Mercy Corps Guatemala PROCOMIDA Program: Award Number: AID-FFP-A-09-00005-00 External Midterm Evaluation Report: Review and Reporting for PROCOMIDA’s Community Food Diversification Program for Mother and Child 07 February 2013 Submitted to Mercy Corps Guatemala by: Health and Development Consulting International (HDCi) LLC Liesl Messerschmidt, MPH, Director www.healthdevinternational.com HDCinternational@gmail.com 1 CONTENTS Contents .................................................................................................................................... 1 List of Tables ............................................................................................................................. 2 List of Figures ............................................................................................................................ 3 Acronyms ................................................................................................................................... 4 Executive Summary ................................................................................................................... 6 Background ............................................................................................................................ 6 Methodology ........................................................................................................................... 6 Summary of Key Findings....................................................................................................... 6 Summary of Recommendations.............................................................................................. 7 1. Introduction ............................................................................................................................ 8 1.1 Purpose of Evaluation and Summary of SOW .................................................................. 8 2. Evaluation Methods ................................................................................................................ 9 2.1 Study Design .................................................................................................................... 9 Sample Size ........................................................................................................................ 9 Data Collection ..................................................................................................................10 AnalysIs .............................................................................................................................11 2.2 Limitations .......................................................................................................................12 2.3 About This Report ............................................................................................................12 3. Context .................................................................................................................................13 4. Results ..................................................................................................................................17 4.1 IPTT ................................................................................................................................17 4.2 Correlations .....................................................................................................................21 Correlation #1 ....................................................................................................................22 Correlation #2 ....................................................................................................................22 Correlation #3 ....................................................................................................................23 Correlation #4 ....................................................................................................................24 Correlation #5 ....................................................................................................................25 4.3 Discussion of Findings by Objective ................................................................................26 Convergence Centers ........................................................................................................26 Community Healthcare .......................................................................................................28 Households ........................................................................................................................29 Mothers ..............................................................................................................................31 SPECIFIC OBJECTIVE 1 ...................................................................................................31 Intermediate Result 1.1 ......................................................................................................35 2 Intermediate Result 1.2 ......................................................................................................35 Intermediate Result 1.3 ......................................................................................................40 SPECIFIC OBJECTIVE 2 ...................................................................................................41 Intermediate Result 2.1 ......................................................................................................42 Intermediate Result 2.2 ......................................................................................................43 Intermediate Result 2.3 ......................................................................................................44 5. Conclusions and Recommendations .....................................................................................44 References ...............................................................................................................................47 Appendices ...............................................................................................................................49 Appendix A: Terms of Reference: Estadística y Opiniones MKT............................................49 Appendix B: Terms of Reference: Health and Development Consulting International (HDCi) LLC .......................................................................................................................................53 Appendix C: List of Sampled Convergence Centers ..............................................................57 Appendix D: Data Collection Tools (Questionnaires and Surveys) .........................................59 Appendix E: Evaluation Dates .............................................................................................163 Appendix F: Information Sources .........................................................................................164 Appendix G: Questionnaire Modules (Topics) ......................................................................165 Appendix H: Implementation Area Map ...............................................................................167 LIST OF TABLES Table 1 Objectives and Results Framework (from PROCOMIDA proposal document) Page 13 Table 2 Indicator Performance Tracking Table (IPTT) 17 Table 3 Average Household Dietary Diversity Score (HDDS, indicator 3) and percent of children 6-24 months with minimum acceptable dietary diversity (indicator 5) 22 Table 4 Average HDDS (indicator 3) and percent of mothers demonstrating increased nutritional knowledge (indicator 7) 22 Table 5 Percent of children 6-24 months with minimum acceptable dietary diversity (indicator 5) and percent of mothers demonstrating increased nutritional knowledge (indicator 7) 23 Table 6 Percent of children 0-6 months exclusively breastfed (indicator 9) and percent of mothers demonstrating increased nutritional knowledge (indicator 7) 24 Table 7 Percent of mothers receiving minimum recommended antenatal care (indicator 14) and percent of mothers receiving minimum recommended postnatal care (indicator 16) 25 Table 8 CC characteristics 27 Table 9 Community healthcare characteristics 28 3 Table 10 Household characteristics 29 Table 11 Home utility characteristics 30 Table 12 Mother characteristics 31 Table 13 Distribution of malnourishment among children aged 0-59 months (<-2 z-score weight-for-age), by sex 31 Table 14 Distribution of stunting among children aged 0-59 months and 6-59 months (<-2 z-score height-for-age), by sex 32 Table 15 Household hunger and dietary diversity 33 Table 16 Average z-scores among children among households with different hunger levels 34 Table 17 Percentage of mothers reporting knowledge of specific feeding practices 36 Table 18 Percentage of pregnant women reporting knowledge of specific warning signs/dangers of pregnancy 37 Table 19 Health and care knowledge of mothers 37 Table 20 Use of prenatal care services 38 Table 21 Health care worker knowledge of danger signs that require medical attention 42 Table 22 Birth options and attendance of medical staff 43 LIST OF FIGURES Figure 1 Changes in the average HDDS and percent of children 6-24 months with minimum acceptable dietary diversity, at baseline and