies by providing training
manuals, guides, and supervision checklists in child health promotion, maternal and
newborn care, and community based family planning strategies.
4. Creation of 43, 18 and 36 training facilitators in PROCOSAN, ECMAC and Birth
Planning respectively in the SILAIS and municipalities of Jinotega.
5. Institutional strengthening of the Jinotega department in quality of services through the
training of 20 key management personnel at SILAIS and municipality levels.
6. Institutional strengthening in monitoring and evaluation for MCH through training and
partnership with 20 key personnel at SILAIS and municipality levels.
7. Development of linkages between the MOH health facilities and 80 communities through
community based services, community health data collection, monthly reporting,
monthly/bimonthly meetings, references and counter references.
8. Model collaboration with the MOH and with the NicaSalud network of NGOs, including
spirit of flexibility, cooperation and support.
9. Mobilization of $1,208,006 in direct funds, and $27,286,110 in medicines and supplies to
complement those provided by the child survival project, i.e. PROSIC, FamiSalud,
ProSalud, and Gifts in Kind from Project HOPE, support for infrastructure.
10. Involvement of the 23 coffee plantation owners in the improvement of health service
provision in the plantations, and the development of linkages with the MOH for follow￾up and monitoring.
11. The support of a Maternity home in WanBlan managed by community health committee.
12. Contribution of technical project staff to training methodologies and materials at the
national level.
Constraints
 MOH staff rotation and staff shortage.
 Staff shortages and large patient load make it difficult for health workers to always
follow the protocols and norms for quality of care.
 Insufficient budget for fuel compounded by rise in international fuel prices (large
distances between the project office and five of the eight municipalities - up to 156
kilometers, and large distances from municipal health center headquarters and certain
communities - up to 55 kilometers).
 Shortage of drugs at the health post level.
 Some indicators identified in DIP were dependent on MOH, not the project.
 The MOH health strategy approach resulted in a heavy load of monitoring indicators for
each strategy. These together put a lot of stress and pressure on those responsible for
follow up.
 The MOH has been very quick to adopt and launch new strategies, but they do not put
any additional logistical, material and financial resources towards the implementation of
these strategies (including the community based components).
53
 The KPC measured results over the entire department of Jinotega rather than just
communities receiving direct support and thus did not reflect the real results in the direct
beneficiary population.
 Lack of support and supervision of ORS corners by health facilities.
 Limited time period for implementation of PROCOSAN strategy because of MOH
strategy change from AIN, thus impacting time needed for training CHWs in childhood
illnesses and strengthening of counseling skills to address traditional feeding behaviors
and practices as well as care-seeking.
Lessons Learned:
 The project effort on relationship building with the MOH, including collaboration,
support, information-sharing and communication, as well as focus on shared interest, was
an investment that paid off in the Jinotega CSP. It greatly contributed to advancing the
priorities outlined in the program DIP.
 For an accurate reflection and evaluation of growth monitoring activities, it is important
to envisage the training of CHWs to be able to plot child weights on child GM cards.
 In the case of a new project, program staff has learned that it would be better to prioritize
two or three indicators for a CDD component, put the necessary level of effort in those
areas with focused messages and strategies that address the challenges and barriers
identified.
 In terms of M&E, the Jinotega CSP staff has also learned a lesson with regard to how
they chose to measure KPC results in a program that had direct and indirect community
beneficiaries. In a new program they would opt to measure KPC only in communities
with direct interventions, while identifying other types of indicators to measure the
department-wide support given by the project in the area of capacity building and quality
of care.
 The slight decline in immunization coverage at the final, identified as being mainly due
to the missing MMR vaccines, is an indication that there was too much of a dependence
on the NID that was not implemented in 2006, rather than ensuring complete coverage
through the routine vaccination services both at the community and health facility
levels. There is also a need for providers to travel with enough vaccines.
 The CSP learned that it is important to emphasize the recommended birth spacing
interval when promoting family planning.
 With regard to improving MOH health services, one lesson learned in the project
experience is that relationship-building and true partnership is the key to making progress
and achieving goals. During the life of the project, Project HOPE was held in very high
esteem by the MOH and was in a position to influence and have an impact on MOH
strategies, quality of care, and community outreach. This happened because of the
following reasons: 1) the CSP devoted their efforts to supporting the MOH in their areas
of priority and needs; 2) the project leadership and staff were flexible, available and
engaged when it came to initiating and supporting health strategies for the department of
Jinotega; 3) project management was resourceful and made efforts to mobilize financial
and technical resources, and link to other donors and institutions to meet identified needs.
 With the issue of high-drop outs of CHWs, the lesson learned by the CSP, similar to what
other projects have also experienced, is that it is important to go step by step and take all
the time necessary for communities to get on board with regard to community
54
participation and mobilization, criteria and choice of community volunteers. In the case
of Jinotega (and Nicaragua in general) the Brigadistas already existed, but in such
situations it is still a good idea to help these individuals and the community revisit the
commitment based on potential new developments and activities.
Best Practice
 The AMATE-IDRE participatory learning methodology for improved participant
absorption of information, information retention, and fun.
 NGO integration in government services such that they support the development,
strengthening and implementation of MOH strategies, including community
linkages, for sustainable health and development.
Recommendations:
1. It is important to support the MOH in problems that they have identified, rather than do
things that they do not feel is their initiative.
2. The MOH has identified the urban areas of Jinotega as areas with high poverty and
overpopulation, poor water and sanitation, as well as increased occurrences of diarrhea and
pneumonia. It is recommended that future projects consider supporting these communities as
well.
3. When addressing culture beliefs and practices around child feeding and care during illness, it is
important for programs to dedicate some time to identify successful behavior change strategies
for those interventions through the use of such things as the BEHAVE model.
4. It is recommended that future programs dedicate some time and resources to the revitalization of
community ORS corners. This activity is complementary to the PROCOSAN monthly GM and
community based vaccination services, and to become more attractive to clients, it could be
expanded to include such things as the provision of iron, vitamin A, condoms and FP
contraceptives, as well as focused counseling on the prior-mentioned and in particular on feeding
and care during episodes of diarrhea.
5. It would be a very good idea to do a qualitative study on the effectiveness and the impact of the
health practice reminders (recordatorios) that are given to mothers as a follow-up to counseling.
This is an innovative strategy and something that could potentially be replicated in other
countries.
6. Train the community volunteer on how to complete the child health card for growth monitoring.
7. Promote growth monitoring in all communities per MOH norms.
8. The SILAIS and municipalities should prioritize trainings to fill in the community volunteer
technical information gaps related to child health management and counseling.
9. Prioritize, emphasize, and strengthen the skills of community volunteers on counseling for
feeding/fluids during illness so they can educate mothers on the importance of this.
10. In order to maintain high vaccination coverage of children under the age of 1, it is important to
implement all the strategies that support vaccination coverage. This includes: train all
community volunteers in the vaccination schedule; identify and refer children for vaccination at
the health facilities; mobilize resources for more frequent and regular community outreach in
communities that are farther away from health facilities; review the registry (PAI) so as ensure
an accurate calculation of the amount of vaccine antigen needed during community vaccination
sessions.
55
11. Based on the experience in Jinotega where a large percentage of births are cesarean section and
depending on the situation, some mothers are unable to breastfeed immediately after delivery. In
order to more accurately measure this indicator, it is suggested that the KPC survey insert a
question verifying the conditions of childbirth and newborn prior to asking about immediate
breastfeeding after delivery.
12. Strengthen and improve counseling around breast milk extraction for new mothers who spend a
time outside the home.
13. To support behavior change for exclusive breastfeeding, grandmothers should be included in the
breastfeeding support group initiative and should be targeted during other opportunities such as
health talks and home visits.
14. Considering the prevalence of anemia in the department of Jinotega, it is recommended that the
MOH make an effort to ensure the availability of iron folic acid for all children under 5 years of
age.
15. To ensure that mothers comply with the intake of iron prescribed for children in an effort to
improve the existing prevalence, there needs to be more promotion, education, and one and one
follow-up with mothers during growth monitoring sessions in communities and visits at the
health facility.
16. Strengthen the capacity and ability of the health committee members to function in the area of
problem identification and problem solving, management, and evaluation of activities with
exchange visits between communities and through meetings and workshops.
17. The family planning strategy should include reaching households with information and
counseling on child spacing recommendations and benefits at both the community and health
facility levels.
18. In a potential follow up of the project, it would be good to plan for additional effort and support
for institutional strengthening of the MOH department of Jinotega in administration and financial
management, resource mobilization and project design.
19. In a potential follow up of the project, it would be good to mobilize resources and linkages
between communities and other NGOs who can support them with other areas of need such as
water, sanitation and hygiene, and agriculture.
Dissemination of Best Practices and Lessons Learned
The CS Nicaragua project has allowed Project HOPE the opportunity to continue solidifying it’s
expertise in implementing CS programs. Relevant best practices and lessons learned from the
current project will be adapted and incorporated into future CS program designs when feasible.
HOPE’s ability to develop positive and productive working relationships with the MOH is a
consistent best practice that will continue to be the cardinal strategy of our international work.
Project HOPE has also strengthened public-private partnerships by working on coffee plantations
in Jinotega. Project HOPE will encourage other pvos to explore this type of collaboration in
future programming to increase access to health care to underserved populations, in this case,
women and children of migrant farmers. The very painful lesson of designating communities
priority/non priority will be strongly discouraged in future programming, although this seems to
be preferred strategy of the SILAIS in Jinotega1
. The lesson learned of limiting the project to
implement a few interventions has also been suggested by USAID and will be applied to future
1 Minnesota International Health Volunteers (MIHV) CS Nicaragua project, 1993-1997, personal
communication with member of Technical Team.
56
program designs, with the desired outcome of more focused activities. Mother home reminder
materials have been an extremely successful strategy of Project HOPE’s that will also be
incorporated into future programming. Project HOPE will use its membership in the CORE
group as an avenue to disseminate the best practices and lessons learned of the CS Nicaragua
project. It bears noting that during this project, Project HOPE had responded to a request for
abstracts from CORE on family planning. Project HOPE highlighted the successful ECMAC
experience in Jinotega and the abstract was viewed favorably by CORE, which encouraged its
dissemination to other pvos.
Scale Up, Expansion, and Sustainability Plans
Please refer to previous comments on the above. Additionally, with the creation of NicaSalud as
a funding agency in Nicaragua, the probability of local ngos in collaboration with the MOH of
sustaining community health activities after projects end is greatly increased. Project HOPE has
leveraged the CS project to receive additional funding from NicaSalud to continue working in
target areas of Jinotega through the FamiSalud project.
57
F. Results Highlight
Implementation of AMATE-IDRE: An Adult Learning Methodology
for Health Education
To meet the enormous staff and volunteer training needs of the health department of Jinotega,
Nicaragua, Project HOPE’s Child Survival CSP adopted the AMATE-IDRE adult learning, participatory
methodology for conducting health education activities to key project partners: MOH staff and
community volunteers. This methodology promotes positive models, active decision making, taking
responsibility, and adoption of key behaviors, while focusing on problem-solving, building capacity,
skills development, and improving job performance.
AMATE consists of five components: Animation (‘Liveliness’)—getting the audience prepared and
interested in learning; Motivation—stimulating the curiosity of the audience, introducing the topic and
finding out what the audience already knows; Appropriation—testing what the audience knows and
challenging assumptions through exchange of knowledge, ideas, experiences and the introduction of
new information and constructing/incorporating the new ideas/ knowledge; Transference—applying the
theory to practical situations, working with new knowledge and skills creatively; and Evaluation—
demonstrating the integration and connection of new knowledge and skills as evidenced by the results
(products) created. IDRE is a simplified version for shorter training sessions (sessions under 4 hours),
and includes the steps of Introduction; Development of the topic; Reflection on use of the new
information; and Evaluation.
The AMATE-IDRE methodology was used by Project HOPE in all of its training activities. It has really
taken off in Nicaragua because of the fact that it has made learning at all levels easy and fun. The
NicaSalud NGO network partners have also approached Project HOPE for training and have had success
with using the methodology for their own training activities. Partners and training participants all speak
very positively of this methodology as one that has also helped with information and skills retention.
Project HOPE gave technical assistance to the integration of the AMATE-IDRE methodology in the
training manuals for the MOH Birth Plan strategy, PROCOSAN and ECMAC as well. As the success of
this methodology is being shared on a national level, it is expected to have wider impact and benefit
with the NGO support of other health departments.
The adoption of AMATE-IDRE by Project HOPE’s CSP has provided the following results:
 12 Project HOPE Nicaragua staff trained as trainers of trainers are competent in the
integration of AMATE-IDRE in training manuals;
 34 MOH staff at the SILAIS, Municipality and health facility levels trained as trainers
and a number of them competent in integration of AMATE-IDRE in training manuals;
 4 staff from CARE; 15 staff from Caritas (CRS) and 10 staff from ADRA trained as
trainers;
 358 CHWs using the participatory methodology in their education session with mothers;
 100 TBAs trained using the methodology.
58
ANNEXES:
A. Evaluation Team Members and their titles
Teams Name Affiliation Role in
interviews
Selected
communities
for
interviews
Marguerite
Joseph
External
Evaluator
Interviewer
Pedro
Ramírez
HOPE
Jinotega
Interviewer
Justo Real HOPE
Jinotega
Notetaker
Agustín
Herrera
HOPE
Jinotega
Notetaker
San Marcos
Abajo (8)
La
Concepción
(9)
El Mojón
(10)
1
Leonel
Martínez
HOPE
Jinotega
Notetaker
Santos
Medina
SILAIS Interviewer
Edgar
Rodríguez
HOPE
Jinotega
Interviewer
Judith
Rizo
HOPE
Jinotega
Notetaker
Javier
Méndez
HOPE
Jinotega
Notetaker
2
Nohemí
Mercado
HOPE
Jinotega
Notetaker
El Zancudal
(8)
Planes de
Vilán (9)
Escambray
(10)
Mario
Ortega
HOPE
Jinotega
Interviewer
Ruth
Madison
HOPE
Center
Interviewer
Horacio
Cano
HOPE
Jinotega
Notetaker
Armando
Zeledón
HOPE
Jinotega
Notetaker
3
Eugenio
Arbizú
HOPE
Jinotega
Notetaker
Sisle 2 (8)
Las Vueltas
(9)
Pacayal (10)
B. Evaluation Assessment Methodology
The evaluation was led by an outside team leader. Also participating as part of the team was a
headquarters technical backstop, program, and partner staff. Group interviews were conducted with the
MOH SILAIS level, NicaSalud partners, coffee growers, and with CSP Educators. Individual interviews
were conducted with MOH Municipality Directors, Educators, Trainers and health providers. They were
also conducted with program staff. The team leader and headquarters backstop person conducted most
of those interviews. Other FGDs and interviews were organized at the community level and these
included mothers, community committees, CHWs and TBAs. Nine communities across six Jinotega
municipalities were selected for these activities. The sample was based on accessibility due to the
59
limited time available (within 3 ½ hours distance from the office), as well as degree of community
mobilization (weak, medium and strong) per staff perception.
Evaluation Schedule:
Date Day Activities
2
May
Wednesday Travel to Jinotega CSP office. FE Planning
meeting (identification of sample communities for
interviews, HFs to visit formation of teams;
confirm dates with MOH).
3
May
Thursday Interviews with project staff and MOH Municipal
Directors.
4
May
Friday Interviews with project staff and MOH partners
continued.
5
May
Saturday Interviews with project management.
6
May
Sunday Development of community interview tools.
7
May
Monday Team feedback and revision of interview tools.
Interview with MOH SILAIS partner.
8
May
Tuesday Community visits: Sisle 2 (Jinotega), San Marcos
Abajo (SRN) and El Zancudal (Yalí).
9
May
Wednesday Community visits: Planes de Vilán (Pantasma),
Las Vueltas (Wiwili) and La Concepción (El Cua).
10
May
Thursday Community visits: El Mojón (Jinotega),
Escambray (Jinotega) and Pacayal (Pantasma).
11
May
Friday Interview with Managua country office managers.
Feedback meeting from 3 FE teams and
development of LL/recommendations.
12
May
Saturday Data analysis and discussions continued.
14
May
Monday Interviews with NicaSalud NGO partners
Interviews with Coffee Plantation owner Project
partners.
Interviews with MOH Municipal Educators,
trainers, and service providers.
15
May
Tuesday Presentation of FE results in Jinotega.
Travel to Managua
16
May
Wednesday Presentation of FE results to USAID Mission in
Managua.
60
Community Interviews
Target Methodology Number
per
community
Mothers (6-12) Focus Group
Discussion
1
Leaders/members of
Community Committee
(6-12)
Focus Group
Discussion
1
TBAs Individual
interview
1 – 2
CHWs Individual or
group interview
1 – 3
Partner meetings
Profile Methodology Number
of
Groups
Coffee Plantation
Owners (6)
NGO partners (3)
Focus Group
Discussion
1
1
MOH SILAIS
management team (6)
Focus Group
Discussion
1
Municipal Directors (3) Individual
Interview
3
Municipal staff (8) Focus Group
Discussion
1
61
Project HOPE, Jinotega Child Survival Program
In-depth Interview Guidelines,
Community Health Volunteer
1. How long have you been a CHW? How many hours/days a month do you
work as a volunteer? What activities are you undertaking?
2. Were you satisfied with the training you received from the project? If no,
why? What more would you have liked to be including in your training? If
yes, explain. (Interviewer: Listen for change in knowledge, skills and
capacity).
3. Has your relationship with the Ministry of Health changed since the
beginning of the project? If so, in what ways? (Interviewer: Listen for
supervision, referrals, meetings, contact, and frequency of reporting).
4. (Interviewer – If not previously mentioned, check whether or not volunteers
collect community health information. If yes, ask the following question:
Does this data help you with your work? If so how? (Interviewer: Listen for
what volunteer does with the information.)
5. Do you receive support or encouragement from the Community Health
Committee or other community members? If yes, what?
6. What motivates you to continue working?
7. There has been a high turnover of CHWs during the life of the project. In
your opinion why is this? What suggestions do you have to reduce drop￾outs?
8. When the project is no longer able to support you, do you think you will be
able to continue to carry out the activities that you are doing now? Do you
think that your relationship with the health facility will change? What
challenges do you expect to encounter?
9. With regard to certain project focus areas, how do you explain the reductions
and/or lack or notable change in the indicators? (Interviewer: Discuss KPC
results. See list).
10. Have you noted any changes in health service provision since the beginning
of the project?
11. Do husbands get involved in health care? Do they support you on decisions
and participation in health activities?
62
Project HOPE, Jinotega Child Survival Program
In-depth Interview Guidelines,
Traditional Birth Attendant
1. Were you satisfied with the training you received from the project? If
no, why? What more would you have liked to be including in your
training? If yes, explain. (Interviewer: Listen for change in knowledge,
skills and capacity).
2. Has your relationship with the Ministry of Health changed since the
beginning of the project? If so, in what ways? (Interviewer: Listen for
supervision, referrals, meetings, contact, and frequency of reporting).
3. Do you continue to do at-home deliveries? If yes, in your experience
what have been advantages or disadvantages to this?
4. Have you needed to refer cases to the health facility? If yes, what kind
of support have you received from the Community Health Committee
or community members?
5. Have you been able to help families with birth planning? What
difficulties have you encountered?
6. Do you usually know when a woman is pregnant? If yes, do you have
the opportunity to support her during the pregnancy? If yes, what
advice do you usually give pregnant women?
7. What motivates you to continue working?
8. With regard to certain project focus areas, how do you explain the
reductions and/or lack or notable change in the indicators?
(Interviewer: Discuss KPC results related to immediate breastfeeding,
vaccination, birth spacing).
63
Project HOPE, Jinotega Child Survival Program
Focus Group Discussion Guidelines,
Community Health Committee
1. Discuss role of the Committee and role of members and what you do
every week/month.
2. How has your involvement with the project contributed to your level
of community organization?
3. How has your involvement with the project contributed to your
capacity for problem identification and problem solving?
4. How has your involvement with the project contributed to the number
of community activities and initiatives that you undertake? Explain.
5. Are there gaps in the training/capacity building that you received from
the project? If yes, what more would you have like to receive?
6. How often do you meet as a committee? Do you develop action plans?
If yes, how often? Give examples from the past year (Unless already
given above).
7. In what ways do you support your CHWs and TBAs?
8. Do you think that this support will be adequate for them to continue
working?
9. Has there been a high turnover of CHWs during the project period? In
your opinion, why is this? What suggestions do you have to reduce
drop-outs?
10. What kind of relationship do you have with the Ministry of Health?
Do you expect to be able to sustain your relationship at the end of the
project?
64
Project HOPE, Jinotega Child Survival Program
Focus Group Discussion Guidelines,
Mothers
1. What is your knowledge of anemia? Do you do anything to prevent
anemia in yourself or your children? If yes, what?
2. What have you learned about immediate breastfeeding? What are
common practices after delivery? Are these different at home
compared to practices after delivering at the health facility?
3. What have you learned about exclusive breastfeeding? What barriers
do mothers have to doing this?
4. What do you know about dehydration and its consequences? What
prevents some mothers from seeking care?
5. What have you learned about feeding and liquids during episodes of
illness in children? What are common practices in your community?
What are barriers to giving as much or more food and liquids during
illness?
6. What are barriers to care-seeking for cough and fast breathing in a
child? What are common practices for the treatment of pneumonia in
your community?
7. What have you learned about hand washing and hygiene? What
prevents some mothers from practicing this knowledge?
8. There has been a reduction in vaccination coverage of children in the
Department of Jinotega since the project started. What are some of
things that might have contributed to this? What problems do people
encounter in getting their children vaccinated?
9. What are your sources of information for STIs/HIV/AIDS? For those
who have learned something about HIV, have you shared this
information with anyone else? Has this information had an impact on
the way you do things? If yes, explain.
10. Many people are aware of family planning and are using modern
contraceptives, but many families do not space their children. What
are the reasons for this?
11. Many women do not have a postpartum visit after delivery. What
makes it difficult for women to have this check up?
65
12. Have you noted any changes in health service provision since the
beginning of the project?
13. Do husbands get involved in health care? Do they support you on
decisions and participation in health activities?
66
Project HOPE, Jinotega Child Survival Program
Focus Group Discussion Guidelines,
Health Workers
1. Did the project trainings you received help you in performing your job?
If yes, how?
2. How has the community mobilization work of the project affected
demand for services?
3. How is the ‘sala de situation’ (HIS) organized? How do you use it and
how is it useful to you?
4. What do you think of references coming from the community?
5. What is your relationship with the community network of volunteers?
6. What challenges do you face in getting your work done?
67
C. List of person interviewed and contacted
Jinotega CSP staff interviewed
Dr. Mario Ortega Project Manager
Dr. Edgar Rodriguez M&E Specialist
Dr. Pedro Ramirez IEC Specialist
Karen Loaisiga Administrative Assistant
Eugenio Arbizu Educator
Agustin Herrera Educator
Armando Jose Zeledon Educator
Javier Mendez Herrera Educator
Judith Rizo Lopez Educator
Justo Jose Real Educator
Nohemi Mercado Educator
Horacio Castillo Educator
Jinotega Department (SILAIS) Management team interviewed
Dra: Ana Cely Gomez. Directora SILAIS-Jinotega.
Dra. Myriam Siles Hernandez Sub-Directora SILAIS-Jinotega.
Dr.Jose Ugarte
Responsable de Docencia e Investigacion-SILAIS￾Jinotega.
Dr.Luis Emilio Rugada Reyes Responsable de AIMN-SILAIS-Jinotega.
Dr. Santos Bernardo Medina
Lopez. Coordinador Cooperacion Externa SILAIS-Jinotega.
Lic. Nerea Lopez Davila Responsable de Enfermeria. SILAIS-Jinotega.
Jinotega Municipality staff interviewed
Dra Maria Lastenia Zelaya
Mendez. Directora de C/S La Concordia.
Starling Herrera La Concordia Health Center – Educator
Enrique Gonzales Guillermo Matute Health Center – Educator
Antonio Pineda MOH San Rafael del Norte –Educador
Rosa Campos Sisle Health Post – Nurse Auxilliary
Rosario Martinez Ernesto Acuna Health Post – Professional Nurse
Cesar Augusto Zavala Datanli Health Post –Nurse Auxilliary
Denis Garcia Pantasma Health Center – Educator
Levis Castillo El Cua Health Center – Educator
Dra. Nineth Palacio Previous Municipality Director for Jinotega
68
Health Facility personnel interviewed
Name Municipality/Community
Dra. Marbely Chavez El Cua.