midterm Page 22 Figure 2 Changes in the average household dietary diversity scale (HDDS) and the percent of mothers demonstrating improved nutritional knowledge, at baseline and midterm 23 Figure 3 Changes in the average HDDS and the percent of mothers demonstrating improved nutritional knowledge, from baseline to midterm 24 Figure 4 Changes in the percent of children 0-6 months who were exclusively breastfed and the percent of mothers demonstrating improved nutritional knowledge, from baseline to midterm 25 Figure 5 Changes in the percent of mothers receiving minimum recommended antenatal care and the percent of mothers receiving minimum recommended postnatal care, from baseline to midterm 26 Figure 6 Mean z-scores for weight-for-age, height-for-age, and weight-for￾height, by age group at midterm 32 Figure 7 Comparison of food group consumption from baseline to midterm 34 4 ACRONYMS AIEPI-AINM-C Integrated Care of Childhood Illness / Care for Children and Mother at the Community Level ANTHRO WHO’s software for Assessing Growth of the World’s Children and Adolescents BCC Behavior Change Communication CC Convergence Center CDC Centers for Disease Control and Prevention CHC Community Health Commission CHV Community Health Volunteer CSB Corn-soy Blend ENA Emergency Nutrition Assessment FANTA III Food and Nutrition Technical Assistance III FEWSnet Famine Early Warning System Network FFP Food for Peace H-A Height-for-age HDCi Health and Development Consulting International LLC HDDS Household Diet Diversity Scale HP Health Post IFPRI International Food Policy Research Institute IPTT Indicator Performance Tracking Table IR Intermediate Result IY Implementation Year LNS Lipid-based Nutritional Supplements M&E Monitoring and Evaluation MCHN Maternal Child Health and Nutrition MIS Management Information System MKT Estadística y Opiniones MKT MNP Micronutrient Powder (Chispitas) MoH Ministry of Health MSPAS Ministry of Public Health and Social Work MYAP Multi-year Assistance Program NGO Non-governmental Organization ORS Oral Rehydration Salts PM2A Preventing Malnutrition in Children Under 2 Approach PREP Pipeline and Resource Estimate Proposal PROCOMIDA Programa Comunitario Materno Infantil de Diversificación Alimentaria (Community Food Diversification Program for Mother and Child) 5 S.D. Standard Deviation SAM Severe Acute Malnutrition SBCC Social and Behavior Change Communication SESAN Secretary of Food Security and Nutrition, Government of Guatemala SO Strategic Objective SPSS Statistical Package for Social Sciences SWOL Strengths, Weaknesses, Opportunities, Limitations TSU Technical Support Unit (PROCOMIDA, Mercy Corps Guatemala) USAID United States Agency for International Development W-A Weight-for-age 6 EXECUTIVE SUMMARY Background Guatemala has some of the worst rates of chronic malnutrition in Latin America, and in the world. Conditions are severest in the northern lowland and highland areas converging in and around Alta Verapaz. Within these geographic areas, the most vulnerable and affected by food insecurity and malnutrition are pregnant and lactating women, and children under two years of age, particularly amongst poor, marginalized, and vulnerable indigenous and ethnic communities, including the Q’eqchí. Malnutrition is especially harmful to children under two, as they can experience lifetime impairment due to weak physical and cognitive development. ‘Programa Communitario Materno Infantil de Diversificación Alimentaria’ (Community Food Diversification Program for Mother and Child, or PROCOMIDA) is a six-year program that started in July 2009 and ends June 2015, and seeks to improve the nutritional status of 266,000 people in 936 vulnerable communities in the department of Alta Verapaz, Guatemala. The goal is improved nutritional status and health of women and children vulnerable to food insecurity in northern Guatemala. Mercy Corps Guatemala is implementing PROCOMIDA, a multi-year assistance program, with funding from the United Sates Agency for International Development Bureau of Democracy, Conflict and Humanitarian Assistance Office of Food for Peace. Methodology Midterm evaluation activities covered two phases: (1) Field Data Collection, April to July 2012, and (2) Analysis and Reporting (January 2013). The purpose was twofold: to meet the midterm evaluation requirements of the donor, and to provide Mercy Corps Guatemala and implementation partners with sound information to use towards improving program implementation in order to achieve final targets and goals by 2015. Summary of Key Findings More than half of the impact and monitoring indicators (17 out of 30) exceeded the target set for implementation year three. All anthropometric impact indicators met or exceeded target. The distribution of food rations to pregnant and lactating women reached close to 20,000 – doubling the target set of 10,000. The distribution of food rations to children aged 6-24 months reached 30% over the midterm target (20,692 compared to the target of 16,000). The percentage of children aged 6-24 months with minimal acceptable dietary diversity almost met target, indicating a need to continue to stress the importance of appropriate feeding practices with mothers. Along with the distribution of food rations, indicators that are related to mother knowledge all far exceeded their targets, demonstrating that the program has been able to transfer knowledge to participating mothers as a result of the BCC strategy. The percentage of mothers demonstrating increased nutritional knowledge exceeded the target of 10% by more than 4-fold (45.7%). Among mothers with increased nutritional knowledge, however, there was no significant association with better average household dietary diversity score (HDDS), the dietary diversity of children aged 6-24 months, or in the practice of exclusive breastfeeding of children aged 0-6 months, compared to mothers with no increase in nutritional knowledge. Households with action plans exceeded the target of 3% by nearly double. The number of Convergence Centers and Health Pots with emergency funds exceeded the target by 14. Both the number of health commissions with regular meetings and those demonstrating progress on action plans met their target, due to the addition of Health Posts. Community Health Commissions met monthly with PROCOMIDA staff, and had half-yearly assemblies to present 7 their progress towards annual work plans to their constituent communities. The expansion and inclusion of educators and staff at Health Posts is responsible for meeting the target for the percentage of detected severe acute malnutrition referred per Ministry of Health protocols. Those not referred (6%) presented no complications, and were able to be treated in the community as defined by the protocol. The number of persons trained in planning and advocacy around food security and health exceeded the target by 118%, which is directly related to the expansion of the program. There are several indicators that did not achieve the midterm target by slight margins, and six indicators that showed values below those at baseline and thus clearly did not achieve midterm targets. For most of these, the drop from baseline was slight. The percent of newborns who receive essential newborn care, the percent of children between 0-6 months that are exclusively breastfed, and the percent of children aged 6-23 months with respiratory diseases that received adequate treatment, were all lower than target, and in all three cases also slightly lower than their baseline value, indicating a need to redirect programmatic efforts on translating improved knowledge into practice and health seeking behavior. The percentage of children receiving full vaccinations, however, dropped significantly to 50.7% from a high baseline figure of 85.9%. The lower MoH budget and subsequently lower coverage for full and timely vaccinations and other interventions compared to baseline largely explains this decrease. The availability of a minimal level of infrastructure, supplies, and medications at health facilities is also contingent upon the MoH budget, which has remained stagnant since baseline. The percent of health facility staff and community health volunteers able to identify a minimum number of core health and nutrition practices was significantly unable to meet midterm target, and in fact dropped from baseline. The percentage of deliveries at health facilities has remained essentially unchanged from baseline, possibly related to the importance of traditional midwives. Summary of Recommendations The overarching recommendation of this midterm evaluation is that PROCOMIDA needs to redirect programmatic efforts on translating improved knowledge and access to rations into improved practice and health seeking behavior. Towards addressing this recommendation, several suggestions or implementing recommendations are proposed. 1. Conduct extensive anthropological ‘learning’ research 2. Pursue a stronger educational presence 3. Reconsider the role of community health volunteers In addition to this overarching recommendation, it is noted that a number of factors affecting program performance are outside of the program’s control. These include access to essential blood pressure monitors, stethoscopes, and thermometers by CCs (which decreased from baseline), and access to essential medications and vaccinations. The program should consider renegotiating with USAID those indicators of access and quality of health services outside of programmatic control, or propose to change the indicators entirely to better measure direct interventions. 