Maria Lourdes Blandon anchez. San Marcos.
Rosa Amanda Campos. El Mojon.
Luis Castillo. Planes de Vilan.
Doris Polanco. Malecon.
Rosario Martinez. Ernesto Acuña.
Marlene Gonzalez Bermudez Tamalaque.
Manrique Martinez. Wiwili.
Project Partners/Collaborators interviewed
Dr. Sergio Amador Project Concern International – Manager
Lic. Marjories Loza Wisconsin Partners – Health Facilitator
Dr. Julio Valerio CARITAS (Catholic Relief Services) –FamiSalud Project coordinator
Ing. Jose Tavare Coffee Farm Jesus Maria – Administrator
Lic. Mario Lopez Coffee Farm La Viola – Manager
Lic. Teresa Leon York Coffee Farm La Colonia – Representative
Lic David Zelaya Coffee Farm Santa Maura – Representative
Sr. Ronaldo Palacios Coffee Farm La Florida – Representative
CHWs interviewed
No Name Community
1 Santos Hernadez Lopez Las Vueltas
2 Esmeralda Hernadez Sisle 1
3 Esmeralda Zeledon Pacayal
4 Jaime Rizo Amaya Planes de vilan
5 Ana Maria Picado Escambray
6 Evelio Galeano El Zancudal
7 Jose Mendoza La concepcion
7 Ester Ruiz Castillo San Marcos
8 Ivania Lanzas San Marcos
9 Xiomara Herrera San Marcos
10 Sandra Torres San Marcos
11 Rosa Antonia Perez El mojon
12 Juana Evangelina Mendez El mojon
13 Martha Gomez El mojon
Traditional Birth Attendants interviewed
No. Name Community
1 Maxima Guatemala. Las Vueltas
2 Francisca Zelaya. Sisle No. 1
3 Virginia Vilches Pacayal.
4 Francisca Picado. Planes de Vilan.
5 Vilma Rosa Rizo. El Zancudal(Los Terreros)
6 Matilde Mairena. El Escambray
7 Juana Maria Castro CH. San Marcos.
69
D. KPC Results from 80 direct beneficiary communities
KPC Final results by indicator – Department of Jinotega, Nicaragua
Indicator (for the entire project area)
FE March
2007 All
areas
FE June
2007
80
communities
GOAL
Maternal and Newborn Care Maternal and Newborn Care
20. % of mothers of children aged 0-23 months who report
having had at least one prenatal visit with a doctor or
nurse.
95% 95% 94%
21. % of mothers of children aged 0-23 months who report
having had two or more prenatal visit with a doctor or
nurse.
40% 90% *
22. % of mothers of children aged 0-23 months that report
receiving on their arm the DT vaccine during the last
pregnancy.
89% 92% **
23. % of children aged 0-23 months whose birth was
attended by a doctor or nurse. 71% 61% 65%
24. % of mothers of children aged 0-11 months who report
having had at least one postpartum visit. 51% 52% 45%
Nutrition and Micronutrients
25. % of children aged 0-23 months weighed in the last four
months according to growth monitoring card. 75% 96% 90%
26. % of children aged 0-23 months with low weight
(Weight-For-Age) (<2Z). 1% 8%
27. % of children aged 0-23 months stunted (Height-For￾Age) (<2Z). %
28. % of children aged 0-23 months with anemia
(hemoglobin level < 11mg/dl). 47% 30%
Breastfeeding Promotion
29. % of mothers of children aged 0-23 months who report
having breastfed within the first hour after birth. 77% 82% 80%
30. % of mothers of children aged 0-23 months who report
having breastfed within the first 8 hours after birth. 85% 89% **
31. % of infants aged 0-5 months who received only breast
milk in the past 24 hours. 56% 74% 70%
Immunization
32. % of children aged 12-23 months with all recommended
vaccines at the moment of their first birthday according
to the growth monitoring card.
78% 87% 80%
Control of Diarrheal Diseases
33. % of mothers of children aged 0-23 months with a
diarrheal episode in the last two weeks who report giving
as much or more food to their child.
31% 59% 60%
34. % of mothers with children aged 0-23 months with a
diarrheal episode in the last two weeks who report giving
as much or more liquids or breast milk to their child.
65% 85% 80%
70
35. % of mothers of children aged 0-23 months who report
having sought assistance or counseling from a health unit
or CORU during the child’s last diarrheal episode.
40% 54% 50%
36. % of mothers of children aged 0-23 months who report
washing their hands with water and soap before the
preparation of meals, before feeding children, after
defecation, and after tending a child that has defecated.
7% 24% 35%
37. % of mothers of children aged 0-23 months that know at
least two signs of dehydration due to diarrhea. 31% 73% 40%
Indicator (for the entire project area)
EF March
2007 All the
areas
EF June
2007
80
communities
META
Pneumonia Case Management
38. % of children aged 0-23 months with cough and fast
breathing in the last two weeks taken to a health unit. 53% 30% 75%
39. % of mothers of children aged 0-23 months that can
identify fast breathing as a danger sign for pneumonia. 83% 90% 90%
Child Spacing
40. % of children aged 0-23 months that were born at least 24
months after the previous surviving child. 77% 90% 86%
41. % of mothers of children aged 12-23 months who desire
no more children in the next two years, who are using
some type of modern child spacing method.
100% 66% 85%
HIV/AIDS
42. % of mothers of children aged 0-23 months who know at
least one way to prevent STIs-HIV/AIDS. 20% 62% 15%
*indicador monitoreado a solicitud de Bonnie Kittle, en consecuencia, no hay meta.
**Indicador no tiene meta, pues solamente se ha dado seguimiento sin ser un objetivo del programa
Improving the Health of Mothers and Children of Rural Jinotega,
Nicaragua: An Integrated Approach in Partnership with the Public and
Private Sector Providers in Coffee-Growing Areas
Cooperative Agreement No. HFP-A-00-02-00026-00
KPC FINAL SURVEY REPORT
Project Location: Department of Jinotega, Nicaragua
Submitted to:
Jill Boezwinkle
Attn: Aimee Rose, Program Assistant
USAID/GH/HIDN/NUT/CSHGP
1300 Pennsylvania Avenue
Room 3.7.74, Ronald Reagan Building
Washington, DC 20523-3700
Attention: Deborah Kumper, Administrative Assistant
ORC Macro- CSTS+
11785 Beltsville Drive
Calverton, Maryland 20705
Submitted by:
Project HOPE – The People-to-People Health Foundation, Inc.
Millwood, Virginia 22646
Tel: (540) 837-2100
Fax: (540) 837-1813
August 29, 2007
HQ Contact person: Field Contact Person:
Ruth Madison, MPH Lic. Silvia Coronado López
Tech Advisor, HWC Unit Country Director
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 1
ACKNOWLEDGMENTS
The Jinotega Child Survival project wishes to thank all the mothers that gladly accepted to take part in
the final evaluation process of the interviews and provided a valuable contribution to the information
obtained.
The project would also like to thank the Community Health Volunteers (CHVs), whose work is cardinal
to the success of the project and who served as guides identifying the project communities and
facilitating travel to them during the final evaluation.
Additionally, thanks are extended to the health personnel of the SILAIS Jinotega, who have been
partners in the project and who facilitated maps and census data of most of the surveyed communities
for the final evaluation.
And finally, the project wishes to thank Lic. Mirna Zelaya of the Central MOH (MINSA Central) and
the technical teams from NicaSalud (FamiSalud), especially, Dr. Adelina Barrera who made available
the complete team of facilitators for training anthropometrical measurements and blood sampling for the
hemoglobin testing.
A special thanks to all the participants in the survey process who are listed below:
INTERVIEWERS SUPERVISORS QUALITY
CONTROL DRIVERS
Edgar Alberto Rodríguez Uriel Pineda Mario Ortega Daniel García
Pedro Ramírez Mora Agustín Herrera Estrada
Eugenio Arbizú Laguna Judith Rizo López
Justo José Real Marlon Sevilla
Horacio Castillo Cano Karla Rugama Reyes
Noemí Mercado Palacios Leonel Martínez
Thomas
Armando Zeledón López Damaris Centeno
Francisco Javier Méndez Isaías González
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 2
TABLE OF CONTENTS
Page
ACRONYMS
EXECUTIVE SUMMARY ............................................................................4
I. BACKGROUND .......................................................................................7
II. PROCESS AND PARTNERSHIP BUILDING ........................................9
Methods of identifying and engaging local partners/stakeholders in the KPC…….9
Specific roles of local partners/stakeholders in the KPC survey....................9
Constraints in making the KPC process more participatory….......................9
Participatory research used in the study .........................................................9
III. METHODS..............................................................................................11
Questionnaire..................................................................................................10
KPC indicators ...............................................................................................12
Sample design.................................................................................................13
Training ..........................................................................................................14
Data collection and quality control procedures ..............................................14
Data analysis...................................................................................................15
IV. RESULTS................................................................................................22
Breastfeeding.........................................................................................22
Nutrition.................................................................................................22
Malnutrition and anemia prevalence .....................................................23
Immunization.........................................................................................24
Diarrhea .................................................................................................25
Pneumonia case management................................................................27
Pneumonia danger signs knowledge......................................................28
Maternal and newborn care ...................................................................29
Child Spacing ........................................................................................29
STIs-HIV/AIDS.....................................................................................29
Rapid CATCH .......................................................................................31
V. DISCUSSION...........................................................................................32
VI. BIBLIOGRAPHY ....................................................................................38
VII. ANNEXES:
A. KPC Questionnaire 0-11 months
B. KPC Questionnaire 12-23 months
C. Indicators by Supervision Area
D. Results from 80 priority communities
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 3
ACRONYMS
ARI Acute Respiratory Infection
BF Breastfeeding
CDD Control of Diarrheal Diseases
CHV Community Health Volunteer
CHW Community Health Worker
CORU Community Oral Rehydration Unit
CSTS Child Survival Technical Support Project
CS Child Survival
DHS Demographic Health Survey
DIP Detailed Implementation Plan
DR Decision Rule
FP Family Planning
GM Growth Monitoring
GMP Growth Monitoring and Promotion
GIK Gift-In-Kind
GON Government of Nicaragua
H/C Health center
H/P Health post
HIS Health Information System
IEC Information, Education and Communication
IMCI Integrated Management of Childhood Illness
IMR Infant Mortality Rate
IUD Intra-Uterine Device
KPC Knowledge, Practice, and Coverage
LAM Lactational Amenorrhea Method
LQAS Lot Quality Assurance Sampling
MCH Maternal and Child Health
MMR Measles, Mumps and Rubella
MN Micronutrients
MOH Ministry of Health
MWH Maternity Waiting Homes
NFP Natural Family Planning
NGO Non-Governmental Organization
NICASALUD Network of PVOs in Nicaragua
OR Operations Research
ORT Oral Rehydration Therapy
ORS Oral Rehydration Salt
ORT Oral Rehydration Therapy
PHC Primary Health Care
PVO Private Voluntary Organization
QA Quality Assurance
RDA Recommended Dietary Allowance
RH Reproductive Health
SILAIS Sistemas Locales de Atencion Integral en Salud
STI Sexually Transmitted Infections
TA Technical Assistance
TBA Traditional Birth Attendant
TFR Total Fertility Rate
VA Vitamin A
VAD Vitamin A Deficiency
W/MCH Woman/Maternal Child Health
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 4
EXECUTIVE SUMMARY
During the month of March 2007, Project HOPE, with the cooperation of the Ministry of Health of
Nicaragua, community agents, and the population in the target communities, planned and implemented
a Knowledge, Practices, and Coverage (KPC) survey among mothers with children under two years of
age. The KPC survey, which sampled communities from all eight municipalities in the Department of
Jinotega, served to provide key information on maternal and child health knowledge and practices.
Results of the survey provided quantitative data to identify the objectives achieved during the final
evaluation of the Child Survival (CS) program, in the mostly rural communities of the department of
Jinotega.
The KPC survey was carried out by the technical team of Project HOPE Jinotega and external personnel
with experience in conducting this type of surveys. Technical assistance was provided by the Director of
Project HOPE Nicaragua and Project HOPE Headquarters personnel. Technical support in the form of
training process and monitoring of the anthropometrical measurement samplings was provided by
NicaSalud and the Ministry of Health (MINSA).
To conduct the final evaluation, Project HOPE team used the Lot Quality Assurance Sampling (LQAS),
a stratified random sampling methodology. In addition, parallel sampling was used to focus on two
target groups for the survey: mothers with children 0-11 months of age, and mothers with children aged
12-23 months. For each of these groups, slightly different instruments were used, which have been
validated by Child Survival Technical Support (CSTS). These instruments had already been used in
prior KPC surveys with some adaptations and inclusion of questions about reproductive health, danger
signs, diarrhea, feeding practices and fluids intake during infant diseases episodes, and HIV/AIDS.
Measurements for weight, height, and hemoglobin levels were also taken for children under two years
of age, and hemoglobin levels for mothers, using the universally accepted HEMOCUE equipment. The
team, which was composed of NicaSalud, MINSA Central, and Project HOPE, provided training for
weighing, height measuring, hemoglobin nutrition components and on sampling and LQAS
methodology for the survey. The sample size was 19 mothers with children under two years of age in
each of the two groups 0 to 11 and 12 to 23 months of age, for each Supervision Area (SA=8), with a
subtotal of 152 mothers by age group, and a grand total of 304 interviewed mothers selected randomly
for the final evaluation.
Data collection took place approximately within a two-week period. Eight survey teams were formed
with one supervisor and one interviewer in each team. Quality control was done by six staff members
from Project HOPE and stakeholders, who used a quality control checklist during the interview process.
In addition, this CS program pilot-tested the use of electronic Portable Digital Assistants (PDAs) for
data capturing and analysis.
The analysis was done using LQAS tabulation forms in the field. Average coverage rates (non￾weighted) were calculated for CS indicators —including Rapid CATCH ones— for the entire program
area. In addition, adjusted coverage rates (weighted) were calculated for each indicator based on
population size. Finally, 95% Confidence Intervals (CI) were calculated for each indicator considering
population size for each SA.
RESULTS
Breastfeeding practices for mothers of children from 0 to 23 months of age showed an average of 77%
of the children receiving breast milk during the first hours after birth. All municipalities were found to
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 5
be equal or above this average. The percentage of children 0 to 5 months of age that received breast
milk in the last 24 hours was 56% (95% CI = +/- 10.8%).
Regarding the nutritional practices of mothers, 76% of children 0 to 23 had weight measurements
recorded in their health cards in the last four months. The municipalities of El Cuá and Bocay were
found to be below average coverage.
Stunting (Height-For-Age) in children aged 0-23 months was 2% and children aged 0-23 months with low
weight (Weight-For-Age) was 1%.
The results for hemoglobin determination for the project area showed that 47% of children under two
years of age have anemia (levels below 11mg/dl.).
The results of the immunization coverage for the project area reflect that 78% of children 12 to 23
months old received all vaccines at the moment of their first birthday. The municipality of Jinotega, El
Cuá and Bocay was found to be below this average coverage.
Regarding diarrhea, the KPC survey revealed low knowledge of danger signs recognition by the mother.
Survey results found that 26% (non-weighted average) of mothers could recognize at least two danger
signs (dehydration signs) during diarrhea episodes for children aged 0 to 11 months old. In the 12 to 23
month old group, 39% (non-weighted average) of mothers could recognize at least two danger signs.
The municipality of Jinotega and Bocay are below this average.
As for the demand of services, results showed a significantly low rate of utilization. The average
number of children with diarrhea seen by qualified medical personnel or at the Community Oral
Rehydration Unit (CORU) was 35% (non-weighted average) for the 0 to 11 months old group. For the
12 to 23 months old group the result was 43% (non-weighted average). Overall, only 40% of children
aged 0-23 months with diarrhea sought help at a health facility or CORU (95% CI= +/- 10.6%).
Regarding the percentage of mothers that reported having given equal amount or more food to their
child during the last diarrheal episodes for both groups (0 to 11 and 12 to 23 months old), the result was
31%.
The percentage of mothers that reported having given equal amount or more liquids to their child during
the last diarrheal episodes for both groups (0 to 11 and 12 to 23 months old) was 65%.
With respect to Acute Respiratory Infections (ARI) management, the percentage of children 0 to 23
months old with fast breathing that were seen at a health unit was 53%. Regarding pneumonia danger
signs knowledge, 88% (non-weighted average) of mothers for children 0 to 11 months old can identify
fast breathing as a danger sign. For the 12 to 23 months old group, the result was 84% (non-weighted
average).
Regarding maternal and newborn care, the percentage of mothers who reported that during their last
pregnancy received the tetanus vaccine (dT) was 91% (non-weighted average) for the 0 to 11 months
old group and 89% (non-weighted average) mothers with children 12 to 23 months of age.
Only 55% (non-weighted average) of mothers with children 0 to 11 months old reported having at least
one postnatal visit. The municipality of Bocay is the only municipality below the project area average.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 6
Almost ¾ of children 71% 0 to 23 months of age had their birth attended by qualified medical
personnel (doctor or nurse). The municipalities of Jinotega, Wiwili, Cua and Bocay were found to be
below the average.
With respect to birth spacing, the percentage of children 0 to 11 months old that were born at least 24
months after the previous surviving child was 76% (non-weighted average). For the 12 to 23 months
old group, the average was 80% (non-weighted average). The municipality of Bocay was found to be
below the average in both groups.
Regarding mothers with children 12 to 23 months of age that stated using some type of modern family
planning method, the average coverage was 100%.
With regard to STIs and HIV/AIDS, the percentage of mothers that know at least one way to prevent the
disease was 24% (non-weighted average) for the 0 to 11 months group. For the mothers with children
12 to 23 months of age, the result was 20% (non-weighted average).
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 7
I. BACKGROUND
The department of Jinotega is located in the north region of Nicaragua, with an area of 9,389 km2
(8%
of the total country surface). The estimate of population for the year 2006, according to the Instituto
Nicaraguense de Estadisticas y Censos (INEC), is 301,214 inhabitants, with a density of 32.08 person
per km2
, much lower than the national average of 75 people per km2
. Jinotega borders at the north with
Honduras, to the south with the department of Matagalpa, to the east with the Region Autónoma del
Atlántico Norte (RAAN) and to the west with the departments of Nueva Segovia, Madriz and Esteli.
Politically, the department is divided into eight municipalities: Jinotega, San Rafael del Norte, La
Concordia, San Sebastian de Yali, Santa Maria de Pantasma, Wiwili, El Cua, and San Jose de Bocay.
The department can be described as mountainous, with warm weather but with specific weather
characteristics in each municipality, ranging from very humid to dry. The city of Jinotega is the capital
of the department, and is located 161 kilometers from the country’s capital Managua. The road Jinotega
to Managua is accessible through Matagalpa on good paved roads and via Esteli on unpaved roads all
year. The municipalities are linked by unpaved roads in poor conditions and some municipalities such
as Wiwili and San Jose de Bocay have communities that are only accessible via the rivers in a large
portion of the territories. The main rivers in the department are: the Coco River, which is the longest
and largest in Central America, and the Bocay and Amaka Rivers which feed into the Coco River and
cross the municipalities of El Cua, and San Jose de Bocay.
Jinotega is characterized as a region producing staple grains, coffee, and non-traditional products, and a
limited cattle industry. The mountainous areas of Jinotega, Wiwili, El Cua, Bocay, Yali and San Rafael
are perfect for the production of coffee. The municipality of Pantasma produces different crops such as
staple grains, vegetables, and tobacco. Some of the areas are classified as “zona seca” (dry zone) in
which there is limited production due to lack of rain. Jinotega also generates electricity by means of the
hydroelectric plant of Lake Apanas, which produces about 30% of the national electrical energy.
The social and economic situation of the department of Jinotega has been depressed in the last years by
the return of large populations to their original homes after the civil war, and by the fall of the
international coffee prices, the main source of financial income for the department of Jinotega.
Water and sanitation
In the urban area, 40% of the houses have drinking water as compared to only 10% in the rural area.
The percentage of houses that have latrines is 41.3% for the whole department of Jinotega (ENDESA
2001).
Poverty
According to the poverty map of the UNDP and the Technical Secretariat of the Presidency for the year
2000, the municipalities of El Cua, Bocay and Wiwili are classified as of extreme poverty; Yali, San
Rafael del Norte and Pantasma are classified as high poverty; La Concordia and Jinotega are medium
poverty. The municipalities with severe poverty represent 41% of the department’s population.
The Ministry of Education (MECD) estimates that the number of education centers covers only 40% of
the territory. According to ENDESA 2001, 39.9% of the population cannot read or write and 41.5% of
women have never attended school. Regarding the education level of heads of family, 55% do not
know how to read or write, only 10% have attended secondary school or higher studies and 35%
completed primary education. Of the heads of family, 20% are single mothers.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 8
The depressed social and economic conditions, directly impact on health indicators of the general
population with a greater risk of illnesses or death. Women of reproductive age and children under five
years old are the group at greater risk, comprising 51.2% of the total population. The latest survey
carried out by the MINSA’s Nutrition Office in 1994 ranked Jinotega as a high risk department
regarding micronutrient deficiency.
Table 1: Health indicators – SILAIS Jinotega
Pathology Rate Dept./ 2000 ENDESA /2001 Rate Rate Dept./ 2004 Rate Dept./ 2006
Mortality from diarrhea 11.8 N/A 128 / 45.8***
Mortality from ARIs 13 N/A 183 / 201***
Maternal mortality 98.6x100,000NVR N/A 224.1x100,000NVR* 163.3x100,000NVR
Infant mortality 18 x 1000 40** x 1,000 11.3 * x 1000 10.7 x 1000
Perinatal mortality 19.8 21 17 * 16.9
Diarrhea prevalence N/A 19.6 34.8
ARIs prevalence N/A 35.4 17.07
* It is suggested that the principal cause in the difference between these two statistics is that in official data, there is a under registration of
live births. In the case of infant mortality, SILAIS Jinotega reports that there has been a reduction of infant deaths related to diarrhea which
has reduced the overall infant mortality rate.
** This data corresponds to infant mortality rate the 10 years prior to the survey (1996-2001), calculated from the history of births and
deaths obtained from interviews of WRA.
***For the year 2006, SILAIS separated the mortality rates for diarrhea and ARI according to age groups. The first age group was for
children under 1 year of age and the second group for children 1 to 5 years of age.
Women’s health indicators for the year 2004 present a coverage of prenatal control of 84.1% with a
concentration of 3.2 visits per pregnant woman. Coverage for postnatal care was 52%, family planning
coverage was 31.6% with a preference for injectables (Depo-Provera). The ENDESA 2001 presents a
coverage for modern family planning methods of 52% and the knowledge of women regarding
HIV/AIDS as 81% of them having heard about the subject and 42.6% knowing two or three forms to
avoid the disease.
Table 2: Department of Jinotega Demographics
Municipalities Population 2003 % Km2 Density
Jinotega 58,788 24.0 1,239 46.7
San Rafael del Norte 16,978 7.0 468 36.3
La Concordia 7,658 3.0 224 42.1
San Sebastian de Yali 21,803 9.0 595 39.2
Pantasma 39,555 16.0 546 68.5
Wiwili 35,847 14.0 2,444 13.9
El Cua 42,572 17.0 3,872 9.9
San Jose de Bocay 24,961 10.0 N/A N/A
Total 248,162 100.0 9,388 26.2
Program description (September 2002 – March 2007)
Project HOPE has been implementing the CS project in the 8 municipalities of Jinotega since 2002.
The strategies and activities designed have been developed around PROCOSAN, Community Based
Distribution of Family Planning Methods (ECMAC, for its initials in Spanish); Birth Plan for Safe
Motherhood; and Community Based Life Saving Skills. All of these initiatives have been implemented
with our partners who include: Ministry of Health- SILAIS Jinotega, Community Health Volunteers
(CHWs and TBAs), the private coffee plantation owners and other ngos in the department such as
CARE, Caritas-CRS, Wisconsin Partners of the Americas and Project Concern International.
The target population includes 60,031 children under five and 70,827 women of reproductive age for a
total of 130,858 beneficiaries. The goal of this program is to reduce morbidity and mortality rates of
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 9
children under five and women of reproductive age in Jinotega’s primarily rural communities. This has
been accomplished by building the service-delivery capacity of local health facilities and organizations;
increasing the skills and elevating the morale of health care providers; strengthening cooperation among
public, private and community stakeholders; and empowering consumers, particularly women, to take
greater responsibility for personal and family health maintenance decisions.
The program includes a specific set of capacity-building activities and objectives as well as health￾related interventions. With respect to capacity building, HOPE will facilitate the establishment of
Department- and Municipality-level Health Councils—to include representatives of SILAIS,
municipalities, private coffee plantations and associations, PVOs, NGOs, community leaders, health
providers, and international donors—to guide and extend the project.
II. PROCESS AND PARTNERSHIP BUILDING
A. Specific roles of local partners/stakeholders in the KCP Survey
Project HOPE/ Jinotega coordinated the planning and the implementation of the Final KPC survey. The
following is a list of local partners and stakeholders involved in the implementation of the KPC and
their specific roles.
MINSA—At the national level, MINSA provided one facilitator, Lic. Mirna Zelaya, who participated in
the training of interviewers in how to weigh children with the special Salter scales. At the SILAIS
level, MINSA provided population (census) data and detailed local maps that were used to select
communities and households, and provided equipment, including HEMOCUE machines that were used
to take hemoglobin measurements. The maps had been drawn in January 2005 by local “brigadistas”
(community health promoters), and were very helpful in orienting the survey team to locate households
once they arrived in a particular community.
B. Constraints in making the process more participatory
La participación del personal del MINSA en el proceso de recolección de datos en la encuesta de medio
termino se enfoco a coordinar las visitas a las comunidades, acompañamiento en algunas visitas a
comunidades seleccionadas y acompañamiento a en algunas visitas de control de calidad de las
encuestas. Un factor que limito el acompañamiento del personal del MINSA durante todo el proceso fue
el período de 15 días que implica realizar todo el estudio y del MINSA nadie pudo ausentarse tanto
tiempo, pues conllevaba dejar un puesto o unidad de salud descubierto.
The participation of MINSA personel in the recollection of information for the final evaluation was
focused on coordinating visits to the communities and visiting communities to ensure proper filling out
of survey forms. One factor that limited the participation of MINSA personnel throughout the entire
survey period of 15 days was that full participation in the survey would result in health facilities being
left unattended for over two weeks, which is inconceivable to all involved.
C. Participatory research used in the study
Information for each KPC was collected using two methods: manually, by each supervisor and
electronically by each interviewer, using Portable Digital Assistants (PDAs) to improve data collection
practices and minimize data errors, as part of the Management Information System of Project HOPE
called SIGHOPE.
III. METHODS
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 10
A. Questionnaires
Questionnaire development process
The sections and questions included in the midterm Project HOPE/ Jinotega KPC Survey are based on
the model of questions and modules contained in KPC 2000+ Questionnaire Manual (Spanish version).
Project HOPE/ Jinotega staff is experienced in developing and implementing cross-sectional maternal
and child health surveys: as they have conducted several such surveys during the project to date: Base
Line and Midterm KPCs. Project HOPE/ Nicaragua staff has also participated in numerous survey
workshops and trainings on LQAS hosted by NicaSalud.
The questionnaires used were adapted and validated during the baseline with the proviso that certain
indicators were incorporated at a later date (RAPID CATCH) and were not collected at baseline.
The LQAS methodology employed to conduct the KPC during the final evaluation was also used at
baseline and during two monitoring exercises conducted by the project. Additionally, it was also
decided to conduct parallel sampling to obtain the needed sample size for the relevant indicators, and
two questionnaires were developed, one for those mothers with infants 0-11 months, and the other for
mothers with children 12-23 months. Parallel sampling is designed to target the most appropriate sub￾target group with the most appropriate questions for that subgroup, allowing for a fewer number of
questions to be administered to any one subgroup. Another advantage is that recall bias may be
reduced, as the question content will focus on behaviors or experiences relatively recent or current to a
particular subgroup. Parallel sampling may also provide higher quality data, as shorter interviews are
less likely to trigger ‘interview fatigue’ compared to longer ones. Lastly, parallel sampling may
produce more precise point estimates, because data from questionnaires with common questions can be
pooled, allowing relatively larger sample sizes for particular items.
Scope of survey, survey length, and versions of the questionnaire
Modules included in the survey questionnaires correspond roughly to the proposed interventions
included in the project proposal submitted to USAID/ Washington in December 2001. The two
questionnaires included the following modules:
Table 3: Number of Questions by Questionnaire
Number of Questions* Number of Questions*
Module 0-11
months
12-23
months
Module 0-11
months
12-23
months
Identification 14 14 Malaria ** 4 4
Background 5 5 Prenatal Care *** 8 5
Nutrition and
Breastfeeding
7 7 Intrapartum and Newborn
Care
5 2
Growth and Monitoring 8 8 Family Planning 5 7
Immunization - 2 HIV/AIDS 3 3
Sick Child 4 2 Water and Sanitation 2 2
Diarrheal Management 9 9 Anthropometry and
Hemoglobin
4 4
Acute Respiratory
Infections
9 9 Total 87 83
* A few questions contain fields for more than one variable
** This intervention area was not included in the baseline but as part of monitoring, the 4 questions on both surveys for both age groups (0-11 y 12-23
months of age), have been included to obtain data on Rapid Catch for Malaria.
*** This intervention area was also included on both questionnaires to obtain information for Rapid Match indicators.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 11
B. KPC Indicators
The following table lists the main indicators proposed for the program with the respective construction:
Table 4: Indicators construction
Indicator Numerator Denominator Question Reference
1. % of children aged 0-23 months
weighed in the last 4 months
according to growth monitoring card
Children aged 0-23 months weighed
in the last 4 months according to
growth monitoring card
Total children 0-23
months with growth
monitoring card
CD2
2. % of children aged 0-23 months with
low weight (weight for age) (<2Z)
Children aged 0-23 months with low
weight (weight for age) (<2Z)
Total children 0-23
months in the study
AH1
Pi 14
3. % of children aged 0-23 months
stunted (height for age) (<2Z)
Children aged 0-23 months stunted
(height for age) (<2Z)
Total children 0-23
months in the study
AH 2
Pi 14
4. % of children aged 0-23 months with
anemia
Children aged 0-23 months with
hemoglobin less than 11mg/dl.
Total children 0-23
months in the study
AH 3
5. % of mothers of children aged 0-23
months who report having breastfed
within the first hour after birth
Mothers of children aged 0-23
months who report having breastfed
within the first hour after birth
Total mothers of children
0-23 months in the study
LN 2
6. % of mothers of children aged 0-23
months who report having breastfed
within the first eight hours after birth
Mothers of children aged 0-23
months who report having breastfed
within the first eight hours after birth
Total mothers of children
0-23 months in the study
LN 2
7. % of infants aged 0-5 months who
received only breast milk in the past
24 hours
Infants aged 0-5 months who
received breast milk only in the past
24 hours
Total infants 0-5 months
in the study
LN6 A = 1
LN6 B-U = 0
Pi 14 < 6
8. % of mothers of children aged 0-23
months that know at least two signs
of dehydration due to diarrhea
Mothers of children aged 0-23
months who can mention at least two
of the following signs: sleepy, sunken
eyes, folding skin, thirsty, restless or
cranky.
Total mothers of children
0-23 months in the study
DM 9 = two or more of A to
E
9. % of mothers of children aged 0-23
months who report having sought
assistance or counseling from a
health unit or CORU during the
child’s last diarrheal episode
Mothers of children aged 0-23
months which had diarrhea in the last
two weeks that report having sought
assistance or counseling from a
health unit or CORU
Total mothers of children
0-23 months in the study
who had diarrhea in the
last two weeks
DM7= A,B,C & F
DM1 = 1
10. % of mothers of children aged 0-23
months with a diarrheal episode in
the last two weeks who report giving
as much or more food to their child
Mothers of children aged 0-23
months with a diarrheal episode in
the last two weeks who report giving
as much or more food to their child
during this episode
Total mothers of children
0-23 months in the study
who had diarrhea in the
last two weeks,
excluding children 0-5
months with exclusive
breastfeeding
DM5= 2 or 3
DM1 = 1 – [(Pi 14 < 6) +
(LN6 A = 1, LN6 B-U = 0)]
11. % of mothers of children aged 0-23
months with a diarrheal episode in
the last two weeks who report giving
as much or more liquids or breast
milk to their child
Mothers of children aged 0-23
months with a diarrheal episode in
the last two weeks who report giving
as much or more liquids or breast
milk to their child during this episode
Total mothers of children
0-23 months in the study
who had diarrhea in the
last two weeks
DM4= 2 or 3
DM1 = 1
12. % of children aged 0-23 months with
cough and fast breathing in the last
two weeks taken to a health unit
Mothers of children aged 0-23
months with cough and fast breathing
in the last two weeks who report
having taken the child to a health unit
Total mothers of children
0-23 months in the study
with cough and fast
breathing in the last two
weeks
IR7= A or B or C
IR2 = 1
13. % of mothers of children aged 0-23
months who can identify fast
breathing as a danger sign for
pneumonia
Mothers of children aged 0-23
months who can identify fast
breathing as a danger sign for
pneumonia
Total mothers of children
0-23 months in the study
IR 9 = B
14. % of children aged 12-23 months
with all recommended vaccines
according to the growth monitoring
card
Children aged 12-23 months with one
dose of BCG, OPV3, 3Pentavalente
and one MMR at the moment of their
first birthday
Total children 12-23
months in the study
IN 2 = A - H
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 12
Indicator Numerator Denominator Question Reference
15. % of mothers of children aged 0-23
months who know at least one way
to prevent STIs-HIV/AIDS
Mothers of children aged 0-23
months who can mention at least one
of the followings: abstinence, use of
condom, having only one sex partner
/ being faithful
Total mothers of children
0-23 months in the study
VS 3 = B or C or D or E
16. % of children aged 0-23 months who
were born at least 24 months after
the previous surviving child
Children aged 0-23 months born at
least 24 months after the previous
surviving child mas los hijos únicos
Total children 0-23
months in the study
PF 3
(Child DOB1-Child DOB2)
>24 months+ Hijos Únicos
17. % of mothers of children aged 12-23
months who desire no more children
in the next two years, who are using
some type of modern child spacing
method
Mothers of children aged 12-23
months who are not pregnant, desire
no more children or are not sure and
report using one of the following
modern child spacing methods:
norplant, injectables, oral, IUD,
condom / diaphragm, gel / foam,
male or female surgical sterilization
Total mothers of children
12-23 months in the
study, excluding
pregnant women
PF 4 = 0 + PF 7 = 02 – 10
152 – PF 4 = 1
18. % of mothers of children aged 0-23
months who report having had at
least one prenatal visit with a doctor
or nurse
Mothers of children aged 0-23
months who report having had at
least one prenatal visit with a doctor
or nurse
Total mothers of children
0-23 months in the study
AP 1 = B
19. % of mothers of children aged 0-23
months that report receiving on their
arm the dT vaccine during the last
pregnancy
Mothers of children aged 0-23
months that report receiving on their
arm the dT vaccine during the last
pregnancy
Total mothers of children
0-23 months in the study
AP 2 = 1 (12 to 23 m)
AP 3 = 1 (0 to 11 m)
20. % of mothers of children aged 0-11
months who report having had at
least one postpartum visit
Mothers of children aged 0-11
months, who report having had at
least one postpartum visit
Total mothers of children
0-11 months in the study
PF 4 = 2 or 3
21. % of children aged 0-23 months
whose birth was attended by a
doctor or nurse
Children aged 0-23 months whose
birth was attended by a doctor or
nurse
Total children 0-23
months in the study
RN 2 = A or B
Table 5: Rapid CATCH Indicators
Indicator Numerator Denominator Question Reference
1. % of children aged 0-23 months with
low weight (weight for age) (<2Z)
Children aged 0-23 months with low
weight (weight for age) (<2Z)
Total children 0-23
months in the study
AH1
Pi 14
2. % of children aged 0-23 months who
were born at least 24 months after
the previous surviving child
Children aged 0-23 months born at
least 24 months after the previous
surviving child
Total children 0-23
months in the study
PF 3
(Child DOB1-Child DOB2)
>24 months
3. % of children aged 0-23 months
whose birth was attended by a
doctor or nurse
Children aged 0-23 months whose
birth was attended by a doctor or
nurse
Total children 0-23
months in the study
RN 2 = A or B
4. % of mothers of children aged 0-23
months that received two doses of
dT vaccine during the last
pregnancy, according to health card
Madres de niños de 0 – 23 meses
que tienen registradas al menos dos
dosis de dT en su tarjeta de
embarazo.
Total de madres de
niños de 0 – 23 meses
con tarjeta de embarazo
AP6=2 0-11m
AP5=2 12-23m
AP4=1 0-11m + AP3=1 12-
23m
5. % of infants aged 0-5 months who
received breast milk only in the past
24 hours
Infants aged 0-5 months who
received breast milk only in the past
24 hours
Total infants 0-5 months
in the study
LN6 A = 1
LN6 B-U = 0
Pi 14 < 6
6. % of children aged 6-9 months who
received breast milk and
complementary feeding in the past
24 hours
Mothers of children aged 6-9 months
that report having given breast milk
and complementary feeding in the
past 24 hours
Total mothers of children
6-9 months in the study
LN 6 A = 1
LN 6 B to U = 1
(minimum 1)
LN 7 > 0
7. % of children aged 12-23 months
with all recommended vaccines at
the moment of their first birthday
according to the growth monitoring
card
Children aged 12-23 months with one
dose of BCG, OPV3, 3Pentavalente
and one MMR at the moment of their
first birthday
Total children 12-23
months in the study
IN 2 = A - H
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 13
Indicator Numerator Denominator Question Reference
8. % of children aged 12-23 months
that received the MMR vaccine
according to the growth monitoring
card
Children aged 12-23 months that
received the MMR according to the
growth monitoring card
Total children 12-23
months in the study
IN 2 = A - H
9. % of children aged 0-23 months who
slept under an impregnated
mosquito net the previous night
Niños de 0-23 meses que durmieron
la noche anterior con mosquitero
impregnado
Total children 0-23
months in the study
CM1=2
CM4=1 both questionnaires
10. % of mothers of children aged 0-23
months that know at least two signs
of childhood illnesses indicating the
need for treatment
Mothers of children aged 0-23
months who can mention at least two
of the following signs: looks tired,
does not eat or drink, sleepy or hard
to awake, has high fevers, has fast
breathing, vomits all food or drinks,
has seizures
Total mothers of children
0-23 months in the study
DM 9 = D
11. % of children aged 0-23 months that
received more liquids and continued
feeding during an illness in the last
two weeks
Mothers of children aged 0-23
months that had diarrhea or ARI in
the last two weeks that report having
given more liquids and continued
feeding during an illness in the last
two weeks
Total mothers of children
0-23 months with
diarrhea or ARI in the
last two weeks in the
study
DM5= 2 or 3
DM1 = 1 – [(Pi 14 < 6) +
(LN6 A = 1, LN6 B-U = 0)]
12. % of mothers of children aged 0-23
months who know at least one way
to prevent STIs-HIV/AIDS
Mothers of children aged 0-23
months who can mention at least one
of the followings: abstinence, use of
condom, having only one sex partner
/ being faithful
Total mothers of children
0-23 months in the study
VS 3 = B or C or D or E
13. % of mothers of children aged 0-23
months who report washing their
hands with water and soap before
the preparation of meals, before
feeding children, after defecation
and after tending a child that has
defecated
Mothers of children aged 0-23
months that mentioned the 4
situations when hands must be
washed: before the preparation of
meals, before feeding children, after
defecation and after tending a child
that has defecated
Total mothers of children
0-23 months in the study
AS1 = B, D , E & F
C. Sampling Design
Universe: 248,162 inhabitants of the Department of Jinotega
Sampling size: A random stratified sampling method, known as LQAS (Lot Quality Assurance
Sampling), was used. Through LQAS, a sample size of 19 interviews per lot were obtained. Eight lots
were identified, corresponding to each municipality in the Department of Jinotega. In addition, parallel
sampling was used to better understand the knowledge, practices, and coverage of mothers with children
0-11 months, and mothers with children 12-23 months. Thus, slightly different questionnaires were used
for each group (see Appendix B for the both instruments used). The sample sized used gave a total of
38 interviews per supervision area, or 152 interviews from each age group, or a grand total of 304
interviews for the total area of the project (Department of Jinotega).
For the purpose of the KPC midterm study, eight supervision areas were defined as follows:
 SA 1: Jinotega  SA 2: San Rafael del Norte
 SA 3: La Concordia  SA 4: San Sebastián de Yalí
 SA 5: Santa Maria de Pantasma  SA 6: Wiwilí
 SA 7: El Cua  SA 8: San José de Bocay
For the selection of the communities, a random sampling framework was used based on the population
of communities within each supervision area. The result was the identification of communities to be
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 14
sampled, which are listed in Appendix C. For each selected community, the census and maps were
updated, which was done in close coordination with MINSA personnel and CHVs.
According to the sampling framework, each one of the homes was numbered within the respective
community map, selecting at random the homes to be interviewed. If there was more than one mother
who had children both 0 to 11 and 12 to 23 months old in the home, only one of them was selected at
random to participate in the survey. In cases where there were no mothers in the home selected for the
survey, the nearest home was identified. No two interviews were ever made to the same mother, nor
were two interviews ever carried out at the same home.
An interview was considered complete after filling out the questionnaire, weighting and measuring the
child and taking the blood sample both from the mother and child. A sampling set was considered
complete after having completed both interviews (0 to 11 and 12 to 23 months old). Only at this point a
new home was selected to start the new sampling set. This procedure was followed until all sets
identified for each community were completed.
D. Training
In preparation for the use of the LQAS methodology, technical and support personnel received training
from Project HOPE´s Specialists, with expertise in the use of LQAS methodology for baseline and
another assessments in Nicaragua. Training was also provided to all personnel in anthropometrical
measurements, blood sampling and hemoglobin determination, from MINSA Central and NicaSalud.
For the hemoglobin determinations, HEMOCUE1
photometers were utilized, which used the principle
that after erythrocytes are hemolyzed by sodium deoxycholate, hemoglobin is released. Hemoglobin is
converted to methemoglobin by sodium nitrate, which together with sodium azide, produce
azidemethemoglobin. The absorbance is then measured at two wavelengths (570 and 880 nm) in order
to compensate for turbidity in the sample. The sample is collected from arterial or venous blood and
place on a microcuvette. For the sampling and survey, procedures and recommendations outlined in the
HEMOCUE Operating Manual were followed.
For the measurement of weight on children, SALTER scales graduated in kilograms were used; and to
gather height measurements, the UNICEF manufactured measuring boards graduated in centimeters
were used (Infantómetros). Procedures outlined in the Manual for Determination of Nutritional Status2
were followed. In order to achieve the standardized performance of the survey teams for all these
procedures, field tests were conducted to assure quality of measure among survey personnel.
E. Data Collection and Quality Control
The KPC data collection was conducted by the technical team from Project HOPE Jinotega and external
personnel with experience in this type of surveys. The collection of data took place approximately
within an intensive two-week fieldwork period. Project HOPE Jinotega used ten survey teams, which
were comprised of one supervisor and one interviewer in each team. The average time of the interview
including for anthropometrical measurements and hemoglobin determination was forty-five minutes.
Project HOPE’s technical personnel collected the survey information manually (supervisor, which in
several cases was non Project HOPE staff) and electronically by Project HOPE staff. Both roles were
1 HemoCue, Blood Hemoglobin Photometer. Operating Manual. Bergstens, HBG H. US 2003
2 COMO PESAR Y MEDIR NINOS. Procedures Manual for Measuring Nutritional Status, UN, Department of Technical Cooperation for Development and Office of Statistics.
New York, 1988.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 15
carried out by highly experienced individuals, which years of KPC experience. Those who utilized
PDAs for data entry were selected based on using said equipment previously. Those who collected the
information manually filled out the paper surveys with pen or pencil. This way of entering the responses
ensured the quality of the surveys
F. Data Analysis
All information collected was entered into the Microsoft Access™ program, by the Project HOPE
Jinotega information systems specialist. Data analysis was made by comparing the specific results
obtained for each supervision area with the average project coverage and with statistical data from the
SILAIS and ENDESA 2001. The results of the survey are presented in LQAS summary tables in
Section IV and discussed in Section V.
Information on weight, height and age was analyzed using the CDC statistical package, EpiNut, using
the population reference of 1978 of the US National Center for Health Statistics, used to determine
nutritional status of children using height for age and weight for age indicators, recommended by the
World Health Organization. Height, weight, and age data was analyzed using the EpiNut statistical
package of the CDC, using the 1978 population reference. The use of this reference population of 1978
is based on the fact that all well nourished children of all populations follow similar growth patterns.
For the midterm evaluation and with the support of the Central Ministry of Health, all project field staff
were trained on how to properly weigh and measure children. Height was determined by laying the
child down and measuring.
Weighted population
It is important to remember that when information from different supervision areas is collected, the
specific estimates obtained for each area will not be exact. It is for this reason that an estimation of
coverage (with respective confidence intervals) areas must be calculated for the total project area by
combining all supervision areas with enough precision. This is accomplished by weighing the results of
each supervision area according to the total population in the project area.
In other words, the weighted population is simply the proportion of the total programmed area
population living within a specific lot or area. Furthermore, this weighted population can be used to
calculate coverage for the total project area as well as confidence intervals.
Even though the weighted estimates are considered more precise than the non-weighted estimates, the
difference between these two is generally not that large. In order to carry out the comparison of data
between all supervision areas and the total project area, the population was weighted for each one of the
supervision areas.
Table 7: Total estimate sample with weighted population:
Supervision area Sampling size
(n)
Population (N) Weighting (wi)
1. Jinotega 38 57,682 57,682 / 249,792 = 0.23
2. San Rafael del Norte 38 18,340 18,340 / 249,792 = 0.07
3. La Concordia 38 6,585 6,585 / 249,792 = 0.03
4. San Sebastián de Yalí 38 23,190 23,190 / 249,792 = 0.09
5. Santa María de Pantasma 38 37,761 37,761 / 249,792 = 0.15
6. Wiwilí 38 33,462 33,462 / 249,792 = 0.13
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 16
7. El Cua 38 46,305 46,305 / 249,792 = 0.19
8. San José de Bocay 38 26,467 26,467 / 249,792 = 0.11
Total project area 304 248,162
The following formulas were used to calculate adjusted (weighted) coverage rates for the entire region at
95% Confidence Intervals (C.I.) for stratified random sampling using weighted coverage rates:
wti pi
   p w 

  
i
ii
n
qp wti
2
96.1C.I.
where:
pw = adjusted coverage rates for a region with multiple Supervision Areas
C.I. = confidence interval for a coverage proportion for a region with multiple Supervision Areas
1.96 = Z score for the 95% confidence interval
wti = the weight for the ith Supervision Area described in Table 10
pi = the coverage proportion for the ith Supervision Area
qi = 1 – pi
ni = the sample size from the ith Supervision Area
The formula for the C.I. was taken from Valadez, Joseph J. “Assessing Child Survival Programs in
Developing Countries” Harvard School of Public Health. Boston. Massachusetts. p94. 1991.
See Annex A for a complete list of all calculations by indicator, including average coverage rates, adjusted
coverage rates (by population weigh), and confidence intervals calculations.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 17
Table 8: KPC Final results by indicator – Department of Jinotega, Nicaragua
Baseline March 2003 Midterm March 2005 Finally Evaluation March 2007
Indicator (for the entire project area) Average
Coverage
Rates (%)
Adjusted
Coverage
Rates (%)
95% C.I.
(+ / -)
Average
Coverage
Rates (%)
Adjusted
Coverage
Rates (%)
95% C.I.
(+ / -)
Average
Coverage
Rates (%)
Adjusted
Coverage
Rates (%)
95% C.I.
(+ / -)
GOAL
Maternal and Newborn Care Maternal and Newborn Care
1. % of mothers of children aged 0-23 months who
report having had at least one prenatal visit with a
doctor or nurse.
89.1 89.0 3.8 93.4 93.5 2.9 95.4 94.9 2.7 94%
2. % of mothers of children aged 0-23 months that report
receiving on their arm the dT vaccine during the last
pregnancy.
85.5 85.4 4.2 89.8 90.2 3.5 89.8 88.6 4.0 **
3. % of mothers of children aged 0-23 months who
report having had at least two prenatal visit with a
doctor or nurse.