8 1. INTRODUCTION 1.1 Purpose of Evaluation and Summary of SOW Food insecurity disproportionately affects the poor, indigenous, smallholder farmer, and landless populations in rural communities. In Latin America, including in Guatemala, food insecurity has led to high rates of chronic child malnutrition. The most vulnerable and affected by food insecurity and malnutrition are pregnant and lactating women and children under two years. ‘Programa Communitario Materno Infantil de Diversificación Alimentaria’ (Community Food Diversification Program for Mother and Child, or PROCOMIDA) is a six-year program that started in July 2009 and ends June 20151 , and seeks to improve the nutritional status of 266,000 people in 936 vulnerable communities in the department of Alta Verapaz, Guatemala. The goal is to improve nutritional status and health of women and children vulnerable to food insecurity in northern Guatemala. PROCOMIDA provides nutritional and health education to empower mothers (defined by the program as mothers) to adopt best practices, including seeking health services. PROCOMIDA works with NGOs and MOH health units to establish community structures organized to improve the provision of culturally and technically appropriate health services. It also provides beneficiaries a balanced ration of food that contains a family ration of rice, beans and vegetable oil with an additional individual ration of fortified corn-soy blend (CSB), which in the case of 40 Convergence Centers is replaced by micronutrients either in lipid based or powder form. Mercy Corps Guatemala is implementing PROCOMIDA, a multi-year assistance program (MYAP), with funding from the United Sates Agency for International Development (USAID) Bureau of Democracy, Conflict and Humanitarian Assistance Office of Food for Peace. The purpose of this midterm evaluation report of PROCOMIDA is to interpret the results of the field data collection to measure progress against program objectives and indicators, and determine whether USAID-supported interventions are contributing to reducing malnutrition and related health conditions (see Appendix A, Estadística y Opiniones MKT Terms of Reference). This midterm report follows USAID Forward evaluation policy, inclusive of rigorous statistical analysis, conclusions, and recommendations. It covers the period July 2009 (project implementation) – June 2012. The scope of work for the midterm report (see Appendix B, HDCi LLC Terms of Reference) specified the need for several correlations based on the following indicators:  Average Household Diet Diversity Score (HDDS, indicator 3) and percent of children ages 6 - 24 months with minimum acceptable dietary diversity (indicator 5)  Average HDDS (indicator 3) and percent of mothers demonstrating increased nutritional knowledge (indicator 7)  Percent of children ages 6 - 24 months with a minimum acceptable dietary diversity (indicator 5) and percent of mothers demonstrating increased nutritional knowledge (indicator 7)  Percent of children ages 0 - 6 months exclusively breastfed (indicator 9) and percent of mothers demonstrating increased nutritional knowledge (indicator 7)  Percent of mothers receiving minimum recommended antenatal care (indicator 14) and percent of mothers receiving minimum recommended post natal care (indicator 16) In addition, the terms indicated that the midterm evaluation report should include: 1 Originally, the program was for five years, but was extended with one year, to June 2015, as field work could not begin until after baseline data collection had been completed (July 2010). 9  Description of findings and their statistical relevance, comparisons and correlations of results, conclusions and recommendations with a purpose of improving program implementation to achieve final targets and goals  Tables of indicators showing statistical relevance in comparison with baseline findings  Tables of indicators comparing midterm results with midterm targets  Tables showing correlations between key indicators (noted above) While this midterm report is intended for submission to the donor and to be shared with local stakeholders, it is also envisioned as a working document for Mercy Corps Guatemala’s PROCOMIDA management team. Together with program partners and counterparts, the management team will use the discussion of findings, lessons, and recommendations to inform and advise the remaining full two years of program implementation, including strategies, priorities, and design changes, towards enhanced realization of the program goal and objectives. 2. EVALUATION METHODS 2.1 Study Design Midterm evaluation activities covered two phases, over the period April 2012 through January 2013.  Phase 1: Data Collection (April – July 2012) was conducted by MKT, a local consultancy team whose technical study group was comprised of a food safety specialist, nutritionist, and field coordinator. Under their leadership, eight field survey teams were formed. All study team members spoke both Spanish and Q’eqchí, were trained in using Tablets for date entry, and in using anthropometry equipment. Phase 1 consisted of literature review, field data collection (June 15 - July 13), and data cleansing in preparation for analysis.  Phase 2: Analysis and Reporting (January 2013) was completed by HDCi LLC. The HDCi team included one public health expert, and one biostatistician. They were tasked with finalizing the midterm evaluation report, in English, including reviewing and verifying, and in some cases re-analyzing, the field data collected for statistical relevance in comparison with the program’s baseline findings and implementation year 3 targets, and drawing conclusions and recommendations. The purpose was twofold: to meet the midterm evaluation requirements of the donor, and to provide Mercy Corps Guatemala and implementation partners with sound information to use towards improving program implementation in order to achieve final targets and goals by 2015. SAMPLE SIZE Based on the terms of reference for Phase 1, the baseline survey modules were utilized as a basis for the midterm evaluation, with additional modules incorporated to measure indicators not included at the time of the baseline. Data collection was digitized using Tablets. The sample was defined in a two staged cluster design. The sampling framework2 used was: [ ] Where: n = sample size 2 http://pdf.usaid.gov/pdf_docs/PNACG172.pdf 10 t = 95% confidence interval for simple cluster (2.045) p = expected prevalence (fraction of 1) q = 1-p (unexpected prevalence) d = desired precision DEFF = Design Effect With this calculation, total sample size was defined at 920 households. With the use of ENA3 software, cluster size was defined at 50 clusters of 20 households (families), rounding the number of households up to 1000. Clusters were selected through the Probability Proportional to Population method. It should be noted that at the community and health services level, PROCOMIDA is implemented through Convergence Centers (CCs), which are rally posts located in rural aldeas (small rural villages) that do not have any other health services. CCs are part of MOH first level of attendance and are managed by local Health implementing NGOs contracted by the Ministry. They generally attend other communities around the CC. Also, health services are only offered once a month, through a mobile health team. Community Health Volunteers are in charge of follow up visits, growth monitoring and emergencies. It was agreed that only CCs present in the program for a minimum of 10 months would be included in the evaluation. A list of all eligible CCs identified was compiled and were subsequently randomly ordered. ENA software automatically weighed each CC according to number of beneficiary households, thus assuring that each household in each CC had the same probability of being selected. Finally, the 20 households were randomly selected from the beneficiary list of each cluster, with an additional five replacements if a selected household was not present or did not want to answer the survey. In addition to the 50 clusters selected, an additional six clusters were randomly selected as replacement, in case of security risks, flooding, landslide, or other factors hindered access by the study teams (see Appendix C for a complete list of CCs sampled, by municipality) DATA COLLECTION MKT, with Mercy Corps Guatemala, developed data collection tools, based on IFPRI baseline tools, to answer the evaluation questions (see Appendix D for a complete list of survey and other interview tools). All study team members then attended a three-week orientation in data collection, digitization using the electronic Tablet devices4 and standardization in anthropometric measures to determine nutritional status, and other components of the program and evaluation methodology. During this orientation training workshop, the methodology of the study was also reviewed, and conducting two-way translation between Spanish and Q’eqchí was evaluated and practiced. Actual fieldwork occurred over four weeks (15 June – 13 July 2012) in the municipalities of Cobán, San Pedro Carchá, Cahabon, Lanquin, and Senahú of the Alta Verapaz Department, Guatemala. Data entered was continuously crosschecked for accuracy. Anthropometric data was sent directly to field editors, who checked consistency in the ENA software, on laptop computers, and returned Z values to the surveyors to be included in the Tablet. These Z values were double-checked at the data analysis stage. A total of 984 surveys were completed at the household level, and no replacement CCs were needed (see Appendix E for a complete list of evaluation dates). After data cleaning, 946 household surveys (96.1% of completed surveys) were included in the analysis, excluding those with missing data or incomplete responses. 