39.5 35.5 5.8 37.5 35.0 5.9 36.8 39.8 6.1 *
4. % of children aged 0-23 months whose birth was
attended by a doctor or nurse. 52.3 51.4 5.8 56.6 53.7 5.7 73.4 71.2 5.5 65%
5. % of mothers of children aged 0-11 months who
report having had at least one postpartum visit. 37.5 32.4 7.9 37.5 32.5 7.9 54.6 50.8 8.5 45%
Nutrition and Micronutrients
6. % of children aged 0-23 months weighed in the last
four months according to growth monitoring card. 73.7 67.9 6.0 86.6 86.1 4.5 75.4 74.5 5.4 90%
7. % of children aged 0-23 months with low weight
(Weight-For-Age) (<2Z). 6.6 7.6 3.5 5.9 7.5 3.5 1.0 1.0 1.3 8%
8. % of children aged 0-23 months stunted (Height-For￾Age) (<2Z). 19.1 19.8 4.9 16.4 17.2 4.7 2.0 2.0 1.9
9. % of children aged 0-23 months with anemia
(hemoglobin level < 11mg/dl). 39.8 41.9 6.1 47.4 47.0 6.2 47.4 47.2 6.2 30%
Breastfeeding Promotion
10. % of mothers of children aged 0-23 months who
report having breastfed within the first hour after birth 67.8 67.8 5.9 83.2 81.6 5.6 76.3 76.9 5.2 80%
11. % of mothers of children aged 0-23 months who
report having breastfed within the first 8 hours after
birth.
82.4 82.4 4.7 82.4 82.4 4.9 85.5 85.3 4.4 **
12. % of infants aged 0-5 months who received only
breast milk in the past 24 hours. 58.2 56.0 12.5 40.8 51.8 9.0 56.2 55.9 10.8 70%
Immunization
13. % of children aged 12-23 months with all
recommended vaccines at the moment of their first
birthday according to the growth monitoring card.
70.4 68.7 8.2 80.9 80.5 6.9 82.0 77.6 8.0 80%
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 18
Baseline March 2003 Midterm March 2005 Finally Evaluation March 2007
Indicator (for the entire project area) Average
Coverage
Rates (%)
Adjusted
Coverage
Rates (%)
95% C.I.
(+ / -)
Average
Coverage
Rates (%)
Adjusted
Coverage
Rates (%)
95% C.I.
(+ / -)
Average
Coverage
Rates (%)
Adjusted
Coverage
Rates (%)
95% C.I.
(+ / -)
GOAL
Control of Diarrheal Diseases
14. % of mothers of children aged 0-23 months that know
at least two signs of dehydration due to diarrhea. 28.3 26.9 5.5 18.8 16.8 4.6 32.2 31.1 5.6 40%
15. % of mothers of children aged 0-23 months who
report having sought assistance or counseling from a
health unit or CORU during the child’s last diarrheal
episode.
33.6 35.7 8.8 49.5 52.5 9.9 39.6 39.9 10.6 50%
16. % of mothers of children aged 0-23 months with a
diarrheal episode in the last two weeks who report
giving as much or more food to their child.
46.0 45.5 9.5 44.0 44.9 10.4 32.3 31.3 10.4 60%
17. % of mothers with children aged 0-23 months with a
diarrheal episode in the last two weeks who report
giving as much or more liquids or breast milk to their
child
69.7 69.1 8.8 69.7 71.0 9.4 70.8 64.7 10.7 80%
18. % of mothers of children aged 0-23 months who
report washing their hands with water and soap
before the preparation of meals, before feeding
children, after defecation and after tending a child that
has defecated
19.1 19.2 4.9 11.2 11.0 3.9 7.6 6.9 3.1 35%
Pneumonia Case Management
19. % of children aged 0-23 months with cough and fast
breathing in the last two weeks taken to a health unit. 60.4 59.7 10.6 54.9 54.7 10.7 55.4 53.3 11.5 75%
20. % of mothers of children aged 0-23 months who can
identify fast breathing as a danger sign for
pneumonia.
74.3 76.0 5.2 78.9 77.6 5.1 85.9 83.3 4.8 90%
Child Spacing
21. % of children aged 0-23 months who were born at
least 24 months after the previous surviving child. 83.9 83.9 4.5 86.5 85.7 4.4 78.0 76.6 5.2 86%
22. % of mothers of children aged 12-23 months who
desire no more children in the next two years, who
are using some type of modern child spacing method.
62.3 65.3 8.7 91.4 90.3 5.4 100.0 100.0 0.0 85%
HIV/AIDS
23. % of mothers of children aged 0-23 months who know
at least one way to prevent STIs-HIV/AIDS. 44.1 43.3 6.0 17.4 14.0 4.2 22.0 20 4.8 15%
*indicador monitoreado a solicitud de Bonnie Kittle, en consecuencia, no hay meta.
**Indicador no tiene meta, pues solamente se ha dado seguimiento sin ser un objetivo del programa
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 19
Table 9: Rapid Catch Indicators
Baseline March 2003 Midterm March 2005 Finally Evaluation March 2007
Indicator (for the entire project area) Average
Coverage
Rates (%)
Adjusted
Coverage
Rates (%)
95% C.I.
(+ / -)
Average
Coverage
Rates (%)
Adjusted
Coverage
Rates (%)
95% C.I.
(+ / -)
Average
Coverage
Rates (%)
Adjusted
Coverage
Rates (%)
95% C.I.
(+ / -)
1. % of children aged 0-23 months with low weight (weight for
age) (<2Z).
6.6 7.6 3.5 5.9 7.5 3.5 1.0 1.0 1.3
2. % of children aged 0-23 months who were born at least 24
months after the previous surviving child. 83.9 83.9 4.5 86.5 85.7 4.4 78.0 76.6 5.2
3. % of children aged 0-23 months whose birth was attended by a
doctor or nurse. 52.3 51.4 5.8 56.6 53.7 5.7 73.4 71.2 5.5
4. % of mothers of children aged 0-23 months that received two
doses of the dT vaccine during the last pregnancy, according to
health card.
37.5 35.0 5.9 95.7 96.1 3.3
5. % of infants aged 0-5 months who received breast milk only in
the past 24 hours. 58.2 56.4 12.5 40.8 51.8 9.0 56.2 55.9 10.8
6. % of children aged 6-9 months who received breast milk and
complementary feeding in the past 24 hours. 80.4 86.8 8.9 77.4 76.7 11.2 79.2 76.8 12.1
7. % of children aged 12-23 months with all recommended
vaccines at the moment of their first birthday according to the
growth monitoring card
71.1 69.6 8.1 80.9 80.5 6.9 75.0 69.5 8.0
8. % of children aged 12-23 months that received the MMR
vaccine according to the growth monitoring card 71.1 69.6 8.1 81.6 80.7 6.9 78.3 72.5 7.7
9. % of children aged 0-23 months who slept under an
impregnated mosquito net the previous night 27.3 25.5 5.4 33.2 30.2 5.6
10. % of mothers of children aged 0-23 months that know at least
two signs of childhood illnesses indicating the need for
treatment
43.4 46.8 6.2 90.5 90.7 3.5 91.1 91.2 3.4
11. % of children aged 0-23 months that received more liquids and
continued feeding during an illness in the last two weeks 55.2 53.4 8.4 13.3 14.4 6.0 8.0 7.3 4.3
12. % of mothers of children aged 0-23 months who know at least
two ways to prevent STIs-HIV/AIDS 5.9 6.3 3.2 17.4 14.0 4.2 22.0 20 4.8
13. % of mothers of children aged 0-23 months who report washing
their hands with water and soap before the preparation of
meals, before feeding children, after defecation and after
tending a child that has defecated
19.1 19.2 4.9 11.2 11.0 3.9 7.6 6.9 3.1
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 20
IV. Results:
Discussion and Analysis
Below are graphs and discussion on the 19 project indicators of the project. Each graph shows Baseline (March
2003), midterm (March 2005) and final (March 2007) evaluation data to facilitate analysis of project indicators
during the life of the project.
A. Maternal and Newborn Care
The percentage of mothers reported having had at least one prenatal visit during their last pregnancy increased
from 89% to 94.9% by the final evaluation.
Percentage of mothers who reporting having two prenatal visits during their last pregnancy increased from 35.5%
at baseline to 39.8% at the final evaluation.
89.0% 93.5% 94.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.1 % of mothers of children aged 0-23 months who report having had at least one
prenatal visit with a doctor or nurse.
35.5% 35.0% 39.8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.2 % of mothers of children aged 0-23 months who report having had a two prenatal
visit with a doctor or nurse acording card.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 21
Institutional births also increased during the life of the project from 51.4% at baseline to 71.2% at final evaluation.
The percentage of mothers who report having a postpartum visit also increased, from 32.4% at baseline to 50.8%
at the final evaluation.
71.2%
51.4% 53.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.3 % of children aged 0-23 months old whose birth was attended by a doctor or
nurse.
50.8%
32.4% 32.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.4 % of mothers who report having had at least one postpartum visit.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 22
B. Nutrition and Micronutrients
En the last two years, the project has witnessed an increase in number of children weighed, as captured by the
baseline and midterm evaluations, which recorded 67.9% and 86.1% respectively. Although the PROCOSAN
program has been supporting activities in many communities, results of the final evaluation reveal that only 74.5%
children were weighed in the last 4 months, according to growth monitoring card.
The prevalence of children with satisfactory growth (weight for age) increased from 92% at baseline to 99% at the
final evaluation.
74.5%
86.1%
67.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.5 % of children aged 0-23 months, weighed in the last four months according to
growth monitoring card.
92.0% 93.0% 99.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.6 % of children aged 0-23 months old with satisfactory growth according to
weight for age (<2Z)
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 23
C. Breastfeeding Promotion
Through the life of the project, there were slight increases in breastfeeding within an hour of birth. At baseline,
67.8% mothers initiated breastfeeding within the hour and by the final evaluation 76.9% of mothers interviewed
had adopted the behavior.
Exclusive breastfeeding continues to be a challenging indicator. Baseline revealed that only 56.4% of mothers
practiced EBF and the result at final evaluation had decreased slightly to only 55.9%
76.9% 67.8% 71.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.8 % of children aged 0- 23 months old who were breastfed within the first hour
after birth
55.9%
51.8%
56.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.9 % of infants aged 0-5 months who received only breast milk in the past 24
hours
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 24
53.0% 52.8%
58.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.7 % of children aged 0-23 months old with out anemia
Hb > 11 mg/dl
There was a slight decrease in children with anemia, from 58% at baseline to 52.8% at the final evaluation.
D. Immunization
The number of children completely vaccinated by their first birthday increased from baseline (68.7%) to midterm
(80.5%) but decreased slightly by the final evaluation (77.6%).
80.5% 77.6%
68.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.9 % of children 12-23 months fully immunized (BCG, OPV3, Pentavalente 3, and
MMR) by 12 months
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 25
E. Control of Diarrheal Diseases
31.3%
45.5% 44.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.11 % of mothers of children aged 0-23 months with a diarrheal episode in the
last two weeks who report giving as much or more food to their child
69.1% 71.0% 64.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.12 % of mothers of children aged 0-23 months with a diarrheal episode in the
last two weeks who report giving as much or more liquids or breast milk to their
child
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 26
Careseeking behavior of mothers, whether at a CORU or health post increased from baseline (35.7%) to midterm
(52.5%) but decreased by the final evaluation (39.9%).
Regarding hand washing, there were no major changes in mothers’ behaviour, as only 19.2% of mothers washed
their hands the four times indicated, while by the final evaluation, only 6.9% of mothers interviewed wash their
hands as recommended.
39.9%
52.5%
35.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.13 % of mothers of children aged 0-23 months who report having sought
assistance or counseling from a health unit or CORU during the child’s last
diarrhea episode.
19.2%
11.0%
6.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.14 % of mothers of children aged 0-23 months who report washing their hands
with water and soap before the preparation of meals, before feeding children, after
defecation and after tending a child that has defecated
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 27
At the end of the project, one can see a slight increase in percentage of mothers who can name at least two
danger signs for diarrhea.
F. Pneumonia Case Management
The percentage of mothers going to the health facility when their child had fast breathing in the last two weeks
decreased from the baseline of 59.7% to 53.3% at final evaluation.
31.1%
16.8%
26.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.15 % of mothers of who can identify at least two danger signs for diarrhea
59.7% 54.7% 53.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.16 % of children aged 0-23 months with cough and fast breathing in the last two
weeks taken to a health unit
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 28
The percentage of mothers who can identify fast breathing as a sign of pneumonia increased from 76% to 83.3%
by the final evaluation.
G. Child Spacing
The percentage of children aged 12-23 months who were born at least 24 months alter the previous sibling
decreased from the baseline of 83.9% to 76.6% by the final evaluation.
77.6% 83.3%
76.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.17 % of mothers who identify fast breathing as a danger sign of pneumonia
85.7%
76.6%
83.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.18 % of children aged 12 to 23 months old that were born at least 24 months
after previous surviving child
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 29
Family planning coverage has increased significantly from the baseline, moving from 65.3% to 100% by the final
evaluation. This result is a product of the various strategies implemented by the project in coordination with the
Ministry of Health.
H. HIV/AIDS
The percent of mothers who know at least two ways to prevent HIV/AIDS increased dramatically from the baseline
of 6.3% to 20%, an increase of over three times.
90.3%
100.0%
65.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.19 % of mothers with children aged 12 to 23 months old who are not pregnant,
desire no more children or are not sure and report using a modern family planning
method
20.0%
14.0%
6.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LB2003 MTE2005 EF2007
Fig.20 % of mothers of children aged 0-23 months who know at least two ways to
prevent HIV / AIDS / STIs
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 30
Table 11: KPC Final results by indicator – Department of Jinotega, Nicaragua
Indicator (for the entire project area) Numerator Denominator
Average
Coverage Rates
(%)
Adjusted
Coverage Rates
(%)
95% C.I.
(+ / -)
1. % of children aged 0-23 months weighed in the last four
months according to growth monitoring card. 214 284 75.4 74.5 5.4
2. % of children aged 0-23 months with low weight (Weight￾For-Age) (<2Z). 3 304 1.0 1.0 1.3
3. % of children aged 0-23 months stunted (Height-For-Age)
(<2Z). 6 304 2.0 2.0 1.9
4. % of children aged 0-23 months with anemia (hemoglobin
level < 11mg/dl). 144 304 47.4 47.2 6.2
5. % of mothers of children aged 0-23 months who report
having breastfed within the first hour after birth 232 304 76.3 76.9 5.5
6. % of mothers of children aged 0-23 months who report
having breastfed within the first 8 hours after birth. 260 304 85.5 85.3 4.4
7. % of infants aged 0-5 months who received only breast
milk in the past 24 hours. 50 89 56.2 55.9 10.8
8. % of mothers of children aged 0-23 months that know at
least two signs of dehydration due to diarrhea. 98 304 32.2 31.1 5.6
9. % of mothers of children aged 0-23 months who report
having sought assistance or counseling from a health unit
or CORU during the child’s last diarrheal episode.
38 96 39.6 39.9 10.6
10. % of mothers of children aged 0-23 months with a
diarrheal episode in the last two weeks who report giving
as much or more food to their child.
31 96 32.3 31.3 10.4
11. % of mothers with children aged 0-23 months with a
diarrheal episode in the last two weeks who report giving
as much or more liquids or breast milk to their child
68 96 70.8 64.7 10.7
12. % of children aged 0-23 months with cough and fast
breathing in the last two weeks taken to a health unit. 46 83 55.4 53.3 11.5
13. % of mothers of children aged 0-23 months who can
identify fast breathing as a danger sign for pneumonia. 261 304 85.9 83.3 4.8
14. % of children aged 12-23 months with all recommended
vaccines at the moment of their first birthday according to
the growth monitoring card.
114 139 82.0 77.6 8.0
15. % of mothers of children aged 0-23 months who know at
least two way to prevent STIs-HIV/AIDS. 67 304 22.0 20.0 4.8
16. % of children aged 0-23 months who were born at least
24 months after the previous surviving child. 237 304 78.0 76.7 5.2
17. % of mothers of children aged 12-23 months who desire
no more children in the next two years, who are using
some type of modern child spacing method.
139 139 100.0 100.0 0.0
18. % of mothers of children aged 0-23 months who report
having had at least one prenatal visit with a doctor or
nurse.
290 304 95.4 94.9 2.7
19. % of mothers of children aged 0-23 months that report
receiving on their arm the dT vaccine during the last
pregnancy.
273 304 89.8 88.6 4.0
20. % of mothers of children aged 0-11 months who report
having had at least one postpartum visit. 83 152 54.6 50.8 8.5
21. % of children aged 0-23 months whose birth was
attended by a doctor or nurse. 223 304 73.4 71.2 5.5
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 31
Table 12: Rapid Catch Indicators
Indicator (for the entire project area) Numerator Denominator
Average
Coverage Rates
(%)
Adjusted
Coverage Rates
(%)
95% C.I.
(+ / -)
1. % of children aged 0-23 months with low weight
(weight for age) (<2Z).
3 304 1.0 1.0 1.3
2. % of children aged 0-23 months who were born at least
24 months after the previous surviving child. 237 304 78.0 76.7 5.2
3. % of children aged 0-23 months whose birth was
attended by a doctor or nurse. 223 304 73.4 71.2 5.5
4. % of mothers of children aged 0-11 months that
received two doses of the dT vaccine during the last
pregnancy, according to health card.
112 117 95.7 96.1 3.3
5. % of infants aged 0-5 months who received breast milk
only in the past 24 hours. 50 89 56.2 55.9 10.8
6. % of children aged 6-9 months who received breast
milk and complementary feeding in the past 24 hours. 38 48 79.2 76.8 12.1
7. % of children aged 12-23 months with all
recommended vaccines at the moment of their first
birthday according to the growth monitoring card
114 139 82.0 77.6 8.0
8. % of children aged 12-23 months that received the
MMR vaccine according to the growth monitoring card 119 139 85.6 80.8 7.6
9. % of children aged 0-23 months who slept under an
impregnated mosquito net the previous night 101 304 33.2 30.2 5.6
10. % of mothers of children aged 0-23 months that know
at least two signs of childhood illnesses indicating the
need for treatment
277 304 91.1 91.2 3.4
11. % of children aged 0-23 months that received more
liquids and continued feeding during an illness in the
last two weeks
12 150 8.0 7.3 4.3
12. % of mothers of children aged 0-23 months who know
at least two ways to prevent STIs-HIV/AIDS 67 304 22.0 20.0 4.8
13. % of mothers of children aged 0-23 months who report
washing their hands with water and soap before the
preparation of meals, before feeding children, after
defecation and after tending a child that has defecated
23 304 7.6 6.9 3.1
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 32
Annex A: Indicators by Supervision Area
The following LQAS tables summarize the results found from the KPC midterm survey. Appendix F shows each indicator by supervision area, along with
decision rules and average coverage rates. 1: Jinotega; 2:San Rafael Norte; 3: La Concordia; 4:Yali; 5: Pantasma; 6: Wiwili; 7: El Cua; 8: Bocay.
Table 10: Breastfeeding
Baseline March 2003 Midterm Evaluation March 2005 Final Evaluation 2007
Indicator
1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD
0-11
months 18 17 17 15 18 17 14 14 86.1 15 16 17 16 18 15 15 13 13 80.92 14 16 16 16 18 16 18 16 17 87.50 15
12-23
months 14 15 18 17 16 16 10 12 78.7 13 15 17 17 16 16 16 15 18 85.53 15 17 13 15 16 17 16 16 15 82.24 14
Total 32 32 35 32 34 33 24 26 82.4 31 34 33 34 31 31 28 31 83.22 33 29 31 34 33 34 32 32 84.87
% of mothers of children aged 0-
23 months who report having
breastfed within the first 8 hours
after birth.
Weighted 0.21 0.06 0.04 0.08 0.13 0.14 0.1 0.8 0.84 0.19 0.06 0.03 0.08 0.13 0.12 0.13 0.08 0.82 0.2 0.06 0.02 0.08 0.13 0.11 0.16 0.09 0.85
0-11
months 15 14 12 13 14 11 14 12 69.5 11 14 15 13 16 15 13 13 9 71.05 12 15 13 14 17 14 18 15 14 78.95 13
12-23
months 10 13 14 16 15 14 8 9 66.0 11 13 16 13 14 13 12 15 14 72.37 12 14 13 15 13 12 16 15 14 73.68 12
Total 25 27 26 29 29 25 22 21 67.8 27 31 26 30 28 25 28 23 71.71 29 26 29 30 26 34 30 28 76.32
% of mothers of children aged 0-
23 months who report having
breastfed within the first hour after
birth.
Weighted 0.16 0.05 0.03 0.07 0.11 0.09 0.1 0.07 0.68 0.17 0.06 0.02 0.07 0.12 0.1 0.13 0.06 0.71 0.18 0.05 0.02 0.07 0.11 0.12 0.15 0.08 0.77
0-11
months 5 8 5 8 5 3 4 8 58.2 5 6 2 3 4 5 4 2 40.79 5 3 3 10 5 11 9 4 56.18
% of infants aged 0-5 months who
received only breast milk in the
past 24 hours. Weighted 0.13 0.06 0.02 0.07 0.08 0.05 0.09 0.06 0.56 0.24 0.04 0.01 0.03 0.06 0.06 0.06 0.02 0.52 0.1 0.04 0.01 0.07 0.06 0.11 0.12 0.05 0.56
Source: Primary data, Final Study, Child Survival – 2007.
By the final evaluation, we can see that only the municipality of San Rafael del Norte was unable to achieve average coverage for the 12-23 month old children
within 8 hours of birth breastfeeding indicator. Also by the final evaluation, all municipalities were able to achieve average coverage in the immediate (within an
hour) breastfeeding indicator, although the exclusive breastfeeding indicator remained unchanged from baseline (56%) to the final evaluation (56%).
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 33
Table 11: Nutrition
Baseline March 2003 Midterm Evaluation March 2005 Final Evaluation 2007
Indicator
1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD
0-11
months 11 19 18 18 16 6 14 10 83.0 14 15 18 17 19 16 17 15 9 82.89 14 16 16 16 16 18 11 11 11 79.31 13
12-23
months 9 16 17 17 14 5 10 5 65.0 10 14 18 16 17 14 17 16 10 80.26 14 14 14 15 14 7 15 10 10 71.22 12
Total 20 35 35 35 30 11 24 15 73.7 29 36 33 36 30 34 31 19 81.58 30 30 31 30 25 26 21 21 75.27
% of children aged 0-23 months
weighed in the last 4 months
according to growth monitoring
card.
Weighted 0.15 0.06 0.04 0.09 0.13 0.05 0.11 0.06 0.68 0.2 0.07 0.03 0.09 0.13 0.14 0.15 0.06 0.86 0.2 0.07 0.02 0.08 0.1 0.1 0.11 0.06 0.74
Source: Primary data, Final Study, Child Survival – 2007.
By the final evaluation, the municipalities of Pantasma, Wiwili, Cua and Bocay were unable to achieve average coverage for infants 0-23 months. In the 12-23
age group, the municipalities of El Cua, Pantasma and Bocay were unable to achieve average coverage.
Table 12: Immunization
Baseline March 2003 Midterm Evaluation March 2005 Final Evaluation 2007
Indicator
1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD
12-23
months 13 13 16 17 10 12 14 12 70.4 12 15 17 15 16 18 16 13 13 80.92 14 10 15 18 17 15 17 11 11 82.01 14
% of children aged 12-23 months
with all recommended vaccines at
the moment of their first birthday
according to the growth
monitoring card Weighted 0.16 0.05 0.03 0.08 0.08 0.09 0.12 0.08 0.69 0.19 0.06 0.02 0.07 0.15 0.12 0.12 0.07 0.81 0.14 0.06 0.03 0.09 0.13 0.12 0.14 0.06 0.78
Source: Primary data, Final Study, Child Survival – 2007.
Complete immunization coverage for children 12 to 23 months of age found was 78%.