3 Emergency Nutrition Assessment for SMART (www.nutrisurvey.net/ena/ena.html) 4 Cybertech 8170 Tablets were used, and the operating system was Java for Android 2.2. 11 Given that initial sample size was estimated at 920 households, the final number of surveys is representative for the entire beneficiary population. Data collection occurred at three levels (see Appendix F for a complete list of informants, References for all information sources, and Appendix G for lists of topics according to respondent level):  Community Level: the survey focused on the presence of health services (state), and access to them, as well as the presence of community-based healthcare (e.g., traditional doctors, midwives), and the function of Health Committees  CC Level: knowledge interviews with Community Health Volunteers (CHV) were conducted, and infrastructure, medicines, and supplies surveyed  Beneficiary Level: background information on household composition as well as questions about diet and feeding practices, knowledge, health seeking behavior, and household action plans were surveyed, and the results of anthropometry measures of all children under 5 years captured In summary, information was collected on the following topics:  Household composition  Household diet diversity scale (HDDS, see FANTA5 website for definitions)  Hunger Scale (see FANTA website for definitions)  Knowledge of mothers and health workers (pregnancy, childbirth, postpartum, new-born, children under two years)  Pre-and postnatal health  Infant feeding (including exclusive breastfeeding)  Preventive health (mother and child)  Morbidity and care seeking  Housing conditions  Resilience strategies  Anthropometry of children under 5 years  Consumption of program rations and micronutrient supplements  Coverage of other programs in the area  Levels of participation in the program  Access to health services  Conditions and infrastructure of CCs and the services provided  Equipment and supplies available at CCs ANALYSIS Initial data analysis was conducted in the fall of 2012 using Statistical Package for Social Sciences (SPSS). Unfortunately, there were delays, and after review the preliminary analysis was not found to meet the needs of the donor nor Mercy Corps Guatemala adequately. As a result, data collected during Phase 1 was re-examined under Phase 2. Additionally, interviews and SWOL (Strengths, Weaknesses, Opportunities, and Limitations) were conducted with members of the PROCOMIDA staff, to contextualize the statistical findings. Data and documentation from the Phase 1 analysis were available in the form of the original (Spanish) and translated (English) survey questionnaires; SPSS data files (segregated into Sections); SPSS Syntax files; documentation on the calculation of specific indicators; the Indicator Performance Tracking Table (IPTT) and copies of previous written reports and drafts. The review and analysis process carried out included the following:  Comparison of IPPT data entry across different versions of the previous reports 5 Food and Nutrition Technical Assistance 12  Review of SPSS datasets, and cross-checking these against survey questionnaires  Translation Spanish-English, where required  Review and re-running of the previous SPSS syntax files, where possible  Finalizing IPPT indicator list and presentation  Harmonizing any conflicting findings from previous draft reports  Generating correlation graphs for selected indicators  Running adding additional summary tables and data analysis, where relevant 2.2 Limitations There were a number of limitations that challenged the process in Phase 1:  Delays in starting fieldwork due to late scheduling of Tablets for data digitization, MSPAS activities, festivities, competing priorities with deliveries of inputs from social programs of the government (e.g., cash transfer), and other training to MSPAS staff.  Delays in receiving the Phase 1 field evaluation report, and in clarifying information with the consultant team.  The quality of the Phase 1 field report, found particularly inadequate in terms of conclusions drawn and recommendations. As a result, Mercy Corps Guatemala was required to hire a second consulting company to finalize the midterm report (Phase 2), under a very tight deadline and budget.  There were linguistic challenges as well due to the need to cross-translate between Spanish, Q’eqchí, and English, though in the field effort was taken to ensure surveyors were extensively trained and standardized in Q’eqchí. There were several additional limitations and challenges in conducting this Phase 2 analysis. In many documents and datasets, including some of the statistical syntax files, the information is recorded in Spanish. The format for the coding of respondent data identification was also a challenge in terms of cross-referencing data from different survey sections (which were recorded in multiple separate files). The translation work required on these, as well as the need for additional data check, meant more time was spent on data management than what is normally expected. Additionally, there was a lack of any qualitative data, as fieldwork was entirely based on quantitative data collection via survey questionnaires. This limited the ability to analyze and draw conclusions. Background literature review, interviews and SWOL (Strengths, Weaknesses, Opportunities, Limitations) conducted with members of the PROCOMIDA staff during Phase 2 attempted to overcome, at least partially, this limitation, while inserting an unavoidable bias towards the views of Mercy Corps Guatemala. Despite close cooperation with Mercy Corps Guatemala in the report finalization, effort was taken by HDCi LLC to ensure that the conclusions and recommendations were drawn external to program personnel. 2.3 About This Report This report begins with background information on food insecurity and malnutrition in Guatemala, and the PROCOMIDA program. Midterm evaluation results are then discussed based on the IPTT, ordered by the percentage of target met, with reference to its Intermediate Result (IR) and in comparison to baseline figures. Indicators are given a unique number throughout the IPTT, in the first column of the table, which is used to guide the discussion. Trigger indicators and correlations are discussed separately. A more detailed discussion of findings is followed then by lessons learned/good practices, and recommendations. The intention is for the recommendations to inform program decisions for the remaining 13 implementation period, towards successful realization of program goal and objectives by mid￾2015, and ultimately program sustainability following closeout. 3. CONTEXT Guatemala has some of the worst rates of chronic malnutrition in Latin America, and in the world. Conditions are severest in the northern lowland and highland areas converging in and around Alta Verapaz. Within these geographic areas, the most vulnerable and affected by food insecurity and malnutrition are pregnant and lactating women, and children under two years of age, particularly amongst poor, marginalized, and vulnerable indigenous and ethnic communities, including the Q’eqchí.6 Malnutrition is especially harmful to children under two, as they can experience lifetime impairment due to weak physical and cognitive development. Since 1979, Mercy Corps has worked globally to alleviate suffering, poverty, and oppression by helping people build secure, productive, and just communities. In the mid-1980s, Mercy Corps began operations in Central America, and in 2001 expanded programming to northern Guatemala, targeting poor areas in the Alta Verapaz Department. Mercy Corps pursued PROCOMIDA, or the Community Food Diversification Program for Mother and Child, at a time when more than 60% of children under five in Alta Verapaz were chronically malnourished, and infant and maternal mortality rates were among the worst in Guatemala. PROCOMIDA seeks to improve the nutritional status of more than 266,000 people in 936 vulnerable communities in selected municipalities in Alta Verapaz Department – areas classified by the Famine Early Warning System Network (FEWSnet) as having poor food security and livelihoods, and with some of the highest rates of stunting and infant and maternal mortality in the country.7 With USAID Title II Food for Peace funding, program implementation initially covered the period