The municipalities of El Cua and Bocay were the ones that were unable to achieve average coverage by the final evaluation, although overall, there was a
10% increase in results in this indicator from 69% at baseline to 78% at the final evaluation.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 34
Table 13: Diarrhea
Baseline March 2003 Midterm Evaluation March 2005 Final Evaluation 2007
Indicator
1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD
0-11
months 2 7 8 6 2 7 5 3 26.3 3 3 4 4 1 4 4 1 3 15.79 1 2 7 3 7 6 8 4 2 25.66 3
12-23
months 9 6 7 6 7 4 3 4 30.3 4 4 4 11 3 5 1 3 2 21.71 2 6 10 6 7 9 9 5 7 38.82 5
Total 11 13 15 12 9 11 8 7 28.3 7 8 15 4 9 5 4 5 18.75 8 17 9 14 15 17 9 9 32.24
% of mothers of children aged 0-
23 months that know at least two
signs of dehydration due to
diarrhea
Weighted 0.07 0.02 0.02 0.03 0.04 0.04 0.03 0.02 0.27 0.04 0.01 0.01 0.01 0.04 0.02 0.02 0.01 0.17 0.05 0.03 0.01 0.03 0.06 0.06 0.04 0.03 0.31
0-11
months 5 1 3 1 2 3 5 1 36.2 3 2 2 4 6 3 4 4 50.00 2 4 1 1 2 2 2 0 35.00
12-23
months 5 1 6 2 0 3 0 2 31.1 4 1 6 3 4 0 6 2 49.06 1 4 2 6 5 1 2 3 42.86
Total 10 2 9 3 2 6 5 3 33.6 7 3 8 7 10 3 10 6 49.53 3 8 3 7 7 3 4 3 39.58
% of mothers of children aged 0-
23 months who report having
sought assistance or counseling
from a health unit or CORU during
the child’s last diarrheal episode.
Weighted 0.15 0.01 0.03 0.03 0.02 0.05 0.04 0.02 0.35 0.15 0.03 0.03 0.06 0.11 0.02 0.1 0.03 0.53 0.08 0.05 0.02 0.07 0.08 0.03 0.06 0.01 0.40
0-11
months 2 4 5 1 4 5 2 2 45.5 2 3 1 2 3 7 3 4 44.64 1 2 1 0 2 1 0 3 25.00
12-23
months 5 0 3 2 5 4 1 7 46.6 3 1 2 2 4 5 3 3 43.40 3 4 1 3 0 3 2 5 37.50
Total 7 4 8 3 9 9 3 9 46.0 5 4 3 4 7 12 6 7 44.02 4 6 2 3 2 4 2 8 31.25
% of mothers of children aged 0-
23 months with a diarrheal
episode in the last two weeks who
report giving as much or more
food to their child.
Weighted 0.11 0.03 0.02 0.03 0.1 0.08 0.03 0.06 0.46 0.11 0.03 0.01 0.04 0.07 0.09 0.06 0.04 0.45 0.1 0.04 0.01 0.03 0.02 0.04 0.03 0.04 0.31
0-11
months 5 4 5 1 7 6 5 5 65.5 2 3 1 3 6 7 6 9 66.07 1 4 1 1 4 3 4 7 62.50
12-23
months 6 2 6 3 6 9 3 10 73.8 6 2 5 4 7 6 5 4 73.58 3 6 2 7 6 5 3 11 76.79
Total 11 6 11 4 13 15 8 15 69.7 8 5 6 7 13 13 11 13 69.83 4 10 3 8 10 8 7 18 69.64
% of mothers of children aged 0-
23 months with a diarrheal
episode in the last two weeks who
report giving as much or more
liquids or breast milk to their child.
Weighted 0.17 0.04 0.03 0.04 0.13 0.1 0.09 0.08 0.69 0.09 0.04 0.02 0.04 0.16 0.05 0.08 0.09 0.57 0.1 0.07 0.02 0.09 0.1 0.08 0.11 0.09 0.65
0-11
months 6 4 5 5 5 3 5 1 22.4 2 2 2 5 4 1 3 1 0 11.84 0 1 2 2 1 1 1 1 3 7.89 0
12-23
months 4 2 7 3 4 3 1 0 15.8 1 3 2 2 0 1 3 4 1 10.53 0 1 2 3 0 1 1 3 0 7.24 0
Total 10 6 12 8 9 6 6 1 19.1 5 4 7 4 2 6 5 1 11.18 2 4 5 1 2 2 4 3 7.57
% of mothers of children aged 0-
23 months who report washing
their hands with water and soap
before the preparation of meals,
before feeding children, after
defecation and after tending a
child that has defecated Weighted 0.06 0.01 0.01 0.02 0.04 0.02 0.03 0 0.19 0.03 0.01 0.01 0.01 0.01 0.02 0.02 0 0.11 0.01 0.01 0 0 0.01 0.01 0.02 0.01 0.07
Source: Primary data, Final Study, Child Survival – 2007.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 35
The above table shows a slight increase in knowledge on signs of dehydration, although the municipalities that were unable to achieve average coverage were
Jinotega and Bocay. There were slight increases in careseeking practices, prevention of diarrhea and increased feeding during illnesses but in some cases,
results at the final evaluation were lower than those achieved at baseline (i.e., handwashing, liquids and food during diarrheal episodes).
Table 14. Pneumonia case management:
Baseline March 2003 Midterm Evaluation March 2005 Final Evaluation 2007
Indicator
1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD
0-11
months 3 5 1 4 5 3 5 4 62.5 4 2 3 2 5 4 3 1 52.17 5 1 4 3 3 4 2 1 58.97
12-23
months 4 1 5 4 2 0 6 6 58.3 3 3 3 2 3 2 4 6 57.78 0 2 3 5 2 4 1 6 52.27
Total 7 6 6 8 7 3 11 10 60.4 7 5 6 4 8 6 7 7 54.98 5 3 7 8 5 8 3 7 55.62
% of children aged 0-23 months
with cough and fast breathing in
the last two weeks taken to a
health unit.
Weighted 0.15 0.04 0.03 0.06 0.1 0.04 0.1 0.08 0.60 0.13 0.05 0.02 0.04 0.11 0.06 0.09 0.05 0.55 0.1 0.05 0.02 0.09 0.09 0.06 0.07 0.06 0.53
0-11
months 16 14 15 13 15 12 16 15 76.3 13 17 13 18 15 15 17 14 13 80.26 14 15 18 18 17 16 18 16 15 87.50 15
12-23
months 16 13 14 18 14 10 14 11 72.4 12 15 16 18 15 13 15 11 15 77.63 13 15 18 19 15 16 16 14 15 84.21 14
Total 32 27 29 31 29 22 30 26 74.3 32 29 36 30 28 32 25 28 78.95 30 36 37 32 32 34 30 30 85.86
% of mothers of children aged 0-
23 months who can identify fast
breathing as a danger sign for
pneumonia
Weighted 0.2 0.05 0.03 0.07 0.11 0.08 0.13 0.08 0.76 0.2 0.05 0.03 0.07 0.12 0.12 0.11 0.07 0.78 0.18 0.07 0.03 0.08 0.13 0.12 0.15 0.08 0.83
Source: Primary data, Final Study, Child Survival – 2007.
The table shows that more mothers at final were able to identify fast breathing as a danger sign of pneumonia and all municipalities were above the decision
rule. Careseeking among mothers remains a problem and has actually decreased from baseline (60%) to final evaluation (53%).
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 36
Table 15: Maternal and newborn care
Baseline March 2003 Midterm Evaluation March 2005 Final Evaluation 2007
Indicator
1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD
0-11
months 18 19 19 19 16 17 16 13 90.1 16 19 19 19 18 18 18 18 15 94.74 16 18 19 19 19 19 17 19 16 96.05 16
12-23
months 18 19 18 18 17 15 17 12 88.2 15 18 19 18 19 17 16 19 14 92.11 16 18 19 19 19 18 18 18 15 94.74 16
Total 36 38 37 37 33 32 33 25 89.1 37 38 37 37 35 34 37 29 93.42 36 38 38 38 37 35 37 31 95.39
% of mothers of children aged 0-
23 months who report having had
at least one prenatal visit with a
doctor or nurse.
Weighted 0.23 0.07 0.04 0.09 0.13 0.12 0.14 0.08 0.89 0.23 0.07 0.03 0.09 0.15 0.13 0.17 0.08 0.93 0.22 0.07 0.03 0.09 0.15 0.12 0.18 0.09 0.95
0-11
months 18 19 19 18 16 14 16 12 86.8 15 18 19 18 17 17 17 17 14 90.13
16 17 19 18 18 18 15 19 14 90.79 16
12-23
months 18 18 18 17 16 13 16 12 84.2 14 18 19 16 18 17 15 19 14 89.47
15 15 19 18 18 18 18 16 13 88.82 15
Total 36 37 37 35 32 27 32 24 85.5 36 38 34 35 34 32 36 28 89.80 32 38 36 36 36 33 35 27 89.80
% of mothers of children aged 0-
23 months that report receiving on
their arm the dT vaccine during
the last pregnancy.
Weighted 0.23 0.07 0.04 0.09 0.13 0.12 0.14 0.08 0.89 0.22 0.07 0.03 0.08 0.14 0.12 0.16 0.07 0.90 0.19 0.07 0.03 0.09 0.14 0.12 0.17 0.08 0.89
0-11
months 6 11 14 7 7 5 4 3 37.5 5 8 11 13 9 5 5 3 3 37.50 5 8 17 12 12 13 8 9 4 54.61 8
% of mothers of children aged 0-
11 months who report having had
at least one postpartum visit. Weighted 0.08 0.04 0.03 0.03 0.06 0.04 0.03 0.02 0.32 0.1 0.04 0.02 0.04 0.04 0.04 0.03 0.02 0.32 0.1 0.07 0.02 0.06 0.1 0.06 0.09 0.02 0.51
0-11
months 12 13 16 9 11 4 12 3 52.6 8 14 16 15 13 7 8 5 5 54.61 9 12 19 17 16 18 11 14 9 76.32 13
12-23
months 13 12 14 12 10 5 11 2 52.0 8 15 17 14 14 10 4 10 5 58.55 9 16 19 15 13 14 12 11 7 70.39 12
Total 25 25 30 21 21 9 23 5 52.3 29 33 29 27 17 12 15 10 56.58 28 38 32 29 32 23 25 16 73.36
% of children aged 0-23 months
whose birth was attended by a
doctor or nurse.
Weighted 0.16 0.05 0.03 0.05 0.08 0.03 0.1 0.02 0.51 0.18 0.06 0.02 0.06 0.07 0.05 0.07 0.03 0.54 0.17 0.07 0.02 0.07 0.13 0.08 0.12 0.04 0.71
Source: Primary data, Final Study, Child Survival – 2007.
In the above table, we observe that the municipalities that consistently have fallen below average coverage are Wiwili, El Cua and Bocay, although overall,
indicators have improved considerably from baseline.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 37
Table 16: Child spacing:
Baseline March 2003 Midterm Evaluation 2005 Final Evaluation 2007
Indicator
1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD
0-11
months 16 16 18 18 15 14 16 10 80.9 14 17 17 16 18 17 17 18 14 88.16 15 14 16 17 15 13 15 14 11 75.66 13
12-23
months 18 17 19 15 17 14 16 16 86.8 15 13 17 17 18 15 19 16 14 84.87 14 16 14 19 15 16 14 16 12 80.26 14
Total 34 33 37 33 32 28 32 26 83.88 30 34 33 36 32 36 34 28 86.51 30 30 36 30 29 29 30 23 77.96
% of children aged 0 to 23
months old that were born at
least 24 months after previous
surviving child
Weighted 0.21 0.06 0.04 0.08 0.13 0.1 0.13 0.08 0.84 0.19 0.06 0.03 0.08 0.13 0.14 0.15 0.07 0.86 0.18 0.06 0.03 0.07 0.12 0.1 0.15 0.06 0.77
12-23
months 12 9 11 11 12 11 11 9 62.3 10 16 16 19 18 18 18 17 17 91.45 16 19 19 17 17 16 16 17 18 100.00 16
% of mothers with children
aged 12 to 23 months old who
are not pregnant, desire no
more children or are not sure
and report using a modern
family planning method Weighted 0.16 0.03 0.02 0.06 0.12 0.09 0.09 0.08 0.65 0.2 0.06 0.03 0.08 0.15 0.14 0.15 0.09 0.90 0.23 0.07 0.03 0.09 0.15 0.13 0.19 0.11 1.00
Source: Primary data, Final Study, Child Survival – 2007.
The percentage of mothers that maintained 2 years spacing between children witnessed a reduction from 84% to 77% at the final evaluation. The municipality
of Bocay was below average coverage.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 38
Table 18: STIs-HIV/AIDS:
Baseline March 2003 Midterm Evaluation March 2005 Final Evaluation 2007
Indicator
1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD 1 2 3 4 5 6 7 8 % RD
0-11
months 2 0 0 1 1 2 1 0 4.605 0 4 6 5 1 2 1 2 2 15.13 1 7 8 8 6 0 2 3 2 23.68 2
12-23
months 3 1 5 1 0 0 1 0 7.237 0 3 5 13 2 2 1 3 1 19.74 1 4 9 3 5 4 4 2 0 20.39 2
Total 5 1 5 2 1 2 2 0 5.921 7 11 18 3 4 2 5 3 17.43 11 17 11 11 4 6 5 2 22.04
% of mothers of children aged 0-
23 months who know at least
one way to prevent STIs￾HIV/AIDS.
Weighted 0.03 0.00 0.01 0.00 0.00 0.01 0.01 0.00 0.06 0.04 0.02 0.01 0.01 0.02 0.01 0.02 0.01 0.14 0.07 0.03 0.01 0.03 0.02 0.02 0.02 0.01 0.20
Source: Primary data, Final Study, Child Survival – 2007.
Although there was an increase from 6% at baseline to 20% at the final evaluation in knowledge among mothers on how to prevent STIs and HIV/AIDs, the
municipalities of Pantasma and Bocay did not achieve average coverage. As these two municipalities have consistently been below average coverage for this
and other indicators, they would be priority areas for any future governmental or non governmental programs.
VI. BIBLIOGRAPHY
1. Espeut, D., CSTS., The CORE Group. Manual de Actividades de Campo, KPC 2000+. August 2001.
2. Valadez, Joseph. Guía Sobre Metodología LQAS. 2001.
3. INEC-MINSA. Encuesta Nicaragüense de Demografía y Salud 2001, ENDESA.
4. Valadez, Joseph. Assessing Child Survival Programs in Developing Countries. Harvard School of Public Health. 1991.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 33
Annex B: KPC Survey 0-11 month old
ENTREVISTA
*MADRES CON NIÑOS (AS) ENTRE 0 a 11 MESES*
ESTUDIO RÁPIDO DE CONOCIMIENTO, PRACTICAS Y COBERTURA (KPC)
Project HOPE Nicaragua – Jinotega
PAGINA INICIAL: IDENTIFICACIÓN INFORMACION
2 MUNICIPIO:
PI_2 JINOTEGA...............................................................................1
SAN RAFAEL DEL NORTE…...................................…………2
LA
CONCORDIA......................................................................3
SAN SEBASTIAN DE
YALI......................................................4
SANTA MARIA DE PANTASMA..............................................5
WIWILI.....................................................................................6
EL CUA....................................................................................7
BOCAY ...................................................................................8
3
PI_3
NUMERO DE LA ENTREVISTA: I______I I_____I
4
PI_4
FECHA DE ENTREVISTA:
(ANO/ MES/ DIA) +-------++-------++-------++-------+ / +-------++-------+ / +-------++-------+
A A A A M M D D
5
PI_5
FECHA DE RE: ENTREVISTA:
(ANO/ MES/DIA)
+-------++-------++-------++-------+ / +-------++-------+ / +-------++-------+
A A A A M M D D
6
PI_6 NOMBRE DEL ENTREVISTADOR:
____________________________________________________
7
PI_7 NOMBRE DEL SUPERVISOR:
____________________________________________________
8
PI_8
TIPO DE COMUNIDAD:
(NOMBRE DE LA COMUNIDAD)
URBANA .................................................................................1
RURAL.....................................................................................2
9
PI_9
NOMBRE DE LA MADRE:
_____________________________________________________
10
PI_10
EDAD DE MADRE (EN ANOS)
I_______I I______I
11
PI_11
NOMBRE DEL NIN@: ____________________________________________________
12
PI_12
SEXO DEL NIN@:
MASCULINO................................................................................1
FEMENINO....................................................................................2
13
PI_13
FECHA DE NACIMIENTO DEL NIN@:
(ANO/MES/DIA)
+-------++-------++-------++-------+ / +-------++-------+ / +-------++-------+
A A A A M M D D
14
PI_14 EDAD DEL NIN@: (EN MESES) I_______I I______I
SECCIÓN 1: ANTECEDENTES DE LA MADRE Y NIÑO
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
AN1
¿Alguna vez ha asistido a la escuela? NO................................................0
SI..................................................1
 3
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 34
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
2
AN2
¿Hasta que nivel llego?
PRIMARIA....................................1
SECUNDARIA .............................2
TÉCNICO .....................................3
UNIVERSITARIO .........................4
 4
 4
 4
3
AN3
¿Puede leer y entender una carta o periódico
fácilmente, con dificultad, o no sabe?
FACILMENTE ..............................1
CON DIFICULTAD .......................2
NO SABE .....................................3
4
AN4
¿Realiza algún trabajo para ganar dinero,
durante el año?
ANOTE TODO LO QUE SE MENCIONE.
NO TRABAJA ..............................
A
ARTESANIAS/ TEJIDO/ ETC B
AGRICULTURA
C
GANADERIA
D
VENDIENDO COMIDAS
SERVICIOS DOMESTICOS F
DUENO DE TIENDA / PULPERÍA
G
TRABAJADORA ASALARIADA
H
OTROS____________________ X
(ESPECIFIQUE)
 LN1
5
AN5
¿Quién cuida a (NOMBRE DEL NIÑ@) mientras
Ud. trabaja o está fuera de su casa?
ANOTE TODO LO QUE SE MENCIONE.
VA CON LA MADRE................... A
ESPOSO/ COMPAÑERO ........... B
HERMANOS MAYORES ............ C
OTROS PARIENTES.................. D
___________________________
(ESPECIFIQUE)
VECINOS / AMIGOS................... E
EMPLEADA DOMESTICA .......... F
CDI/ CICO ...................................G
OTROS____________________X
(ESPECIFIQUE)
SECCIÓN 2: NUTRICIÓN INFANTIL
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
LN1
¿Alguna vez le dio de mamar a (NOMBRE
DEL NIÑ@)? NO 0
SI .................................................1
 6
2
LN2
¿Cuánto tiempo después del parto tardo en
pegarse al pecho a (NOMBRE DEL
NIÑ@) ?
DURANTE LA PRIMERA HORA 1
ENTRE LA PRIMERA Y 8 HORAS 2
DESPUES 8 HORAS 3
NO SABE/NO RECUERDA................... 4
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 35
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
3
LN3
¿Durante los primeros tres días despues del
parto le dio a (NOMBRE DEL NIÑ@)) su
primera leche?
NO .............................................. 0
SI ................................................ 1
NO SABE.................................... 8
4
LN4
¿Actualmente le está dando de mamar a
(NOMBRE DEL NIÑ@)?
NO .............................................. 0
SI 1
 6
5
LN5
¿Durante cuánto tiempo le dio el pecho a
(NOMBRE DEL NIÑ@)? SI MENOS DE UN
MES, ANOTE ‘00’ MESES
MESES
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
6
LN6
Ahora quisiera preguntarle acerca de los tipos de líquidos que (NOMBRE DEL NIÑ@) bebió ayer durante
el día y la noche. ¿Bebió (NOMBRE DEL NIÑ@) algunos de los siguientes líquidos ayer durante el día ó
la noche?
PUEDE MARCAR MAS DE UN RESPUESTA. Bebió (NOMBRE DEL NIÑ@) . .
A
¿Leche materna?
NO .............................................. 0
SI ................................................ 1
B
¿Agua o cocimiento?
NO .............................................. 0
SI ................................................ 1
C
¿Leche de vaca, de cabra, o en polvo?
NO .............................................. 0
SI ................................................ 1
D
¿Jugo de frutas?
NO .............................................. 0
SI ................................................ 1
E
¿Te o café?
NO .............................................. 0
SI ................................................ 1
F
¿Algún otro líquido como gaseosas (sodas)
refrescos, o sopas?
NO .............................................. 0
SI ................................................ 1
Ahora quisiera preguntarle acerca del tipo de comidas que (NOMBRE DEL NIÑ@) comió ayer durante el día y la
noche,
¿Comió (NOMBRE DEL NIÑ@) algunas de las siguientes comidas ayer durante el día y la noche?
PUEDE MARCAR MAS DE UN RESPUESTA
G ¿Cualquier alimento hecho de granos como
maíz, arroz, trigo, avena?
NO .............................................. 0
SI ................................................ 1
H ¿Algún alimento fortificado con vitaminas o
minerales como azucar y harina fortificada, o
sal?
NO .............................................. 0
SI ................................................ 1
I ¿Ayote, pijibay o zanahorias?
NO .............................................. 0
SI ................................................ 1
J ¿Algún comida como (papas, yuca,
quequisque, o malanga)?
NO .............................................. 0
SI ................................................ 1
K ¿Algún vegetal que tenga hojas verdes
oscuras como hoja de ayote, o yuca?
NO .............................................. 0
SI ................................................ 1
L ¿Mango maduro?
NO .............................................. 0
SI ................................................ 1
M ¿Algún otro vegetal o fruta como chaya,
naranja, banana?
NO .............................................. 0
SI ................................................ 1
N ¿Carne como cerdo, res, etc.?
NO .............................................. 0
SI ................................................ 1
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 36
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
O ¿Aves como pollo, pato, etc.?
NO .............................................. 0
SI ................................................ 1
P ¿ Pescado o mariscos?
NO .............................................. 0
SI ................................................ 1
Q ¿Huevos?
NO .............................................. 0
SI ................................................ 1
R ¿Alguna leguminosas (frijoles, lentejas, frijol
de soya, etc.)?
NO .............................................. 0
SI ................................................ 1
S ¿Algun tipo de mani o cacahuate?
NO .............................................. 0
SI ................................................ 1
T
¿Queso, crema, cuajada, mantequilla, u otros?
NO .............................................. 0
SI ................................................ 1
U ¿Algún alimento frito con aceite, manteca o
mantequilla?
NO .............................................. 0
SI ................................................ 1
7
¿Cuántas veces comió (NOMBRE DEL NIÑ@)
alimentos sólidos o semisólidos (p.ej, mogos
de carne, cuajadas) ayer durante el día o la
noche?
SI FUERON 7 VECES O MAS, ANOTE ‘7’.
NUMERO DE VECES
NO SABE.................................. 8
SECCIÓN 3: CONTROL DEL CRECIMIENTO Y DESARROLLO
NO PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
CD1
¿Tiene (NOMBRE DEL NIÑ@) una tarjeta
infantil para el control del peso?
EN CASO AFIRMATIVO: ¿Me la puede
mostrar por favor?
NO DISPONIBLE/ PERDIDA/
EXTRAVIADA....0
SI, LA VI
..............................................................1
NUNCA TUVO TARJETA
....................................................2
NO SABE
............................................................8
 NE1
 NE1
 NE1
2
CD2
FIJESE EN LA TARJETA DE INFANTIL
DE CONTROL DE CRECIMIENTO DEL
BEBE (NOMBRE DEL NIÑ@) Y NOTE
SI HA SIDO PESADO EN LOS
ULTIMOS CUATRO MESES.
NO FUE PESADO 0
SI FUE PESADO ........................ 1
 4
3
CD3
¿Dónde fue pesado el niño en los últimos 4
meses?
LA UNIDAD DE SALUD.................1
EN SESIONES DE PESAJE EN LA
COMUNIDAD.................................2
OTROS..........................................3
(ESPECIFIQUE)
4
CD4
MIRE TAMBIEN LA TARJETA DE
CONTROL DE CRECIMIENTO E
INDIQUE SI HAY ESPACIO PARA
REGISTRAR LAS CAPSULAS CON
VITAMINA ‘A’
NO HAY 0
SI HAY ........................................ 1
 6
5
CD5
SI LA TARJETA TIENE ESPACIO PARA
REGISTRAR VITAMINA A, ANOTE LA
ULTIMA FECHA EN QUE SE SUMINISTRÓ
LA CAPSULA DE VITAMINA A.
I__l__l__l__l l___l___l l___ll___l
A A A A M M D D
6 MIRE TAMBIEN LA TARJETA DE CONTROL NO HAY 0  NE1
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 37
NO PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
CD6 DE CRECIMIENTO E INDIQUE SI HAY
ESPACIO PARA REGISTRAR LAS DOSIS DE
‘HIERRO’’
SI HAY ........................................ 1
7
CD7
SI LA TARJETA TIENE ESPACIO PARA
REGISTRAR EL HIERRO, ANOTE LAS
FECHAS EN QUE LE SUMINISTRARON LAS
DOSIS DE HIERRO EN LOS ULTIMOS 6
MESES
1. I__l__l__l__l l___l___l l___ll___l
A A A A M M D D
2. I__l__l__l__l l___l___l l___ll___l
A A A A M M D D
3. I__l__l__l__l l___l___l l___ll___l
A A A A M M D D
SECCIÓN 4a: NIÑO/A ENFERMO/A
SECCIÓN 4a : ENFERMEDADES PREVALENTES EN LA INFANCIA EN LOS NIÑOS
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACIÓN SALTAR
1
NE1
A veces los niños se enferman y necesitan
atención o tratamiento contra enfermedades.
¿Cuáles son las señales de peligro que
pudieran indicar que su niño necesita
atención inmediata?
ANOTE TODAS LAS QUE SE MENCIONEN
NO SABE.........................................................A
TIENE MAL ASPECTO O NO
JUEGA NORMALMENTE.................................B
NO COME NI BEBE..................……................C
LETARGICO O DIFICIL DE DESPERTAR......D
FIEBRE ALTA...................................................E
RESPIRACION RAPIDA O DIFICULTOSA.......F
VOMITA TODO LO QUE COME O
BEBE.........G
CONVULSIONES..............................................H
OTROS _____________________ I
(ESPECIFIQUE)
 2
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 38
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACIÓN SALTAR
2
NE2
¿En las ultimas dos semanas (NOMBRE DEL
NIÑ@) experimento algunas de las cosas
siguientes? LEA LAS OPCIONES Y ANOTE
TODAS LO QUE SON AFIRMATIVAS
¿Diarrea?
¿Sangre en las heces?
¿Tos?
¿Respiración difícil/ rapida o acelerada?
¿Fiebre?
¿Malaria?
¿Convulsiones?
DIARREA..........................................................A
SANGRE EN LAS HECES................................B
TOS...................................................................C
RESPIRACIONRAPIDA//ACERERADA............D
FIEBRE..............................................................E
MALARIA............................................................F
CONVULSIONES...............................................G
NINGUNA...........................................................H
3
NE3
¿Cómo se da cuenta usted cuando un nino
menor de dos meses esta muy mal y debe
buscar atención medica y tratamiento
inmediato?
ANOTE TODAS LAS QUE SE MENCIONEN
NO SE...............................................................A
OMBLIGO ENROJECIDO O SUPURANDO......B
CONVULSIONES..............................................C
QUEJIDO...........................................................D
ANORMALMENTE SOMNOLIENTO.................E
DIFICULTAD PARA ALIMENTARSE.................F
ALETEO NASAL................................................G
MOLLERA ABOMBADA...........H
RESPIRACIÓN RAPIDA...........I
OTROS___________________J
(ESPECIFIQUE)
 4
4
NE4
¿Cómo se da cuenta usted cuando un niño
mayor de dos meses esta muy mal y debe
buscar atención medica y tratamiento
inmediato?
NO SE................................................................A
DEJO DE COMER O BEBER.............................B
CONVULSIONES...............................................C
VOMITA TODO LO QUE COME O
BEBE..........D
OTROS._____________________J
(ESPECIFIQUE)
 DM1
SECCIÓN 4b: DIARREA (MANEJO DE CASOS DE DIARREA)
NO. PREGUNTAS Y FILTRO CATEGORIA DE CODIFICACION SALTAR
1
DM1
¿Ha tenido (NOMBRE DEL NIÑ@) diarrea en
las últimas dos semanas?
NO 0
SI..................................................1
NO SABE 8
 9
 9
2
DM2
¿Cuándo (NOMBRE DEL NIÑ@) tenia diarrea,
recibio algún tratamiento?
¿Algo más?
ANOTE TODO LO MENCIONADO.
NADA
.................................................................
A
SRO...................................................................B
SUERO CASERO..............................................C
SOLUCIONES A BASE DE
CEREALES............D
 3
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 39
NO. PREGUNTAS Y FILTRO CATEGORIA DE CODIFICACION SALTAR
Medicinas Antidiarreicas/Antibióticos.................E
(IV) INTRAVENOSO..........................................F
REMEDIOS CASEROS.....................................G
OTROS___________________(Especifique).. X
3
DM3
¿Cuándo (NOMBRE DEL NIÑ@) tenia diarrea le
dio el pecho, menos que lo normal,
aproximadamente lo mismo, o más que lo
usual?
MENOS........................................1
IGUAL ..........................................2
MAS .............................................3
NO DIO PECHO ..........................4
NO SABE.....................................8
4
DM4
¿Cuándo (NOMBRE DEL NIÑ@) tenia diarrea le
dieron además de su pecho, menos que lo usual
para beber, aproximadamente lo mismo, o más
de lo usual?
MENOS........................................1
IGUAL ..........................................2
MAS .............................................3
NADA DE BEBER........................4
NO SABE.....................................8
5
DM5
¿Cuando (NOMBRE DEL NIÑ@) tenia diarrea le
dieron menos que lo usual de comer,
aproximadamente lo mismo, o más que lo
usual?
MENOS........................................1
IGUAL ..........................................2
MAS .............................................3
NADA DE COMER ......................4
NO SABE.....................................8
6
DM6
¿Cuándo (NOMBRE DEL NIÑ@) tenia diarrea
¿Pidió consejo o ayuda? NO 0
SI..................................................1
 8
7
DM7
¿Dónde pidió el consejo o ayuda para la diarrea
de (NOMRE)?
ANOTE TODO LO MENCIONADO
SI LA FUENTE ES UN HOSPITAL, CENTRO
DE SALUD O CLÍNICA, ANOTE EL NOMBRE
DEL SITIO:
_______________________________________
(NOMBRE DEL SITIO)
HOSPITAL.........................................................A
CENTRO/PUESTO DE SALUD.........................B
MÉDICO/CLINICA PARTICULAR......................C
FARMACIA.........................................................D
TIENDA..............................................................E
BRIGADISTA/UROC..........................................F
CURANDERO....................................................G
PARTERA..........................................................H
AMIGO/PARIENTE.............................................I
OTROS:_________________(Especifique)___J
8
DM8
¿Durante el período en que (NOMBRE DEL
NIÑ@) se recuperaba de la diarrea, le dio
menos de lo usual de beber y comer,
aproximadamente lo mismo, o más que lo
usual?
MENOS........................................1
IGUAL ..........................................2
MAS .............................................3
AUN CON DIARREA....................4
NO SABE.....................................8
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 40
NO. PREGUNTAS Y FILTRO CATEGORIA DE CODIFICACION SALTAR
9
DM9
¿Cuándo esta con diarrea, ¿Cómo se da cuenta
que esta grave?
ANOTE TODO LO MENCIONADO.
SOMNOLIENTO.........................A
OJOS HUNDIDOS......................B
PLIEGUE/ PIEL..........................C
BEBE CON SED.........................D
INQUIETO/ IRRITABLE..............E
NO SABE....................................F
OTROS____________________K
(ESPECIFIQUE)
 IR1
SECCIÓN 4c: INFECCIONES RESPIRATORIAS AGUDAS
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
IR1
¿Ha estado (NOMBRE DEL NIÑ@) enfermo
con tos en las últimas dos semanas?
NO............................................... 0
SI................................................. 1
NO SABE.................................... 8
 9
 9
2
IR2
¿Ha estado (NOMBRE DEL NIÑ@) con
dificultad en respirar, o respiraba como
cansado (disnea) o respiraba más rápido que
lo usual en forma entrecortada y poco
profunda?
NO............................................... 0
SI................................................. 1
NO SABE 8
 9
 9
3
IR3
¿Qué cantidad de liquidos le dio a (NOMBRE
DEL NIÑ@) durante la enfermedad?
MAS DE LO NORMAL................ 1
LA MISMA CANTIDAD ............... 2
MENOS....................................... 3
LE DABA SOLO PECHO 4  5
4
IR4
¿Qué cantidad de alimentos le dio a
(NOMBRE DEL NIÑ@) durante la
enfermedad?
MAS DE LO NORMAL................ 1
LA MISMA CANTIDAD ............... 2
MENOS....................................... 3
5
IR5
¿Ha pedido consejo o tratamiento para
(NOMBRE DEL NIÑ@) para la tos/
respiración rápida?
NO 0
SI................................................. 1
 8
6
IR6
¿Cuánto tiempo después llevo a (NOMBRE
DEL NIÑ@) para consejos o tratamiento
contra la tos y respiración rápida?
El MISMO DIA............................. 1
DIA SIGUIENTE.......................... 2
DOS DIAS................................... 3
TRES DIAS O MAS .................... 4
7
IR7
¿Dónde recibió consejos o tratamiento para
(NOMBRE DEL NIÑ@) contra la tos y
respiración rápida?1
ANOTE TODO LO MENCIONADO
SI LA FUENTE ES UN HOSPITAL, CENTRO
DE SALUD O CLINICA, ANOTE EL
NOMBRE DEL SITIO:
______________________________
(NOMBRE DEL SITIO)
HOSPITAL GENERAL................ A
CENTRO/ PUESTO DE SALUD. B
MEDICO/ CLIN. PARTICULAR ..C
FARMACIA .................................D
BRIGADISTA / URO ................... E
CURANDERO..............................F
PARTERA .................................G
AMIGO/ PARIENTE...................H
OTROS______________(Especifique)X
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 41
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
8
IR8
¿Cuándo (NOMBRE DEL NIÑ@) tenia tos y
respiración rápida/ dificultosa, ¿Recibio algún
tratamiento? ¿Cual?
ANOTE TODO LO MENCIONADO
NADA .......................................... A
PENICILINA PROCAÍNICA ........ B
PANADOL...................................C
AMOXICILINA.............................D
ERITROMICINA.......................... E
TRIMETROPIN SULFA................F
OTROS______________(Especifique)X
 9
9
IR9
¿Cuándo un nino esta con una enfermedad
respiratoria, ¿Cómo se da cuenta que esta
grave?
ANOTE TODO LO MENCIONADO
NO SABE
..........................................................A
RESPIRACIÓN RAPIDA /AGITADA..................B
RETRACCIONES
INTERCOSTALES...............C
PERDIDA DEL APETITO
....................................................D
FIEBRE..............................................................E
TOS....................................................................F
OTRO_____________________(Especifique) X
 CM1
SECCIÓN 4d : CONTROL DE MALARIA
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
CM1
Tiene usted algún mosquitero en su casa? NO...............................................0
SI.................................................1

Sec.5a
2
CM2
Quién usó anoche el mosquitero para dormir?
NIÑO (A) (NOMBRE)....................1
ELLA (LA ENTREVISTADA).........2
ESPOSO O COMPAÑERO...........3
OTRO_____________________96
3
CM3
Cuánto tiempo hace que usted (es) compraron
u obtuvieron ese mosquitero?
MESES _____ _____
NO SABE.....................................88
4CM4 Fue el mosquitero remojado en un líquido para
ahuyentar los zancudos?
NO.................................................0
SI ..................................................1
NO SABE.....................................88
SECCIÓN 5a: ATENCION PRENATAL
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
AP1
¿Consultó a alguien para recibir cuidado
prenatal cuando estaba embarazada de
(NOMBRE DEL NIÑ@)?
EN CASO AFIRMATIVO: ¿A quién consultó?
¿Alguien más?
TRATE DE AVERIGUAR EL TIPO DE
PERSONA Y ANOTE TODAS LAS PERSONAS
MENCIONADAS POR LA MADRE
NADIE.............................................A
MEDICO / ENFERMERA................B
PARTERA TRADICIONAL.............C
BRIGADISTA..................................D
OTROS ____________(ESPECIFIQUE)___
X
 7
2
AP2
Durante su control prenatal, le aconsejaron
sobre lo siguiente:
¿Lactancia?
¿Espaciamiento de Embarazos?
¿Uso de la lactancia materna como método de
planificación familiar, lo que conocemos como
MELA ?
¿Señales de peligro durante el embarazo?
NO
SI
Lactancia..................................................0
1
Espaciamiento de embarazos..................0
1
MELA....................................................... 0
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 42
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
Señales de peligro en Embarazo..............0
1
3
AP3
¿Cuando estuvo embarazada de (NOMBRE
DEL NIÑ@) le aplicaron en el brazo la vacuna
contra de tetano?
NO............................................... 0
SI................................................. 1
NO SABE .................................... 8
4
AP4
¿Tiene usted una tarjeta de control del
embarazo?
NO DISPONIBLE 0
SI, LA VI...................................... 1
NUNCA TUVO 2
 7
 7
5
AP5 FIJESE EN ÑA TARJETA DE CONTROL
PRENATAL DE LA MADRE Y ANOTE
CUANTAS ATENCIONES PRENATALES SE
REALIZÓ
NINGUNO ................................... 0
UNA ............................................ 1
DOS O MAS................................ 2
6
A
P6
REVISE LA TARJETA Y ESCRIBA EL
NÚMERO DE DOSIS DE dT MIENTRAS
ESTABA EMBARAZADA DE (NOMBRE).
NINGUNO ................................... 0
UNA ............................................ 1
DOS O MAS................................ 2
7
AP7
¿Cuando usted estuvo embarazada de
(NOMBRE DEL NIÑ@) tomó tabletas de hierro?
NO............................................... 0
SI................................................. 1
NO SABE ................................... 8
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
8
AP8
¿En el embarazo, cuáles son los
síntomas que le indican la
necesidad de buscar
urgentemente cuidados de
salud?
ANOTE TODO LO
MENCIONADO.
NO SABE..............................................................................A
FIEBRE..................................................................................B
FALTA DE RESPIRACION....................................................C
HEMORRAGIA......................................................................D
HINCHAZON DEL CUERPO O PIE/MANO/CARA................E
DOLOR DE PARTO ANTES DE TIEMPO.............................F
LA CRIATURA NO MUEVE...................................................G
VOMITO INCONTENIBLE.....................................................H
DOLOR DE CABEZA INTENSO Y CHISPERIO
......................................................I
OTROS___________________(ESPECIFIQUE)_________X
SECCIÓN 5b: PARTO Y CUIDADO INMEDIATO DEL RECIEN NACIDO
NO. PREGUNTAS Y FILTROS CATEGORIA DE CODIFICACION SALTAR
1
RN1
¿Dónde dio a luz a (NOMBRE DEL NIÑ@)?
SI ES UN HOSPITAL, CENTRO DE SALUD O
CLINICA, ANOTE EL NOMBRE DEL SITIO.
EN CASA .....................................1
HOSPITAL ...................................2
CLINICA.......................................3
CENTRO DE SALUD...................4
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 43
NO. PREGUNTAS Y FILTROS CATEGORIA DE CODIFICACION SALTAR
______________________________________
__(NOMBRE DEL SITIO))
PUESTO DE SALUD...................5
OTROS______________(Especifique)6
2
RN2 ¿Quién le atendió el parto de (NOMBRE DEL NIÑ@)?
ANOTE TODOS LOS MENCIONADOS
MEDICO
.............................................................A
ENFERMERA
.....................................................B
PARTERA ENTRENADA
....................................................C
PARTERA EMPÍRICA
TRADICIONAL...............D
TRABAJADOR DE SALUD
COMUNITARIO......E
FAMILIAR____________(ESPECIFIQUE)__
__F
OTRO
_______________(ESPECIFIQUE)___G
ELLA MISMA
.....................................................H
3
RN3
¿Se usó un equipo de parto limpio?
NO .............................................. 0
SI ................................................ 1
NO SABE.................................... 8
4
RN4
¿Qué instrumento se usó para cortar el cordón?
NAVAJA DE AFEITAR NUEVA....1
TIJERA ESTERIL.........................2
OTRO INSTRUMENTO......... .....3
NO SABE/ NO RECUERDO.........4
5
RN5
¿Quién le cortó el cordón a (NOMBRE DEL
NIÑ@) ?
MEDICO........................................1
ENFERMERA...............................2
PARTERA TRADICIONAL...........3
BRIGADISTA...............................4
FAMILIAR_____________ (ESPECIFIQUE)
__ 5
OTRO______________(ESPECIFIQUE)___
__ 6
ELLA MISMA .............................. 7
SECCIÓN 6: PLANIFICACIÓN FAMILIAR
NO. PREGUNTAS Y FILTROS CATEGORIA DE CODIFICACION SALTAR
1
PF1
¿Cuántos niños que viven en este hogar son
menores de cinco años?
UN NIÑO ..................................1
DOS NIÑOS............................. 2
TRES O MAS........................... 3
 4
2
PF2
¿Cuántos de esos niños son hijos biológicos
suyos?
UN NIÑO ..................................1
DOS NIÑOS............................. 2
TRES O MAS........................... 3
 4
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 44
NO. PREGUNTAS Y FILTROS CATEGORIA DE CODIFICACION SALTAR
HIJO/A #1
(NOMBRE DEL NIÑ@)
SEXO
VARON ......... 1
HEMBRA....... 2
FECHA DE
NACIMIENTO
HIJO/A #2
(PROX. MAYOR)
SEXO
VARON .........1
HEMBRA.......2
FECHA DE
NACIMIENTO
DIA DIA
MES MES
3
PF3
¿Cuál es el sexo y fecha de nacimiento de los
dos niños más jóvenes?
AÑO AÑO
4
PF4
¿Después de nacer (NOMBRE DEL NIÑ@)
alguien le hizo a Ud. un chequeo de salud?
EN CASO AFIRMATIVO, PREGUNTE: ¿Le
dieron información acerca de planificación
familiar o espaciamiento de nacimientos en esa
ocasión?1
SIN CHEQUEO PUERPERAL
............................1
CHEQUEO PERO SIN INFORMACION
............2
RECIBIO INFORMACION
................. ...................................3
 VS1
 VS1
5
PF5
¿Le dieron información acerca del método
MELA o Amenorrea de Lactancia?
NO............................................0
SI..............................................1
NO RECUERDA ......................8
SECCIÓN 7: VIH/ SIDA
NO PREGUNTAS Y FILTROS CATEGORIA DE CODIFICACION SALTAR
1
VS1
¿Ha oido alguna vez hablar de la
enfermedad del SIDA?
NO............................................0
SI.............................................. 1
 AS1
2
VS2
¿Hay algo que se pueda hacer para evitar que
nos de el SIDA? NO............................................0
SI.............................................. 1
NO SABE.................................8
 AS1
 AS1
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 45
NO. PREGUNTAS Y
FILTROS
CATEGORIAS A CODIFICAR SALTAR
3
VS3
¿Qué se puede
hacer?
¿Algo más?
ANOTE TODO LO
MENCIONADO
NO SABE.................................................................................................A
ABSTENERSE DEL SEXO.......................................................................B
.
USAR CONDONES..................................................................................C
LIMITAR EL SEXO A UNA PAREJA/ SER FIEL A UNA PAREJA............D
LIMITAR EL NUMERO DE PAREJAS
SEXUALES...................................E
EVITAR EL SEXO CON PROSTITUTAS..................................................F
EVITAR EL SEXO CON PERSONAS QUE TIENEN MUCHAS
PAREJAS..................................................................................................G
EVITAR RELACIONES CON PERSONAS DEL MISMO SEXO...............H
EVITAR EL SEXO CON PERSONAS QUE SE INYECTAN DROGAS......I
EVITAR TRANSFUSIONES DE SANGRE................................................J
EVITAR INYECCIONES...........................................................................K
EVITAR BESOS........................................................................................L
EVITAR PICADURAS DE MOSQUITO....................................................M
OBTENER PROTECCIÓN DE UN CURANDERO TRADICIONAL..........N
EVITAR COMPARTIR NAVAJAS/HOJAS DE AFEITAR..........................O
OTROS_________________________________(ESPECIFIQUE)____W
OTROS_________________________________ (ESPECIFIQUE)___X
 AS1
SECCIÓN 8: AGUA Y SANEAMIENTO
NO.
PREGUNTAS Y FILTROS
CATEGORIAS A CODIFICAR SALTAR
1
AS1
¿Cuándo se lava usted las manos con jabón?
ANOTE TODO LO QUE SE MENCIONE.
NUNCA
..............................................................A
ANTES DE PREPARAR LA COMIDA
......................................... ...........B
ANTES DE COMER............. ...
.........................C
ANTES DE ALIMENTAR A LOS NIÑOS D
TRAS DEFECAR/ ORINAR
.................... ................................E
TRAS ATENDER A UN NIÑO QUE HA
DEFECADO
...................................................F
DESPUES DE BOTAR LAS HECES DEL
BEBE............................. ...............................
....G
CUANDO ME
BANO...........................................H
OTROS____________________X
(ESPECIFIQUE)
 2
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 46
NO.
PREGUNTAS Y FILTROS
CATEGORIAS A CODIFICAR SALTAR
2
AS2
¿Donde hace sus necesidades usualmente
usted y su familia?
LETRINA O
SANITARIO......................................1
EN ALGUN ESPACIO DE SU
PROPIEDAD.....2
AL AIRE LIBRE..........
.....................................3
DIRECTAMENTE EN EL RIO......4
OTRO_____________________5
(ESPECIFIQUE)
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 47
SECCIÓN 9: ANTROPOMETRÍA Y HEMOGLOBINA
NO. PREGUNTAS Y FILTROS CATEGORIA DE CODIFICACION SALTAR
DEL NIÑO
1
AH1
PESO (Kg / grs)
_____ _____ . _____ _____
2
AH2
TALLA (CENTÍMETROS)
METODO DE MEDICION: ACOSTADO _____ _____ . _____ _____
3
AH3 HEMOGLOBINA (gr. / dl) _____ _____ . _____ _____
DE LA MADRE
4
AH4 HEMOGLOBINA (gr. / dl) _____ _____ . _____ _____
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 48
Annex C: KPC 12-23 month old child
ENTREVISTA
*MADRES CON NIÑOS (AS) ENTRE 12 a 23 MESES*
ESTUDIO RÁPIDO DE CONOCIMIENTO, PRACTICAS Y COBERTURA (KPC)
Project HOPE Nicaragua – Jinotega
PAGINA INICIAL: IDENTIFICACIÓN INFORMACION
2 MUNICIPIO:
PI_2 JINOTEGA...............................................................................1
SAN RAFAEL DEL NORTE…...................................…………2
LA
CONCORDIA......................................................................3
SAN SEBASTIAN DE
YALI......................................................4
SANTA MARIA DE PANTASMA..............................................5
WIWILI.....................................................................................6
EL CUA....................................................................................7
BOCAY ...................................................................................8
3
PI_3 NUMERO DE LA ENTREVISTA: I______I I_____I
4
PI_4
FECHA DE ENTREVISTA:
(AÑO / MES/ DIA) +-------++-------++-------++-------+ / +-------++-------+ / +-------++-------+
A A A A M M D D
5
PI_5
FECHA DE RE: ENTREVISTA:
(AÑO / MES/ DIA)
+-------++-------++-------++-------+ / +-------++-------+ / +-------++-------+
A A A A M M D D
6
PI_6
NOMBRE DEL ENTREVISTADOR:
____________________________________________________
7
PI_7
NOMBRE DEL SUPERVISOR:
____________________________________________________
8
PI_8
TIPO DE COMUNIDAD:
(NOMBRE DE LA COMUNIDAD)
URBANA .................................................................................1
RURAL.....................................................................................2
9
PI_9
NOMBRE DE MADRE:
_____________________________________________________
10
PI_10
EDAD DE MADRE (EN ANOS) I_______I I______I
11
PI_11
NOMBRE DEL NIN@: ____________________________________________________
12
PI_12
SEXO DEL NIN@:
MASCULINO................................................................................1
FEMENIÑO..................................................................................2
13
PI_13
FECHA DE NACIMIENTO DEL NIN@: +-------++-------++-------++-------+ / +-------++-------+ / +-------++-------+
A A A A M M D D
14
PI_14
EDAD DEL NIN@: (EN MESES) I_______I I______I
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 49
SECCIÓN 1: ANTECEDENTES DE LA MADRE Y NIÑO
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
AN1 ¿Alguna vez ha asistido a la escuela? NO 0
SI..................................................1
 3
2
AN2
¿Hasta que nivel llego? PRIMARIA....................................1
SECUNDARIA .............................2
TÉCNICO.....................................3
UNIVERSITARIO.........................4
 4
 4
 4
3
AN3
¿Puede leer y entender una carta o periódico
fácilmente, con dificultad, o no sabe?
FACILMENTE ..............................1
CON DIFICULTAD.......................2
NO SABE .....................................3
4
AN4
¿Realiza algún trabajo para ganar dinero,
durante el año?