July 2009 – June 2014, and was officially extended to June 2015 through Agreement Modification 6, signed June 2012. The PROCOMIDA goal is improved nutritional status and health of women and children vulnerable to food insecurity in northern Guatemala. Two strategic objectives (SO) complement this goal (see Table 1 below). PROCOMIDA targets pregnant and lactating women and children less than two years of age, and healthcare service providers, in the municipalities of Cobán, San Pedro Carchá, Lanquin, Cahabon, Senahú. In August 2012, the additional municipalities of Chahal, Fray Barolomé de las casas, and Chisec were added (see Appendix H for a map of all implementation areas). Table 1: Objectives and Results Framework (from PROCOMIDA proposal document) Goal: Improved nutritional status and health of women and children vulnerable to food insecurity in northern Guatemala Strategic Objectives Intermediate Results Activities 1. By 2015, pregnant and lactating women, children under 2, and malnourished children under 5 in program areas have improved and sustainable health and nutrition status 1.1 Increased consumption of energy and nutrient dense foods in households with pregnant/lactating women, a child 6-24 months of age, and/or a child 24-59 months with acute malnutrition 1.2 Improved household knowledge, attitudes and practices for key care behaviors 1.3 Increased engagement of households in reducing vulnerability  Consultation with government and civil society leaders  Establish / strengthen community health commissions  Disseminate criteria and selection of beneficiaries  Provide preventative rations to all pregnant or lactating women and all children aged 6-24 months  Management of acute malnutrition  Develop behavior change 6 FEWSnet Guatemala Country Profile Website; FAO Socioeconomic Studies of Vulnerable Groups in Guatemala. 7 World Food Program 2009; ENSMI 2009. 14 to food insecurity communication (BCC) messages  Enhance the capacity of community outreach actors (CHCs, CHVs, etc.) to deliver BCC  Form mothers’ groups  Improved practices reinforced through home visits, ration distribution and radio  Establish community emergency funds to facilitate transportation to health services  Connect with ongoing Mercy Corps food security programs 2. By 2015, health care service providers at community through municipal levels have improved Service quality and delivery 2.1 Increased communication and interaction between vulnerable populations and health service providers 2.2 Increased and improved provision of minimum standards in health services to women and children 2.3 Increased promotion and planning by health care providers to meet community health care needs  Enhanced technical capacity of health service providers to provide strong MCHN care  Improve MoH extension services through building capacity of SIAS NGOs  Strengthen recognition and treatment of children with SAM  Facilitate regular meetings among community health commissions, community leaders, health service providers to plan around community health-related priorities and concerns  Facilitate orientation visits to CCs, health posts and health centers by community members  Strengthen health facility capacity to provide culturally and linguistically appropriate care  Build the capacity of SIAS￾implementing NGOs and MoH health post staff to prioritize, plan and advocate for community health priorities with key municipal, departmental and national actors and decision-makers PROCOMIDA employs a preventive methodology based on research and results from World Vision’s PM2A8 approach, which focuses on protecting children at the most critical period in their development. To do this, PROCOMIDA works with local non-governmental organizations (NGOs) and Ministry of Health (MoH) to establish and/or strengthen community structures to improve the provision of culturally and technically appropriate health services and adequate maternal child health and nutrition (MCHN) service coverage and quality. Under the preventive approach, all households with pregnant mothers, lactating mothers, and children under two are targeted, not just those already experiencing malnutrition. While the program defines the child as its main beneficiary, the involvement of the mothers is necessary at all levels of intervention, so the program measures beneficiaries in mother/child units A fourth beneficiary group consists of mothers with children between 2-5 years of age with acute malnutrition, who are enlisted for a three month period. All beneficiaries are registered with a unique code, ultimately assigned to each household, and receive a beneficiary card that they take with them to trainings and food distributions. This allows PROCOMIDA to track their participation. Each of these beneficiary 8 Preventing Malnutrition in Children Under 2 Approach 15 categories participate for a minimum of six months and a maximum of 30 months. As of June 2012, 28,783 households have participated in the program, the vast majority of the beneficiaries being children 6-24 months of age, as expected. At baseline, while household hunger was found to be uncommon, the quality of household and child diets was poor. Growth faltering often starts in the first few months of life, and intensifies gradually throughout the first two years to reach a plateau at ages 2-3 years old, compounded by repeated bouts of illness (see Figure 6 below). Low quality household and infant diets mean that children lack essential micronutrients. Stunting is a major problem. Overall, the average height-for-age z-scores were significantly lower among boys compared to girls. However, there is no significant difference in the prevalence of stunting between boys and girls – boys were shorter in general, but no more were categorized as stunted. There was, however, almost no wasting found, and the prevalence of underweight was at moderate levels, with the majority of underweight likely explained by high levels of stunting. To address these concerns, PROCOMIDA provides beneficiaries with a balanced ration to overcome food insecurity: individual rations of CSB, and household rations of rice, pinto beans, and vegetable oil. Food supplementation is an incentive for mothers’ participation and a source of macro- and micro-nutrients for pregnant and lactating women and children between 6-24 months of age. As of June 2012, 181,400 household rations (rice, beans, vegetable oil) and 188,017 individual rations (CSB, LNS, or MNP) were distributed (100% on target). Additionally, in 40 Convergence Centers (CCs) micronutrients either in a lipid-based nutritional supplements (LNS, 20 CCs), or micronutrient powder (MNP, 20 CCs) is distributed as an individual ration, replacing CSB, as part of a research component (see below). Program activities are implemented through CCs. The main tasks of the CCs are to carry out the Integrated Care of Prevalent Childhood Illnesses and Integrated Health Care for Women and Children at the Community Level (AIEPI-AINM-C) program, Guatemala’s integrated healthcare strategy established by the Ministry of Public Health and Social Work (MSPAS). The AIEPI-AINM-C provides integrated case management of childhood illness, monthly growth monitoring and promotion for children, standard preventive care for pregnant and lactating women, and the provision of vaccinations and micronutrient supplements for pregnant and lactating women and children under five years of age. Additionally, they are essential to the new Presidential Initiative ‘Zero Hunger’. CCs are, however, limited in their ability to supply quality healthcare due to lack of necessary medical equipment and supplies, including drugs, and limited health staff knowledge. PROCOMIDA enhances the activities of the CCs through targeted actions to strengthen all those that relate to health care in the population. As of June 2012, PROCOMIDA is being implemented in 270 CCs and 14 Health Posts, for a total of 284 locations for training and distribution of food rations. The program baseline study found that two-thirds of mothers were illiterate and did not speak Spanish, and there was a high prevalence of overweight and obese mothers (BMI 24.8). Mothers are also very short in stature, associated with growth retardation in utero and also during early childhood. Knowledge of correct breastfeeding practices was high, but only half of mothers could identify the correct age to introduce complementary foods to infants. Early introduction of inappropriate foods along with poor food hygiene, poor water quality, and poor sanitation are a concern leading to poor nutritional status and morbidity, and contributing to high rates of stunting and diarrhea. Frequency of feeding was also inadequate in many children, pointing to the fact that mothers’ knowledge does not always correspond to actual practice. At baseline, few mothers knew the danger signs of pregnancy or the danger signs of childhood illness. While most attended a sufficient number of prenatal visits, postnatal care appeared inadequate, and less than half of recommended visits were attended. Growth monitoring and 16 promotion in children 12 - 23 months of age was nearly universal, yet less than half of children received a mega-dose of vitamin A, and only half received iron and folic