ANOTE TODO LO QUE SE MENCIONE.
NO TRABAJA ...............................
A
ARTESANIAS/ TEJIDO/ ETC
B
AGRICULTURA
C
GANADERIA
D
VENDIENDO COMIDAS
SERVICIOS DOMESTICOS ..........
F
DUENO DE TIENDA / PULPERÍA
G
TRABAJADORA ASALARIADA
H
OTROS____________________
X
(ESPECIFIQUE)
 LN1
5
AN5
¿Quién cuida a (NOMBRE DEL NIÑ@) mientras
Ud. trabaja o está fuera de su casa?
ANOTE TODO LO QUE SE MENCIONE.
VA CON LA MADRE................... A
ESPOSO/ COMPAÑERO ........... B
HERMANOS MAYORES ............ C
OTROS PARIENTES.................. D
___________________________
(ESPECIFIQUE)
VECINOS / AMIGOS .................. E
EMPEADA DOMESTICA .............F
CDI/ CICO ...................................G
OTROS____________________X
(ESPECIFIQUE)
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 50
SECCIÓN 2: NUTRICIÓN INFANTIL
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
LN1
¿Alguna vez le dio de mamar a (NOMBRE DEL
NIÑ@)?
NO............................................... 0
SI................................................. 1
 6
2
LN2
¿Cuánto tiempo después después del parto
tardo en pegarse al pecho a (NOMBRE DEL
NIÑ@) ?
DURANTE LA PRIMERA HORA
.....................1
ENTRE LA PRIMERA HORA Y 8 HORAS......2
DESPUES 8
HORAS.......................................3
NO SABE ACUERDA...................
.............................. ....................4
3
LN3
¿Durante los primeros tres días después del parto
le dio a (NOMBRE DEL NIÑ@)) su primera
leche?
NO............................................... 0
SI................................................. 1
NO SABE.................................... 8
4
LN4
¿Actualmente le está dando de mamar a
(NOMBRE DEL NIÑ@)?
NO............................................... 0
SI .......................................... 1  6
5
LN5
¿Durante cuánto tiempo le dio el pecho a
(NOMBRE DEL NIÑ@)?
SI MENOS DE UN MES, ANOTE ‘00’ MESES
MESES
6
LN6
Ahora quisiera preguntarle acerca de los tipos de líquidos que (NOMBRE DEL NIÑ@) bebió ayer durante el
día y la noche.
¿Bebió (NOMBRE DEL NIÑ@) algunos de los siguientes líquidos ayer durante el día ó la noche?
PUEDE MARCAR MAS DE UN RESPUESTA
Bebió (NOMBRE DEL NIÑ@) . .
A
¿Leche materna?
NO............................................... 0
SI................................................. 1
B
¿Agua o cocimiento?
NO............................................... 0
SI................................................. 1
C
¿Leche de vaca, de cabra, o en polvo?
NO............................................... 0
SI................................................. 1
D
¿Jugo de frutas?
NO............................................... 0
SI................................................. 1
E
¿Te o café?
NO............................................... 0
SI................................................. 1
F
¿Algún otro líquido como gaseosas (sodas)
refrescos, o sopas?
NO............................................... 0
SI................................................. 1
Ahora quisiera preguntarle acerca del tipo de comidas que (NOMBRE DEL NIÑ@) comió ayer durante el día y la
noche,
¿Comió (NOMBRE DEL NIÑ@) algunas de las siguientes comidas ayer durante el día y la noche?
PUEDE MARCAR MAS DE UN RESPUESTA
G ¿Cualquier alimento hecho de granos como maíz,
arroz, trigo, avena?
NO............................................... 0
SI................................................. 1
H ¿Algún alimento fortificado con vitaminas o
minerales como azúcar, harina fortificada, o
sal?
NO............................................... 0
SI................................................. 1
I ¿Ayote, pijibay o zanahorias?
NO............................................... 0
SI................................................. 1
J ¿Algún comida como papas, yuca, quequisque,
malanga?
NO............................................... 0
SI................................................. 1
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 51
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
K ¿Algún vegetal que tenga hojas verdes oscuras
como hoja de ayote, o yuca?
NO............................................... 0
SI................................................. 1
L ¿Mango maduro?
NO............................................... 0
SI................................................. 1
M ¿Algún otro vegetal o fruta como chaya, naranja,
o banano o otras?
NO............................................... 0
SI................................................. 1
N ¿Carne como cerdo, res, etc.?
NO............................................... 0
SI................................................. 1
O ¿Aves como pollo o pato?
NO............................................... 0
SI................................................. 1
P ¿ Pescado, o mariscos?
NO............................................... 0
SI................................................. 1
Q ¿Huevos?
NO............................................... 0
SI................................................. 1
R ¿Alguna leguminosas? (frijoles, lentejas, frijol de
soya, etc?)
NO............................................... 0
SI................................................. 1
S ¿Algun tipo de mani o cacahuate?
NO............................................... 0
SI................................................. 1
T
¿Queso, crema, cuajada, mantequilla, otros?
NO............................................... 0
SI................................................. 1
U ¿Algún alimento frito con aceite, manteca o
mantequilla?
NO............................................... 0
SI................................................. 1
7
¿Cuántas veces comió (NOMBRE DEL NIÑ@)
alimentos sólidos o semisólidos (p.ej, mogos de
carne, cuajadas) ayer durante el día o la noche?
SI FUERON 7 VECES O MAS, ANOTE ‘7’.
NUMERO DE VECES
NO SABE.................................. 8
SECCIÓN 3: CONTROL DEL CRECIMIENTO Y DESARROLLO
NO PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
CD1
¿Tiene (NOMBRE DEL NIÑ@) una
tarjeta infantil para el control del peso?
EN CASO AFIRMATIVO: ¿Me la puede
mostrar por favor?
NO DISPONIBLE/
PERDIDA/EXTRAVIADA..............0
SI, LA VI
.......................................................................1
NUNCA TUVO TARJETA
... ...........................................2
NO SABE....................................................................8
 8
 8
 8
2
CD2
FIJESE EN LA TARJETA DE
INFANTIL DE CONTROL DE
CRECIMIENTO DE (NOMBRE
DEL NIÑ@) Y NOTE SI HA SIDO
PESADO EN LOS ULTIMOS
CUATRO MESES.
NO FUE PESADO.................0
SI FUE PESADO.........................1
 4
3
CD3
¿Dónde fue pesado el niño en los últimos
4 meses?
LA UNIDAD DE
SALUD...............................................1
EN SESIONES DE PESAJE EN LA COMUNIDAD.....2
OTROS........................................................................3
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 52
NO PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
(ESPECIFIQUE)
4
CD4
MIRE TAMBIEN LA TARJETA DE
CONTROL DE CRECIMIENTO E
INDIQUE SI HAY ESPACIO PARA
REGISTRAR LAS CAPSULAS CON
VITAMINA ‘A’
NO HAY ................................0
SI HAY.........................................1
 6
5
CD5
SI LA TARJETA TIENE ESPACIO PARA
REGISTRAR VITAMINA A, ANOTE LA
ULTIMA FECHA EN QUE SE
SUMINISTRÓ LA CAPSULA DE
VITAMINA A.
I___l___l___l___l l___l___l l___ll___l
D D M M A A A A
6
CD6
MIRE TAMBIEN LA TARJETA DE
CONTROL DE CRECIMIENTO E
INDIQUE SI HAY ESPACIO PARA
REGISTRAR LAS DOSIS DE ‘HIERRO’’
NO HAY.......................................0
SI HAY.........................................1
 8
7
CD7
SI LA TARJETA TIENE ESPACIO PARA
REGISTRAR EL HIERRO, ANOTE LAS
FECHAS EN QUE LE SUMINISTRARON
LAS DOSIS DE HIERRO EN LOS
ULTIMOS 6 MESES
1. I___l___l___l___l l___l___l l___ll___l
D D M M A A A A
2. I___l___l___l___l l___l___l l___ll___l
D D M M A A A A
3. I___l___l___l___l l___l___l l___ll___l
D D M M A A A A
8
CD8
PARA LOS NIÑOS MAYORES DE 12
MESES:
¿Ha recibido (NOMBRE DEL NIÑO)
desparasitante en los últimos seis
meses?
NO ...............................................0
SI .................................................1
NO SABE.....................................8
SECCIÓN 4: INMUNIZACIÓN DE NIÑOS/AS
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTA
R
1
IN1
¿Tiene Ud. la tarjeta de vacunas de (NOMBRE
DEL NIÑO)?
SI LA RESPUETA ES AFIRMATIVA: ¿Puedo
verla por favor?
NO DISPONIBLE/ PERDIDA/
EXTRAVIADA...........0
SI, VISTA POR
ENTREVISTADOR..........................1
NUNCA TUVO
TARJETA.........................................2
NO
SABE..................................................................8
NE1
 NE1
 NE1
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 53
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTA
R
2
IN2
(1) COPIE LA FECHA DE
VACUNACION PARA CADA
VACUNA DE LA TARJETA.
(2) ANOTE ‘88' EN LA COLUMNA ? DIA? SI LA
TARJETA MUESTRA QUE SE DIO LA VACUNA,
PERO SIN INDICAR FECHA.
(DIA/ MES / ANO)
D D M M A A A
A
A BCG BCG ....
B POLIO 1 P1........
C POLIO 2 P2........
D POLIO 3 P3........
E PENTAVALENTE 1 PENTA
1
F PENTAVALENTE 2 PENTA
2
G PENTAVALENTE 3 PENTA
3
H MMR / Anti-Sarampión MMR
SECCIÓN 5: NIÑO/A ENFERMO/A
SECCIÓN 5a : ENFERMEDADES PREVALENTES EN LA INFANCIA Y EN LOS NIÑOS
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACIÓN
SALTAR
1
NE1
A veces los niños se enferman y
necesitan atención o tratamiento
contra enfermedades. ¿Cuáles son
las señales de peligro que pudieran
indicar que su niño necesita
atención inmediata?
ANOTE TODAS LAS QUE SE
MENCIONEN
NO
SABE.............................................................................A
TIENE MAL ASPECTO O NO JUEGA NORMALMENTE....B
NO COME NI BEBE……......................................................C
LETARGICO O DIFICIL DE DESPERTAR.........................D
FIEBRE ALTA......................................................................E
RESPIRACION RAPIDA O DIFICULTOSA.........................F
VOMITA TODO LO QUE COME O
BEBE...........................G
CONVULSIONES.................................................................H
OTROS _____________________ I
(ESPECIFIQUE)
OTROS _____________________J
(ESPECIFIQUE)
 2
2
NE2
¿En las ultimas dos semanas
(NOMBRE DEL NIÑ@) tuvo alguno
de los siguientes cosas?
LEA LAS OPCIONES Y ANOTE
TODAS LO QUE SON
AFIRMATIVAS
¿Diarrea?
¿Sangre en las heces?
¿Tos?
¿Respiración difícil/ rapida o
acererada?
DIARREA...................................................A
SANGRE EN LAS HECES.........................B
TOS............................................................C
RESPIRACION RAPIDA/ ACERERADA....D
FIEBRE.......................................................E
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 54
¿Respiración rápida o acelerada?
¿Fiebre?
¿Malaria?
¿Convulsiones?
MALARIA....................................................F
CONVULSIONES.......................................G
NINGUNA...................................................H
SECCIÓN 5b: DIARREA (MANEJO DE CASOS DE DIARREA)
NO. PREGUNTAS Y FILTRO CATEGORIA DE CODIFICACION SALTAR
1
DM1
¿Ha tenido (NOMBRE DEL NIÑ@) diarrea en
las últimas dos semanas?
NO................................................0
SI..................................................1
NO SABE ..............................8
 9
 9
2
DM2
¿Cuándo (NOMBRE DEL NIÑ@) tenia diarrea,
recibió algún tratamiento?
¿Algo más?
ANOTE TODO LO MENCIONADO.
NADA
...........................................................A
SRO.............................................................B
SUERO CASERO........................................C
SOLUCIONES A BASE DE CEREALES.....D
MEDICINAS ANTI-DIARREICAS
O ANTIBIOTICOS......................................E
(IV) INTRAVENOSO....................................F
REMEDIOS CASEROS...............................G
OTROS___________________ X
(ESPECIFIQUE)
 3
3
DM3
¿Cuándo (NOMBRE DEL NIÑ@) tenia diarrea le
dio el pecho, menos que lo normal,
aproximadamente lo mismo o más que lo usual?
MENOS........................................1
IGUAL ..........................................2
MAS .............................................3
NO DIO PECHO ..........................4
NO SABE.....................................8
4
DM4
¿Cuándo (NOMBRE DEL NIÑ@) tenia diarrea le
dieron además de su pecho, menos que lo usual
para beber, aproximadamente lo mismo, o más
de lo usual?
MENOS........................................1
IGUAL ..........................................2
MAS .............................................3
NADA DE BEBER........................4
NO SABE.....................................8
5
DM5
¿Cuando (NOMBRE DEL NIÑ@) tenia diarrea le
dieron menos que lo usual de comer,
aproximadamente lo mismo, o más que lo
usual?
MENOS........................................1
IGUAL ..........................................2
MAS .............................................3
NADA DE COMER ......................4
NO SABE.....................................8
6
DM6
¿Cuándo (NOMBRE DEL NIÑ@) tenia diarrea
¿Pidió consejo o ayuda? NO .........................................0
SI..................................................1
 8
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 55
NO. PREGUNTAS Y FILTRO CATEGORIA DE CODIFICACION SALTAR
7
DM7
¿Dónde pidió el consejo o ayuda para la diarrea
de (NOMRE)?
ANOTE TODO LO MENCIONADO
SI LA FUENTE ES UN HOSPITAL, CENTRO DE
SALUD O CLÍNICA, ANOTE EL NOMBRE DEL
SITIO:
_______________________________________
(NOMBRE DEL SITIO)
HOSPITAL......................................A
CENTRO/PUESTO DE SALUD......B
MÉDICO/CLINICA PARTICULAR.. C
FARMACIA.....................................D
TIENDA..........................................E
BRIGADISTA/UROC......................F
CURANDERO................................G
PARTERA......................................H
AMIGO/PARIENTE..........................I
OTROS:_____________________J
(ESPECIFIQUE)
NO. PREGUNTAS Y FILTRO CATEGORIA DE CODIFICACION SALTAR
8
DM8
¿Durante el período en que (NOMBRE DEL
NIÑ@) se recuperaba de la diarrea, le dio
menos de lo usual a beber y comer,
aproximadamente lo mismo, o más que lo
usual?
MENOS........................................1
IGUAL ..........................................2
MAS .............................................3
AUN CON DIARREA....................4
NO SABE.....................................8
9
DM9
¿Cuándo un niño esta con diarrea, ¿Cómo se da
cuenta que esta grave?
ANOTE TODO LO MENCIONADO.
SOMNOLIENTO.........................A
OJOS HUNDIDOS......................B
PLIEGUE/ PIEL..........................C
BEBE CON SED.........................D
INQUIETO/ IRRITABLE..............E
NO SABE....................................F
OTROS____________________K
(ESPECIFIQUE)
OTROS____________________K
(ESPECIFIQUE)
 IR1
SECCIÓN 5c: INFECCIONES RESPIRATORIAS AGUDAS
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
IR1
¿Ha estado (NOMBRE DEL NIÑ@) enfermo con
tos en las últimas dos semanas? NO.........................................0
SI .................................................1
NO SABE.....................................8
 9
 9
2
IR2
¿Ha estado (NOMBRE DEL NIÑ@) con dificultad
en respirar, o respiraba como cansado (disnea) o
respiraba más rápido que lo usual en forma
entrecortada y poco profunda?
NO.........................................0
SI .................................................1
NO SABE..............................8
 9
 9
3
IR3
¿Qué cantidad de líquidos le dio a (NOMBRE DEL
NIÑ@) durante la enfermedad?
MAS DE LO NORMAL ................1
LA MISMA CANTIDAD................2
MENOS .......................................3
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 56
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
IR1
¿Ha estado (NOMBRE DEL NIÑ@) enfermo con
tos en las últimas dos semanas? NO.........................................0
SI .................................................1
NO SABE.....................................8
 9
 9
LE DABA SOLO PECHO .....4  5
4
IR4
¿Qué cantidad de alimentos le dio a (NOMBRE
DEL NIÑ@) durante la enfermedad?
MAS DE LO NORMAL ................1
LA MISMA CANTIDAD................2
MENOS .......................................3
5
IR5
¿Ha pedido Ud. consejo o tratamiento para
(NOMBRE DEL NIÑ@) para la tos/ respiración
rápida?
NO.........................................0
SI ................................................. 1
 8
6
IR6
¿Cuánto tiempo después llevo a (NOMBRE DEL
NIÑ@) para consejos o tratamiento contra la tos y
respiración rápida?
El MISMO DIA.............................1
DIA SIGUIENTE..........................2
DOS DIAS ...................................3
TRES DIAS O MAS.....................4
7
IR7
¿Dónde recibió consejos o tratamiento para
(NOMBRE DEL NIÑ@) contra la tos y respiración
rápida?1
ANOTE TODO LO MENCIONADO
SI LA FUENTE ES UN HOSPITAL, CENTRO DE
SALUD O CLINICA, ANOTE EL NOMBRE DEL
SITIO:
______________________________
(NOMBRE DEL SITIO)
HOSPITAL GENERAL ................A
CENTRO/ PUESTO DE SALUD .B
MEDICO/ CLIN. PARTICULAR.. C
FARMACIA................................. D
BRIGADISTA / URO....................E
CURANDERO..............................F
PARTERA ................................ G
AMIGO/ PARIENTE .................. H
OTROS___________________ X
(ESPECIFIQUE)
8
IR8
¿Cuándo (NOMBRE DEL NIÑ@) tenia tos y
respiración rápida/ dificultosa, ¿Recibió algún
tratamiento? ¿Cual?
ANOTE TODO LO MENCIONADO
NADA....................................A
PENICILINA PROCAÍNICA.........B
PANADOL .................................. C
AMOXICILINA ............................ D
ERITROMICINA ..........................E
TRIMETROPIN SULFA................F
OTROS____________________X
(ESPECIFIQUE)
 9
9
IR9
¿Cuándo un nino esta con una enfermedad
respiratoria, ¿Cómo se da cuenta que esta grave?
ANOTE TODO LO MENCIONADO
NO SABE
...................................................
A
RESPIRACIÓN
RAPIDA/AGITADA............B
RETRACCIONES
INTERCOSTALES.......C
PERDIDA DEL
APETITO...........................D
FIEBRE......................................................E
CM1
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 57
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
IR1
¿Ha estado (NOMBRE DEL NIÑ@) enfermo con
tos en las últimas dos semanas? NO.........................................0
SI .................................................1
NO SABE.....................................8
 9
 9
TOS............................................................F
OTRO____________________________
X
(ESPECIFIQUE)
SECCIÓN 5d : CONTROL DE MALARIA
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
CM1
Tiene usted algún mosquitero en su casa? NO...............................................0
SI.................................................1
 Sec.
6a
2
CM2
Quién usó anoche el mosquitero para dormir? NIÑO (A) (NOMBRE)....................1
ELLA (LA ENTREVISTADA).........2
ESPOSO O COMPAÑERO...........3
OTRO_____________________96
3
CM3
Cuánto tiempo hace que usted (es) compraron u
obtuvieron ese mosquitero?
MESES _____ _____
NO SABE.....................................88
4CM4 Fue el mosquitero remojado en un líquido para
ahuyentar los zancudos? NO.................................................0
SI ..................................................1
NO SABE.....................................88
SECCIÓN 6a: ATENCION PRENATAL
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
1
AP1
¿Consultó a alguien para recibir cuidado prenatal
cuando estaba embarazada de (NOMBRE DEL
NIÑ@)?
EN CASO AFIRMATIVO: ¿A quién consultó?
¿Alguien más?
TRATE DE AVERIGUAR EL TIPO DE PERSONA Y
ANOTE TODAS LAS PERSONAS MENCIONADAS
POR LA MADRE
NADIE.............................................A
MEDICO / ENFERMERA................B
PARTERA TRADICIONAL.............C
BRIGADISTA..................................D
OTROS ___________________ X
(ESPECIFIQUE)
 RN1
2
AP2
¿Cuando estuvo embarazada de (NOMBRE DEL
NIÑ@) le aplicaron en el brazo la vacuna contra de
tétano?
NO................................................0
SI..................................................1
NO SABE.....................................8
3
AP3
¿Tiene usted una tarjeta de control del embarazo? NO DISPONIBLE ..................0
SI, LA VI.......................................1
NUNCA TUVO.......................2
 RN1
 RN1
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 58
NO. PREGUNTAS Y FILTROS CATEGORIAS DE CODIFICACION SALTAR
4
AP4
FIJESE EN LA TARJETA DEL CONTROL
PRENATAL DE LA MADRE Y ANOTE CUANTAS
ATENCIONES PRENATALES SE REALIZÒ
NINGUNO....................................0
UNA .............................................1
DOS O MAS ................................2
5
AP5
REVISE EN LA TARJETAY ESCRIBA EL NÙMERO
DE DOSIS DE dT MIENTRAS ESTABA
EMBARAZADA DE (NOMBRE)
NINGUNO....................................0
UNA .............................................1
DOS O MAS ................................2
SECCIÓN 6b: PARTO Y CUIDADO INMEDIATO DEL RECIEN NACIDO
NO. PREGUNTAS Y FILTROS CATEGORIA DE CODIFICACION SALTAR
1
RN1
¿Dónde dio a luz a (NOMBRE DEL NIÑ@)?
SI ES UN HOSPITAL, CENTRO DE SALUD O
CLINICA, ANOTE EL NOMBRE DEL SITIO.
(NOMBRE DEL SITIO))
EN CASA .....................................1
HOSPITAL ...................................2
CLINICA.......................................3
CENTRO DE SALUD...................4
PUESTO DE SALUD...................5
OTRA______________________6
(ESPECIFIQUE)
2
RN2 ¿Quién le atendió el parto de (NOMBRE DEL NIÑ@)?
ANOTE TODOS LOS MENCIONADOS
MEDICO
.......................................................A
ENFERMERA
....................................................B
PARTERA
ENTRENADA.............................C
PARTERA EMPÍRICA
TRADICIONAL.........D
TRABAJADOR DE SALUD
COMUNITARIOE
FAMILIAR__________________F
(ESPECIFIQUE)
OTRO ____________________G
(ESPECIFIQUE)
ELLA MISMA .............................. H
SECCIÓN 7: PLANIFICACIÓN FAMILIAR
NO. PREGUNTAS Y FILTROS CATEGORIA DE CODIFICACION SALTAR
1
PF1
¿Cuántos niños que viven en este hogar son
menores de cinco años?
UN NIÑO............................1
DOS NIÑOS .............................2
TRES O MAS ...........................3
 4
2
PF2
¿Cuántos de esos niños son hijos biológicos
suyos?
UN NIÑO ..................................1
DOS NIÑOS .............................2
TRES O MAS ...........................3
 4
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 59
NO. PREGUNTAS Y FILTROS CATEGORIA DE CODIFICACION SALTAR
HIJO/A #1
(NOMBRE DEL
NIÑ@)
SEXO
VARON..........1
HEMBRA.......2
FECHA DE
NACIMIENTO
HIJO/A #2
(PROX. MAYOR)
SEXO
VARON..........1
HEMBRA .......2
FECHA DE
NACIMIENTO
DIA DIA
MES MES
3
PF3
¿Cuál es el sexo y fecha de nacimiento de los
dos niños más jóvenes?
AÑO AÑO
4
PF4
¿Está embarazada actualmente? NO......................................0
SI ..............................................1
NO ESTA SEGURA .................8
 VS1
5
PF5
¿Quiere tener otro niño? NO......................................0
SI ..............................................1
NO SABE...........................8
 7
 7
6
PF6
¿Cuándo quiere tener su próximo niño? 2 AÑOS O MENOS ..................1
MAS DE 2 AÑOS .....................2
NO ESTA SEGURA .................8
7
PF7
¿Está haciendo algo actualmente o usando algún
método para demorar o evitar el embarazo?
SI NO, CIRCULE ‘01' [NINGUN METODO]
EN CASO AFIRMATIVO, pregúntele, “¿Cuál es
el método principal que usan usted o su esposo/
pareja para evitar/ aplazar el embarazo?”