acid. About one-third of children 18-23 months of age were not fully immunized, and most vaccinations were received later than recommended. Only 60% of the baseline sample of children under two consumed four or more food groups, and 52% consumed iron-rich or fortified foods in the previous 24 hours. To address identified gaps in knowledge and health seeking behavior amongst beneficiary mothers, PROCOMIDA developed and implements a comprehensive and targeted behavior change communication (BCC) component that utilize the BEHAVE Framework and a multi-level response designed to reinforce BCC information, education, and new behavior adoption at the household and community levels. Around 80 key messages were identified and organized around five themes: (i) food and health; (ii) exclusive breastfeeding; (iii) care of pregnant and lactating mothers; (iv) care of children from 6-24 months; and (v) sick and malnourished children. Materials include flip charts, ration bags with messages, and pamphlets. They are utilized during monthly trainings provided by program field staff (with the aid of a training guide). All training materials are pictorial with little or no text, and the BCC Strategy uses adult literacy techniques focused on collective participative learning through positive deviance. Trainers divide beneficiaries into four identified groups, according to interest and cultural necessity: (i) pregnant women; (ii) lactating mothers with children from 0-6 months of age; (iii) mothers with children from 6-24 months; and (iv) mothers of sick children. Each training focuses on a key message, coordinated with existing MOH messages. Educational sessions include recipe demonstrations with ‘model’ mothers, who replicate them with beneficiaries assigned to them, increasing local capacity in adequate diet and food preparation practices, and assuring sustainability and program impact. Field staff further complement trainings with household visits, stressing the importance of attending trainings, strengthening key messages, monitoring food ration use, and following up on malnourished children. All program field staff themselves receive monthly trainings in BCC, nutrition, monitoring and evaluation (M&E), and data management (MIS), and in taking standardized anthropometric measurements, use of data collection forms, identification and referral of severe acute malnutrition (SAM), etc. Separately, community health volunteers (CHVs) working in intervention areas are trained in nutritional evaluation, nutrition, and malnutrition. Decentralized health service providers (local NGO Health Implementers) and their teams are invited to attend all trainings. Additional institutional strengthening is extended to these providers to improve data management capacity with the NGO Health Implementers and the MoH Alta Verapaz Area. NGO Health Implementer office staff receive quarterly training in areas of organizational capacity and strengthening. All of these activities build local capacity and contribute towards the sustainability of the program. In addition to directly activity implementation, PROCOMIDA incorporates a research component, led by the International Food Policy Research Institute (IFPRI) in collaboration with Mercy Corps, and with funding from USAID’s Food and Nutrition Technical Assistance (FANTA) project. There are five research arms and one control group, each comprised of 20 CCs randomly selected from the initial preselected CCs. As one of IFPRI’s focuses is operations research, all data collected by PROCOMIDA to date is quantitative, though more qualitative monitoring for specific areas is being considered from IY4 onwards (e.g., quality of services, adoption of practices). The program utilizes an Indicator Performance Tracking Table (IPTT), to which several changes have been made since implementation in 2009. 17 4. RESULTS 4.1 IPTT Table 2 below is an extract from the Indicator Performance Tracking Table (IPTT) to show the list of Impact Indicators, Monitoring Indicators, and Trigger Indicators with respect to the baseline, midterm target, and midterm evaluation (achieved) values. Values in the ‘Midterm Evaluation’ column are listed in blue for those that have exceeded the midterm targets, in black for those that are in progress but have not yet achieved the respective targets, and in red for those that recorded values that are less than the baseline values. Table 2: Indicator Performance Tracking Table (IPTT) Indicators Baseline (2009) Midterm Target (2012) Midterm Evaluation # Indicator Objective 1: By 2015, mothers 9 have the capacity to improve and maintain the health and nutritional status of household members, particularly for children less than 2 years of age, acutely malnourished children under 5 years of age, and pregnant and lactating women #1 Impact Indicator 1: % children 0-59 months underweight (<-2 z-score weight-for-age) 12.9% 12.0% 12.3% #2 Impact Indicator 2: % children 6-59 months stunted (<-2 z-score height-for-age) 59.2% 56.5% 56.1% #3 Impact Indicator 3: Average Household Dietary Diversity Score (HDDS) 5.8 (±s.d. 1.6) 6.3 7.5 (±s.d. 1.9) Intermediate Result 1.1: Increased consumption of energy and nutrient dense foods by pregnant and lactating women, all children 6- 24 months of age, and acutely malnourished children between 24-59 months of age #4 Monitoring Indicator 1: # pregnant and lactating women receiving food rations (accumulative) 0 10,000 19,989 #5 Monitoring Indicator 2: % children 6-24 months with minimum acceptable dietary diversity 60.1% 70.0% 63.2% #6 Monitoring Indicator 2: # children aged 6-24 months receiving food rations (accumulative) 0 16,000 20,692 Intermediate Result 1.2: Improve household knowledge, attitudes and practices for key care behaviors #7 Monitoring Indicator 1: % mothers10 demonstrating increased nutritional knowledge 0 10% 45.7% #8 Monitoring Indicator 2: % of newborns who receive essential newborn care 75.0% 80.0% 70.6% #9 Monitoring Indicator 3: % children 0-6 months exclusively breastfed 65.1% 75.0% 60.8% 9 The term ‘mother’ is used here, however this evaluation notes that the program defines ‘mother’ as ‘mother’, and has replaced all subsequent language to reflect this 10 Mothers are primarily mothers, and the terms are interchangeable. 18 #10 Monitoring Indicator 4: % mothers that know the danger signs of pregnancy 5.9% 20.0% 34.0% #11 Monitoring Indicator 5: % mothers with proper identification of childhood illness warning signs 4.9% 20.0% 69.6% #12 Monitoring Indicator 6: % children aged 0-23 months with diarrhea that received adequate treatment 26.3% 50.0% 27.5% #13 Monitoring Indicator 7: % children aged 6-23 months with respiratory diseases that received adequate treatment 40.5% 50.0% 39.0% #14 Monitoring Indicator 8: % mothers receiving minimum recommended antenatal care 82.2% 86.0% 85.0% #16 Monitoring Indicator 10: % mothers receiving minimum recommended postnatal care 26.9% 32.0% 60.1% #17 Monitoring Indicator 11: % children receiving full vaccinations 85.9% 89.0% 50.7% #18 Monitoring Indicator 12: % children receiving routine health services 18.3% 45.0% 27.4% Intermediate Result 1.3: Increased engagement of households in reducing vulnerability to food security #19 Monitoring Indicator 1: % households with household actions plans 1.8% 3.0% 5.8% #20 Monitoring Indicator 2: # Training and Distribution Points with emergency funds 0 270 284 Objective 2: By 2015, health care service providers at the community through municipal levels have improved service quality and delivery #21 Impact Indicator 1: % health facility staff and community volunteers able to identify minimum number of core health and nutrition practices 6.5% 20.0% 4.3% #22 Impact Indicator 2: % health facilities meeting minimum standards for health and nutrition services and practices 0.0% 20.0% 19.1% #30 Impact Indicator 3: % of local CHVs who meet minimum standards/thresholds for performance 0.0% 2.0% 2.1% Intermediate Result 2.1: Increased communication and interaction between community members and health service providers #23 Monitoring Indicator 1: # health commissions with regular meetings 0 270 284 #24 Monitoring Indicator 2: # health commissions demonstrating progress on action plans 0 270 284 #25 Monitoring Indicator 3: # of pregnant women in health facility orientation visits 0 540 0 19 #26 Monitoring Indicator 4: % deliveries at health facilities 35.9% 38.0% 33.5% Intermediate Result 2.2: Increased and improved provision of minimum standards in health services to women and children #27 Monitoring Indicator 1: # health facility staff trained in health and nutrition best practices 0 60 121 #28 Monitoring Indicator 2: Availability of a minimal level of infrastructure, supplies and medications at health facilities 0.0% 25.0% 0.0% #29 Monitoring Indicator 3: % of detected SAM cases referred per MOH protocols N/A 90.0% 94.0% Intermediate Result 2.3: Increased promotion and planning by health care providers to meet community health care needs #31 Monitoring Indicator 1: # persons trained in planning and advocacy around food security and health 0 1,680 1,988 Trigger Indicators*: #32 Trigger Indicator 1: Wasting: Percent of children 6-59 months who are wasted (<-2 z-score weight for height) - <4.0% 0.8% #33 Trigger Indicator 2: Change in food prices - 8.74 4.01 #34 Trigger Indicator 3: Irregular rainfall - 2,351 2,659 #35 Trigger Indicator 4: Security - 35.7 N/A #36 Trigger Indicator 5: Coping strategies - <10 25.1 * Trigger indicators use colors to identify risk: red = high risk; yellow = moderate risk; green = no risk As seen, at the time of the midterm evaluation, more than half of the impact and monitoring indicators (17 out of 30) exceeded the target set for IY3.  SO 1: All anthropometric impact indicators met or exceeded target. These are extremely important results for the program, including the percentage of children 0-59 months underweight (which dropped from 12.9% to 12.3%), the percentage of children 6-59 months stunted (which dropped 3.1% from 59.2% to 56.1%),and the average HDDS (which improved from 5.8 to 7.5).  IR 1.1: The distribution of food rations to pregnant and lactating women (indicator 4) reached close to 20,000 – doubling the target set of 10,000. The distribution of food rations to children aged 6-24 months (indicator 6) reached 30% over the midterm target (20,692 compared to the target of 16,000). As a result of agreed-upon ration reductions (after it was found that not all rations were being consumed), the program was able to expand its interventions, hence increasing coverage. Indicator 5 (the percentage of children aged 6-24 months with minimal acceptable dietary diversity) almost met target, indicating a need to continue to stress the importance of appropriate feeding practices with mothers. 20  IR 1.2: Along with the distribution of food rations, indicators that are related to mother knowledge all far exceeded their targets, demonstrating that the program has been able to transfer knowledge to participating mothers as a result of the BCC strategy. The percentage of mothers demonstrating increased nutritional knowledge (indicator 7) exceeded the target of 10% by more than 4-fold (45.7%). This increase, however, does not appear to have any impact on nutritional diversity and breastfeeding practices. Among mothers with increased nutritional knowledge, there was no significant association with better average household dietary diversity score (HDDS), the dietary diversity of children aged 6-24 months, or in the practice of exclusive breastfeeding of children aged 0-6 months, compared to mothers with no increase in nutritional knowledge (see below, Correlations 2, 3 and 4, respectively).  IR 1.3: Households with action plans (indicator 19) exceeded the target of 3% by nearly double. The number of CCs and Health Posts (HP) with emergency funds exceeded the target by 14.  SO 2: Both indicators nearly or just met the target. Further involving CHVs in field activities, encouraging NGO Health Implementers to strengthen CHV support, and linking NGO Health Implementers, CHVs, and Community Health Commissions (CHCs) should further improve outcomes and ensure sustainability in this area.  IR 2.1: Both the number of health commissions with regular meetings (indicator 23) and those demonstrating progress on action plans (indicator 24) met their target, due to the addition of HPs. CHCs meet monthly with PROCOMIDA staff, and have half-yearly assemblies to present their progress towards annual work plans to their constituent communities.  IR 2.2: The expansion and inclusion of educators and staff at HPs is responsible for the meeting of indicator 29 (percentage of detected severe acute malnutrition, or SAM cases referred per MoH protocols). Those not referred (6%) presented no complications, and were able to be treated in the community as defined b the protocol.  IR 2.3: The number of persons trained in planning and advocacy around food security and health (indicator 32) exceeded the target by 118%, which is directly related to the expansion of the program. There are several indicators that did not achieve the midterm target by slight margins, and six indicators that showed values below those at baseline and thus clearly did not achieve midterm targets. For most of these, the drop from baseline was slight.  IR 1.2: The percent of newborns who receive essential newborn care (indicator 8), the percent of children between 0-6 months that are exclusively breastfed (indicator 9), and the percent of children aged 6-23 months with respiratory diseases that received adequate treatment (indicator 13), were all lower than target, and in all three cases also slightly lower than their baseline value, indicating a need to redirect programmatic efforts on translating improved knowledge into practice and health seeking behavior. The percentage of children receiving full vaccinations (indicator 17), however, dropped significantly to 50.7% from a high baseline figure of 85.9%. The lower MoH budget and subsequently lower coverage for full and timely vaccinations and other interventions compared to baseline largely explains this decrease. For all of these indicators, and other indicators that exceeded baseline but failed to meet midterm target, it will be important for the program to address these issues with the MoH, or renegotiate these indicators, since they depend largely on the MoH budget and supply chain management. 21  SO 2: The percent of health facility staff and CHVs able to identify a minimum number of core health and nutrition practices (indicator 21) was significantly unable to meet midterm target, and in fact dropped from baseline. This is an important issue and requires attention from the program. Currently the program is starting to involve more CHVs in its training sessions, in addition to holding separate quarterly training sessions specifically for CHVs. In IY3, training focused on improving their growth monitoring practices, and detection of SAM. For the next year, IY4, the focus will be on danger signs, in conjunction with traditional midwives, as well as nutrition issues. The program is also designing specific training materials for the CHV and traditional midwives that include danger signs and nutrition practices.  IR 2.1: No impact has been measured for indicator 28 (number of pregnant women in health facility orientation visits), given the negative impact MoH supply chain problems have on it. The program is considering if it is more effective to take the traditional community midwives to visit the health facilities instead, as they play an important role in decision-making around where women deliver. Related to this issue, the percentage of deliveries at health facilities (indicator 26) has remained essentially unchanged from baseline, possibly related to the importance of traditional midwives. For this reason, the program is designing training materials for midwives and training will start once the MoH approves the training materials (occurred in December 2012).  IR 2.2: As with indicators under IR 1.2, the availability of a minimal level of infrastructure, supplies, and medications at health facilities (indicator 28) is contingent upon the MoH budget, which has remained stagnant since baseline. The availability of community health funds to improve the CC structure is not enough, as it does not affect the availability of supplies and medications. Trigger indicators were measured through secondary data sources, mostly from government institutions, with the exception of indicator 36 (coping strategies), which was calculated using the Coping Strategy Index and measured through the annual household survey. As trigger indicators are not linked directly to specific program activities, change cannot be attributable. Information on security was unavailable for this midterm evaluation (indicator 35) from the Governor of Alta Verapaz. Coping strategies (indicator 36) increased, meaning that people in intervention areas had to implement more strategies to cope with food insecurity, even though they received food rations. Additionally, there were changes in food prices (indicator 33). 4.2 Correlations In addition to the list of midterm indicator values listed in Table 2, further analysis on several indicators and other parameters are presented here. For comparisons of average values (e.g. mean HDDS scores) between two groups, the t-test was used. When analyzing the relationship between two categorical variables (e.g. percentage distribution between mothers with increased or no increase in nutritional knowledge, and the relationship to the distribution of households with children with or without the minimum acceptable dietary diversity), the chi-square test was used. For the analysis of the change in the percentage of mothers receiving the minimum recommended prenatal care compared to those receiving the minimum recommended postnatal care, the data (prenatal care versus postnatal care) was treated as paired for each mother. In this case, the McNemar test was used to measure whether there was a significant difference between access to prenatal care compared to postnatal care. In all statistical analyses, a 95% significance level was used and a p-value of less than 0.05 indicates a statistically significant association. 