NINGUN METODO........................................................01
NORPLANT..... .............................................................02
INYECCIONES..............................................................03
PÍLDORA ......................................................................04
DIU.................................................................................05
METODO BARRERA/ DIAFRAGMA.............................06
CONDON......................................................................07
ESPUMA / GELATINA................................................. 08
LIGAMIENTO DE TROMPAS/ ESTERILIZACION...... .09
VASECTOMIA...................................... ....................... 10
AMENORREA DE LACTANCIA/MELA..........................11
RITMO...........................................................................12
ABSTINENCIA.............................................................. 13
COITO INTERRUMPIDO/RETIRO................................14
OTROS____________________________________ 15
(ESPECIFIQUE)
SECCIÓN 8: VIH/ SIDA
NO PREGUNTAS Y FILTROS CATEGORIA DE CODIFICACION SALTAR
1
VS1
¿Ha oido alguna vez hablar de
la enfermedad del SIDA?
NO............................................0
SI..............................................1
 AS1
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 60
NO PREGUNTAS Y FILTROS CATEGORIA DE CODIFICACION SALTAR
2
VS2
¿Hay algo que se pueda hacer
para evitar que nos de el SIDA?
NO............................................0
SI..............................................1
NO SABE .................................8
 AS1
 AS1
3
VS3
¿Qué se puede hacer?
¿Algo más?
ANOTE TODO LO
MENCIONADO
NO SABE.................................................................................A
ABSTENERSE DEL SEXO......................................................B
USAR CONDONES.................................................................C
LIMITAR EL SEXO A UNA PAREJA/ SER FIEL A UNA
PAREJA...................................................................................D
LIMITAR EL NUMERO DE PAREJAS SEXUALES.................E
EVITAR EL SEXO CON PROSTITUTAS................................F
EVITAR EL SEXO CON PERSONAS QUE TIENEN
MUCHAS PAREJAS................................................................G
EVITAR RELACIONES CON PERSONAS DEL MISMO
SEXO.......................................................................................H
EVITAR EL SEXO CON PERSONAS QUE SE INYECTAN
DROGAS INTRAVENOSAS......................................................I
EVITAR TRANSFUSIONES DE SANGRE...............................J
EVITAR
INYECCIONES...........................................................K
EVITAR BESOS.......................................................................L
EVITAR PICADURAS DE MOSQUITO...................................M
OBTENER PROTECCIÓN DE UN CURANDERO
TRADICIONAL.........................................................................N
EVITAR COMPARTIR NAVAJAS/HOJAS DE
AFEITAR.........O
OTROS____________________W
(ESPECIFIQUE)
OTROS_____________________X
(ESPECIFIQUE)
 AS1
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 61
Annex D: Results from the 80 Priority Communities
Introduction
This brief introduction is to provide an overview of the survey conducted only in the 80 intervention communities of the
project. In order to illustrate the investment the project made in the 80 direct intervention communities, the project
decided to conduct a mini KPC in those communities in addition to the overall KPC which covered all 750
communities. This second survey would allow the CS team to see the results of their education and supervision
efforts as applied to the 80 communities. The results of that survey (referred to as KPC-80 in the report) are included
in this annex to facilitate analysis and discussion. One of the challenges with the current CS project was the
ambitious goal of covering all 750 communities within the department of Jinotega. The project team believed that with
additional funding, they would be able to provide coverage to these communities, by supplementing the original CS
budget. Policy decisions at Project HOPE HQ derailed this plan and the limited additional funding sources that would
have facilitated providing services to the 750 communities were unable to be pursued. Faced with this constraint and
with the consent of USAID, the project selected 80 direct intervention communities that would receive regular
trainings for HF staff, CHWs and TBAs and receive more frequent follow up visits from project staff. It is these 80
communities that were interviewed as part of KPC-80.
The reason the project undertook this exercise was that when the project team approached USAID and requested
that the final evaluation only include the 80 direct intervention communities, that request was summarily denied.
The project used the LQAS methodology to administer the baseline, midterm and final evaluations. Local project staff
from Project HOPE Nicaragua were trained to administer the survey and mothers of children under 2 years of age
were interviewed in the 8 municipalities within the department of Jinotega. Given economic and time constraints, the
anemia indicators were not collected in the 80 community survey. The presentation of the results of the 80 community
survey are presented below as well as a comparison with all project communities.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 62
KPC Final vs. KPC 80 communities- Results by indicator – Department of Jinotega, Nicaragua
Indicator (for the entire project area) FE March 2007
All the areas
FE June 2007
80 communities GOAL
Maternal and Newborn Care Maternal and Newborn Care
24. % of mothers of children aged 0-23 months who report having had at
least one prenatal visit with a doctor or nurse. 95% 95% 94%
25. % of mothers of children aged 0-23 months who report having had
two or more prenatal visit with a doctor or nurse. 40% 90% *
26. % of mothers of children aged 0-23 months that report receiving on
their arm the dT vaccine during the last pregnancy. 89% 92% **
27. % of children aged 0-23 months whose birth was attended by a doctor
or nurse.
71% 61% 65%
28. % of mothers of children aged 0-11 months who report having had at
least one postpartum visit. 51% 52% 45%
Nutrition and Micronutrients
29. % of children aged 0-23 months weighed in the last four months
according to growth monitoring card. 75% 96% 90%
30. % of children aged 0-23 months with low weight (Weight-For-Age)
(<2Z). 1% 8%
31. % of children aged 0-23 months stunted (Height-For-Age) (<2Z). %
32. % of children aged 0-23 months with anemia (hemoglobin level <
11mg/dl). 47% 30%
Breastfeeding Promotion
33. % of mothers of children aged 0-23 months who report having
breastfed within the first hour after birth 77% 82% 80%
34. % of mothers of children aged 0-23 months who report having
breastfed within the first 8 hours after birth. 85% 89% **
35. % of infants aged 0-5 months who received only breast milk in the
past 24 hours. 56% 74% 70%
Immunization
36. % of children aged 12-23 months with all recommended vaccines at
the moment of their first birthday according to the growth monitoring
card.
78% 87% 80%
Control of Diarrheal Diseases
37. % of mothers of children aged 0-23 months with a diarrheal episode in
the last two weeks who report giving as much or more food to their
child.
31% 59% 60%
38. % of mothers with children aged 0-23 months with a diarrheal episode
in the last two weeks who report giving as much or more liquids or
breast milk to their child
65% 85% 80%
39. % of mothers of children aged 0-23 months who report having sought
assistance or counseling from a health unit or CORU during the child’s
last diarrheal episode.
40% 54% 50%
40. % of mothers of children aged 0-23 months who report washing their
hands with water and soap before the preparation of meals, before
feeding children, after defecation and after tending a child that has
defecated
7% 24% 35%
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 63
41. % of mothers of children aged 0-23 months that know at least two signs
of dehydration due to diarrhea. 31% 73% 40%
Indicator (for the entire project area) EF March 2007
All the areas
EF June 2007
80
communities
GOAL
Pneumonia Case Management
42. % of children aged 0-23 months with cough and fast breathing in the
last two weeks taken to a health unit. 53% 30% 75%
43. % of mothers of children aged 0-23 months who can identify fast
breathing as a danger sign for pneumonia. 83% 90% 90%
Child Spacing
44. % of children aged 0-23 months who were born at least 24 months after
the previous surviving child. 77% 90% 86%
45. % of mothers of children aged 12-23 months who desire no more
children in the next two years, who are using some type of modern child
spacing method.
100% 66% 85%
HIV/AIDS
46. % of mothers of children aged 0-23 months who know at least one way
to prevent STIs-HIV/AIDS. 20% 62% 15%
*indicador monitoreado a solicitud de Bonnie Kittle, en consecuencia, no hay meta.
**Indicador no tiene meta, pues solamente se ha dado seguimiento sin ser un objetivo del programa
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 64
Comparison of Results: 80 Priority Communities vs. All Areas
Maternal and Newborn Care
95 95 94
0
10
20
30
40
50
60
70
80
90
100
EF Total March 2007 EF 80c June 2007 Goal
% of mothers of children aged 0-23 months who report having had
at least one prenatal visit with a doctor or nurse
The project surpassed the goal of 94% of mothers with children 0-23 months old having at least one prenatal visit. Overall, 95% of
mothers interviewed for the survey had at least one prenatal visit during the current pregnancy. In the KPC- 80 survey, the result was
the same.
71 61 65
0
10
20
30
40
50
60
70
80
90
100
EF Total March 2007 EF 80c June 2007 Goal
% of children aged 0-23 months whose birth was attended by a
doctor or nurse
In the overall KPC, 71% of mothers of children 0-23 months old had their birth attended by a doctor or nurse. This indicator, which
stresses skilled attendants at birth, is instrumental in reducing maternal and infant mortality, especially during the neonatal period. In
the KPC-80, 61% of births of children 0-23 months were attended by a medical professional, which was slightly less than the target
of 65%.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 65
51 52
45
0
10
20
30
40
50
60
70
80
90
100
EF Total March 2007 EF 80c June 2007 Goal
% of mothers of children aged 0-11 months who report having at
least one postpartum visit
In both the overall KPC and the KPC- 80 survey, the target of 45% of mothers with children aged 0-11 months having
at least one postpartum visit, was achieved. The final KPC and KPC- 80 results indicate that 51% and 52% of moms
respectively, have had at least one postpartum visit during their most recent pregnancy.
Nutrition and Micronutrients
75
96
90
0
10
20
30
40
50
60
70
80
90
100
EF Total March 2007 EF 80c June 2007 Meta
% of children aged 0-23 months weighed in the last four months
according to growth monitoring card
The results varied dramatically for this indicator, as evidenced by the graph above. In the overall KPC, only 75% of
children 0-23 months had been weighed in the last 4 months, per the growth monitoring card. In contrast, 96% of
children 0-23 months in the KPC-80 communities had been weighed according to the growth monitoring card. It
would appear that the frequent follow up by project staff influenced the continued attendance of mothers at growth
monitoring sessions.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 66
Breastfeeding Promotion
77
82
80
74
75
76
77
78
79
80
81
82
EF Total March 2007 EF 80c June 2007 Meta
% of mothers of children aged 0-23 months who report having
breastfed within the first hour after birth
The goal for the breastfeeding indicator was that 80% of mothers of children 0-23 months breastfeed their infants
within an hour of birth. In the overall KPC, 77% of mothers reported breastfeeding their infants within the specified
time period, while results of the KPC-80 survey reveal that 82% of mothers were able to achieve the objective.
56
74 70
0
10
20
30
40
50
60
70
80
EF Total March 2007 EF 80c June 2007 Goal
% of infants aged 0-5 months who received only breast milk in the
past 24 hours
Exclusive breastfeeding is an important indicator for infant health and has been shown to reduce the incidence of
diarrhea and ear infections in infants. The two KPCs conducted reveal very different results. In the overall KPC, 56%
of infants received only breastmilk in the past 24 hours, while in the KPC-80, 74% of infants were exclusively
breastfeed, surpassing the project goal of 70%.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 67
Immunization
78
87
80
72
74
76
78
80
82
84
86
88
EF Total March 2007 EF 80c June 2007 Goal
% of children aged 12-23 months with all recommended vaccines at
the moment of their first birthday according to the growth
monitoring card
In the overall KPC, seventy eight (78%) percent of children 12-23 months of age received all their recommended
vaccinations by their first birthday. This contrasts with the results from the KPC-80 which revealed that 87% of
children 12-23 months of age received the necessary vaccinations by age one. This exceeded the project target of
80%.
Control of Diarrheal Diseases
31
59 60
0
10
20
30
40
50
60
EF Total March 2007 EF 80c June 2007 Goal
% of mothers of children aged 0-23 months with a diarrheal episode
in the last two weeks who report giving as much or more food to
their child
Neither the overall KPC nor the KPC-80 were able to achieve the project goal of 60% of mothers of children 0-23
months providing the same or more food to their child during a bout of diarrhea. In the overall KPC, only 31% of
mothers provided the same or more food to their sick child., while in the KPC-80 communities, 59% of mothers gave
the same or more food to their child during a recent diarrhea episode.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 68
65
85 80
0
10
20
30
40
50
60
70
80
90
EF Total March 2007 EF 80c June 2007 Goal
% of mothers with children aged 0-23 months with a diarrheal episode
in the last two weeks who report giving as much or more liquids or
breast milk to their child
Eighty five (85%) percent of mothers in the 80 direct intervention communities gave more liquids or breastmilk to their
children aged 0-23 months during a recent bout of diarrhea. This result exceeded the project goal of 80%. In the
overall KPC, only 65% of mothers provided more liquids or breastmilk to their children aged 0-23 months during a
recent episode of diarrhea.
40
54
50
0
10
20
30
40
50
60
EF Total March 2007 EF 80c June 2007 Goal
% of mothers of children aged 0-23 months who report having
sought assistance or counseling from a health unit or CORU during
the child´s last diarrheal episode
The project established Community Oral Rehydration Units or CORU’s to promote ORS at the community level. The
project goal was that 50% of mothers of children aged 0-23 months seek assistance or counseling from a health unit
or CORU during the child’s last diarrheal episode. The KPC-80 survey revealed that 54% of mothers sought help at
the CORU during their child’s last episode of diarrhea, while in the overall KPC, only 40% of mothers sought
assistance from the CORU.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 69
7
24
35
0
5
10
15
20
25
30
35
EF Total March 2007 EF 80c June 2007 Goal
% of mothers of children aged 0-23 months who report washing
their hands with water and soap before the preparation of meals,
before feeding children, after defecation and after tending a child
that has defecated
This indicator was a challenge for both the overall KPC and the KPC-80 to achieve. The project goal was that 35% of
mothers of children aged 0-23 months who report washing their hands with water and soap before the preparation of
meals, before feeding children, after defecation and after tending a child that has defecated. In the overall KPC, only
7% of mothers reported washing their hands in the four instances specified, while in the KPC-80 survey, the results
were more than 3 times better: 25% of mothers report washing their hands with water and soap before the
preparation of meals, before feeding children, after defecation and after tending a child that has defecated.
31
73
40
0
10
20
30
40
50
60
70
80
EF Total March 2007 EF 80c June 2007 Goal
% of mothers of children aged 0-24 months that know at least two
signs of dehydration due to diarrhea
The project goal was that 40% of mothers of children aged 0-24 months know at least two signs of dehydration due to
diarrhea. In the overall KPC, 31% of mothers were able to identify at least two signs of dehydration, while in the KPC￾80, 73% of mothers interviewed could name at least two signs of dehydration due to diarrhea.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 70
Pneumonia Case Management
53
30
75
0
10
20
30
40
50
60
70
80
EF Total March 2007 EF 80c June 2007 Goal
% of children aged 0-23 months with cough and fast breathing in
the last two weeks taken to a health unit
Overall, mothers of children 0-23 months who have had coughing and fast breathing in the last two weeks have not
adopted the behavior of taking their child to a health unit. The project goal was 75%, but only 53% of mothers in the
overall KPC brought their child to a health facility when s/he presented cough and/or fast breathing. Even more
alarming was that in the KPC-80 community survey, only 30% of mothers of children 0-23 months brought their child
in for medical attention as indicated. All of this is more troubling when the indicator on knowledge (below) is analyzed.
Future projects should conduct qualitative studies to determine the barriers that prevent mothers from taking their
children to health facilities at the first sign of rapid breathing.
83
90 90
78
80
82
84
86
88
90
EF Total March 2007 EF 80c June 2007 Goal
% of mothers of children aged 0-23 months who can identify fast
breathing as a danger sign for pneumonia
It is encouraging to see that the vast majority of mothers can identify fast breathing as a sign of pneumonia. In the
overall KPC, 83% of moms identified this danger sign, while 90% of mothers in the KPC-80 survey did as well. The
challenge is to translate knowledge into practice (see above indicator).
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 71
Child Spacing
77
90
86
70
72
74
76
78
80
82
84
86
88
90
EF Total March 2007 EF 80c June 2007 Goal
% of children aged 0-23 months who were born at least 24 months
after previous surviving child
The messages regarding child spacing have begun to bear fruit in some communities of the project. The overall KPC
revealed that 77% of children 0-23 months were born at least 24 months after previous surviving child, while 90% of
children 0-23 months in the 80 direct intervention communities were born 2 years after a prior sibling. The project
goal for this indicator was 86%.
100
66
85
0
10
20
30
40
50
60
70
80
90
100
EF Total March 2007 EF 80c June 2007 Goal
% of mothers of children aged 12-23 months who desire no more
children in the next two years, who are using some type of modern
child spacing method
This indicator revealed very surprising results. The goal was that 85% of mothers of children aged 12-23 months who
desire no more children in the next two years, use using some type of family planning method. In the overall KPC,
100% of the mothers interviewed indicated that they were using a modern child spacing method, while in the 80
intervention communities, only 66% of mothers interviewed indicated that they were using a modern method to space
pregnancies.
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 72
HIV/AIDS
20
62
15
0
10
20
30
40
50
60
70
EF Total March 2007 EF 80c June 2007 Goal
% of mothers of children aged 0-23 months who know at least one
way to prevent STIs-HIV/AIDS
Both in the overall KPC and in the KPC-80, the target of 15% of mothers of children aged 0-23 months who
know at least one way to prevent STIs-HIV/AIDS was reach. In the overall KPC, 20% of mothers knew at least one
way to prevent HI/AIDS and STIs, while a whopping 62% of mothers in the 80 intervention communities were able to
name at least one way to avoid sexually transmitted diseases, including HIV/AIDS.
■
Project HOPE CS-18: Jinotega, Nicaragua
2007 KPC Final Report Page 73
Child Survival and Health Grants Program Project Summary
Dec-27-2007
Project HOPE 
(Nicaragua)
General Project Information: 
Cooperative Agreement Number: HFA-A-00-02-00026-00
Project Grant Cycle: 18
Project Dates: (9/30/2002 - 9/29/2007)
Project Type: Standard
PROJECT HOPE Headquarters Technical
Backstop: Bonnie Kittle 
Field Program Manager: Francisco Torres 
Midterm Evaluator: 
Final Evaluator: Marguerite Joseph 
USAID Mission Contact: Dr. Ivan Tercero 
Field Program Manager Information:
Name: Francisco Torres
Address: Project HOPE/Nicaragua 
Managua , Nicaragua 
Phone: 011-505-278-0116, 270 31 24 
Fax:
E-mail: hopenic1@cablenet.com.ni 
Alternate Field Contact:
Name: Alejandro Soza
Address: Colonia Los Robles No. 72 De la Funeraria 
Managua , 
Phone: 011-505-270-3124 
E-mail: hopenic2@cablenet.com.ni 
Funding Information:
USAID Funding:(US $): $1,300,000 PVO match:(US $) $1,300,000 
Project Information:
Description:
The goal of this program is to reduce morbidity and mortality rates of children under five
and women of reproductive age in the Department of Jinotega’s primarily rural
communities. Specific program health interventions and level of effort include maternal
and newborn care, nutrition/micronutrient deficiencies, breastfeeding promotion, control of
diarrheal disease, pneumonia case management, immunization, child spacing, and
HIV/AIDS/STIs. The program builds upon HOPE’s experience implementing strong public
health education programs in Boaco, Chontales, and three municipalities of Jinotega. It
benefits from lessons learned in HOPE’s innovative and highly successful child survival
program on the coffee plantations of Guatemala’s Boca Costa region. The proposed
interventions are implemented in accordance with Nicaragua’s “Integrated Services to the
Child” (AIN) approach, Central America’s version of IMCI. Other strategies employed are:
building the service-delivery capacity of local health facilities and organizations; increasing
the skills and elevating the morale of health care providers; strengthening cooperation
among public, private and community stakeholders; and empowering consumers,
particularly women. 
Location:
Located along Nicaragua’s northern border with Honduras, Jinotega is mainly rural and
mountainous, and is among the country’s poorest departments. Coffee production is the
main economic activity, with an estimated 12,000 plantations in the region. Severely
affected by Hurricane Mitch in late 1998, the plantations in Jinotega have suffered further
economic losses due to the recent sharp downturn in coffee prices. As a result, the size of
the labor force has been significantly reduced, with an attendant impact on household
income and health status. 
Project Partners Partner Type Subgrant Amount
SILAIS Jinotega Collaborating Partner 
General Strategies Planned:
Private Sector Involvement
Strengthen Decentralized Health System
Information System Technologies 
M&E Assessment Strategies:
KPC Survey
Health Facility Assessment
Organizational Capacity Assessment with Local Partners
Organizational Capacity Assessment for your own PVO
Lot Quality Assurance Sampling
Participatory Evaluation Techniques (for mid-term or final evaluation) 
Behavior Change & Communication (BCC) Strategies:
Interpersonal Communication
Peer Communication
Support Groups 
Groups targeted for Capacity Building:
PVO Non-Govt
Partners
Other Private
Sector Govt Community
Field Office HQ
CS Project
Team 
(None Selected) Business Dist. Health
System
Health Facility
Staff
CHWs 
Interventions/Program Components:
Immunizations (7 %)
 (IMCI Integration)
Nutrition (13 %)
 (IMCI Integration)
 (CHW Training)
 - Comp. Feed. from 6 mos.
 - Growth Monitoring
 - Maternal Nutrition
Pneumonia Case Management (10 %)
 (IMCI Integration)
 (CHW Training)
 - Pneum. Case Mngmnt.
 - Access to Providers Antibiotics
 - Recognition of Pneumonia Danger Signs
Control of Diarrheal Diseases (15 %)
 (IMCI Integration)
 (CHW Training)
 - Hand Washing
 - ORS/Home Fluids
 - Feeding/Breastfeeding
 - Care Seeking
 - Case Mngmnt./Counseling
Maternal & Newborn Care (30 %)
 (IMCI Integration)
 (CHW Training)
 - Recog. of Danger signs
 - Newborn Care
 - Post partum Care
 - Delay 1st preg Child Spacing
 - Normal Delivery Care
 - Birth Plans
 - Emergency Transport
Child Spacing (10 %)
 (IMCI Integration)
 (CHW Training)
 - Child Spacing Promotion
Breastfeeding (10 %)
 (IMCI Integration)
 (CHW Training)
 - Promote Excl. BF to 6 Months
 - Intro. or promotion of LAM
HIV/AIDS (5 %)
 (CHW Training)
Target Beneficiaries:
Infants < 12 months: 8,101
Children 12-23 months: 8,149
Children 0-23 months: 16,250
Children 24-59 months: 43,781
Children 0-59 Months 60,031
Women 15-49 years: 70,827
Population of Target Area: 254,192
Rapid Catch Indicators:
Numerator Denominator Percentage Confidence
Interval
Percentage of children age 0-23
months who are underweight (-2
SD from the median
weight-for-age, according to the
WHO/NCHS reference
population)
3 304 1.0% 1.1
Percentage of children age 0-23
months who were born at least
24 months after the previous
surviving child
237 304 78.0% 4.7
Percentage of children age 0-23
months whose births were
attended by skilled health
personnel
223 304 73.4% 5.0
Percentage of mothers of
children age 0-23 months who
received at least two tetanus
toxoid injections before the birth
of their youngest child
112 117 95.7% 3.7
Percentage of infants age 0-5
months who were exclusively
breastfed in the last 24 hours
50 89 56.2% 10.3
Percentage of infants age 6-9
months receiving breastmilk and
complementary foods
38 48 79.2% 11.5
Percentage of children age 12-23
months who are fully vaccinated
(against the five
vaccine-preventable diseases)
before the first birthday
114 139 82.0% 6.4
Percentage of children age 12-23
months who received a measles
vaccine
119 139 85.6% 5.8
Percentage of children age 0-23
months who slept under an
insecticide-treated bednet the
previous night (in malaria-risk
areas only)
101 304 33.2% 5.3
Percentage of mothers who
know at least two signs of
childhood illness that indicate
the need for treatment
277 304 91.1% 3.2
Percentage of sick children age
0-23 months who received
increased fluids and continued
feeding during an illness in the
past two weeks
12 150 8.0% 4.3
Percentage of mothers of
children age 0-23 months who
cite at least two known ways of
reducing the risk of HIV
infection
67 304 22.0% 4.7
Percentage of mothers of
children age 0-23 months who
wash their hands with soap/ash
before food preparation, before
feeding children, after
defecation, and after attending to
a child who has defecated
23 304 7.6% 3.0
Comments for Rapid Catch Indicators
 In the
Midterm KPC Report, all the 95% Confidence Intervals have been calculated adjusted to
population of supervision areas. Therefore, there are slight differences between the 95% C.I.
in the report against the ones in this Project Data Sheet form.