22 CORRELATION #1 Table 3: Average household dietary diversity score (HDDS, indicator 3) and percent of children 6- 24 months with minimum acceptable dietary diversity (indicator 5) Dietary diversity (DD) among children aged 6-24 months n (%) Mean HDDS (±s.d.) t-test p-value With minimum acceptable DD 369 (63.2%) 6.5 (2.1) <0.001* Below minimum acceptable DD 215 (36.8%) 8.0 (1.8) * indicates statistical significance (p-value < 0.05). Figure 1: Changes in the average HDDS and percent of children 6-24 months with minimum acceptable dietary diversity, at baseline and midterm As noted, despite average HDDS significantly improving and exceeding the midterm target, 36.8% of children 6-24 months were found to have below the minimum acceptable dietary diversity, and demonstrate only a moderate improvement in overall dietary diversity from baseline to midterm. Interestingly, the mean HDDS is significantly higher for children with below minimum acceptable dietary diversity. CORRELATION #2 Table 4: Average HDDS (indicator 3) and percent of mothers demonstrating increased nutritional knowledge (indicator 7) Nutritional knowledge among mothers n (%) Mean HDDS (±s.d.) t-test p-value Increased knowledge 288 (45.6%) 7.4 (1.9) 0.571 No increase in knowledge 344 (54.4%) 7.5 (2.0) Here, the number of mothers with an increase in nutritional knowledge versus those with no increase in knowledge is nearly equivalent. There was, however, no significant association between nutritional knowledge among mothers and the average HDDS. 40 45 50 55 60 65 5.5 5.6 5.7 5.8 5.9 6 6.1 6.2 6.3 6.4 6.5 Y1 (BL) Y3 (MTE) (%) HDDS Ave. HDDS % min. acceptable DD (age 6-24 mo.) 23 Figure 2: Changes in the average household dietary diversity scale (HDDS) and the percent of mothers demonstrating improved nutritional knowledge, at baseline and midterm CORRELATION #3 Table 5: Percent of children 6-24 months with minimum acceptable dietary diversity (indicator 5) and percent of mothers demonstrating increased nutritional knowledge (indicator 7) Nutritional knowledge among mothers Dietary diversity (DD) among children aged 6-24 months Chi2 - test p-value With minimum acceptable DD Below minimum acceptable DD Total Increased knowledge 162 (63.3%) 94 (36.7%) 256 (45.2%) 0.948 No increase in knowledge 197 (63.5%) 113 (36.5%) 310 (54.8%) Total 359 (63.4%) 207 (36.6%) 566 0 5 10 15 20 25 30 35 40 45 50 5.5 5.6 5.7 5.8 5.9 6 6.1 6.2 6.3 6.4 6.5 Y1 (BL) Y3 (MTE) HDDS (%) Ave. HDDS % improved nutritional knowledge 24 Figure 3: Changes in the average HDDS and the percent of mothers demonstrating improved nutritional knowledge, from baseline to midterm Among mothers of children aged 6-24 months (n=566), the mothers with increased nutritional knowledge had no significant difference in the average dietary diversity of their children, compared to mothers with no increase in nutritional knowledge. CORRELATION #4 Table 6: Percent of children 0-6 months exclusively breastfed (indicator 9) and percent of mothers demonstrating increased nutritional knowledge (indicator 7) Nutritional knowledge among mothers Breastfeeding among children 0-6 months Chi2 - test p-value Exclusively breastfed Not exclusively breastfed Total Increased knowledge 21 (58.3%) 15 (41.7%) 36 (45.6%) 0.686 No increase in knowledge 27 (62.8%) 16 (37.2%) 43 (54.4%) Total 48 (60.8%) 31 (39.2%) 79 0 5 10 15 20 25 30 35 40 45 50 5 15 25 35 45 55 65 75 Y1 (BL) Y2 Y3 (MTE) Min. acceptable DD 6 Improved nutritional knowledge (%) -24 mo. (%) % min. acceptable DD (age 6-24 mo.) % improved nutritional knowledge 25 Figure 4: Changes in the percent of children 0-6 months who were exclusively breastfed and the percent of mothers demonstrating improved nutritional knowledge, from baseline to midterm Among mothers with increased nutritional knowledge, there was no significant association with the practice of exclusive breastfeeding of children aged 0-6 months, compared to mothers with no increase in nutritional knowledge. CORRELATION #5 Table 7: Percent of mothers receiving minimum recommended antenatal care (indicator 14) and percent of mothers receiving minimum recommended postnatal care (indicator 16) Antenatal care Postnatal care McNemar test p-value Received the minimum recommended Did not receive the minimum recommended Total Received the minimum recommended 370 (65.7%) 193 (34.3%) 563 (87.8%) <0.001* Did not receive the minimum recommended 48 (61.5%) 30 (38.5%) 78 (12.2%) Total 418 (65.2%) 223 (34.8%) 641 * indicates statistical significance (p-value < 0.05). 0 5 10 15 20 25 30 35 40 45 50 5 15 25 35 45 55 65 75 85 Y1 (BL) Y2 Y3 (MTE) Improved nutritional knowledge (%) Exclusive breastfeeding 0-6 mo. (%) % exclusive breasfeed (0-6 mo.) % improved nutritional knowledge 26 Figure 5: Changes in the percent of mothers receiving minimum recommended antenatal care and the percent of mothers receiving minimum recommended postnatal care, from baseline to midterm Despite a high percentage of mothers receiving the minimum recommended prenatal care (87.8%), there was a significant decrease in the percentage of mothers receiving the minimum required postnatal care (65.2%). Overall, however, the percentage of mothers receiving minimum recommended postnatal care increased dramatically from baseline to midterm. 4.3 Discussion of Findings by Objective The presentation of findings begins with the characteristics of convergence centers, community healthcare, households, and mothers, with comparisons between the baseline and midterm evaluation findings. This information provides a contextual framework for further discussion by strategic objectives and intermediate results. As with the IPPT above, where possible, values in the ‘Midterm Evaluation’ column are listed in blue for those that exceed baseline figures, black for those equivalent or unchanged, and red for those that fall below baseline. CONVERGENCE CENTERS CCs were selected by PROCOMIDA used a two-step selection methodology. First, at the municipal level a list of CCs was compiled from those identified by the Guatemalan Government as being in food insecure communities (prioritized through the Secretary of Food Security and Nutrition, or SESAN). Then, the locations of these CCs were assessed for their accessibility by 5-ton delivery trucks, necessary for regular (monthly) ration distribution. It should be remembered that community members still walk from communities to the CCs to pick up rations. PROCOMIDA is currently refining this methodology in consideration of smaller delivery trucks. This will reduce the issue of road access, and increase the number of eligible CCs and remote locations covered by the program. In addition, the program is negotiating with the MoH to shift resources in an effort to have full coverage by jurisdiction. 0 10 20 30 40 50 60 70 40 45 50 55 60 65 70 75 80 85 90 Y1 (BL) Y2 Y3 (MTE) Received minimum postnatal care (%) Received minimum antenatal care (%) % min. antenatal care % min. postnatal care 27 Table 8: CC characteristics Characteristics Baseline n = 45 Midterm n = 47 Personnel: Percentage of CCs that had at least one… Doctor 13.3 8.5 Nurse 86.7 83.0 Institutional facilitator 100 87.2 CC-approved midwife 100 97.9 Community facilitator 100 100 CHV 88.9 76.6 Has basic health team 88.9 97.9 Optional Staff: Percentage of CCs that had at least one… Traditional midwife 8.9 21.3 Technical worker 26.7 29.8 Health educator 68.9 59.6 Infrastructure: Percentage of CCs that had… Own building 82.2 89.4 Bathroom 75.6 87.2 Electricity 24.4 21.3 Cement floor 77.8 83.0 Medical Equipment: Percentage of CCs that had at least one… Hospital bed 82.2 72.4 Adult scale 95.6 100 Children scale 100 100 Fixed height board 20 23.4 Portable height boards 40 93.6 Blood pressure monitor 28.9 14.9 Stethoscope 31.1 12.8 Thermometer 35.6 17.7 Essential medicine and micronutrient supplements: Percentage of CCs that had… ORS 82.2 85.1 Amoxicillin 93.3 83.0 Trimetroprim-Sulfametoxazole 68.9 83.0 Penicillin 80.0 66.0 Albendazole 88.9 74.5 Children supplements Vitamin A 2.2 36.2 Chispitas (micronutrient powder 44.4 61.7 Women supplements Iron 93.3 74.5 Folic acid 88.9 85.1 Prenatal supplements 11.1 10.6 28 Recalling the role of CCs in health delivery, it is of concern that the presence of key healthcare personnel (institutional team members) at CCs has declined compared to baseline (see Table 8). For example, only 8.5% of CCs have at least one doctor, compared to 13.3% at baseline. Additional reductions to team personnel are noted for ‘at least one’ nurse, institutional facilitator, CC-approved midwife, and educator.11 Interestingly, those reporting the presence of a community health team (comprised of CHV as lead and receiving training, health guardian as their assistant, and a traditional midwife) increased from 88.9% at baseline to 97.9% at midterm. Compared to personnel, CC infrastructure, with the exception of electricity, improved, and 89.4% of CCs report they now have their own building. Unfortunately, CC access to basic medical equipment and supplies continues to pose a challenge, which is beyond PROCOMIDA’s scope. While CCs report improved access to scales and height boards, provided as part of a start-up package to all participating CCs by the program, access to essential blood pressure monitors, stethoscopes, and thermometers decreased by half or more from baseline. The availability of essential medicines and micronutrient supplements decreased for six of ten drugs assessed, most notably for penicillin (66% at midterm compared to 80% at baseline) and iron for women (74.5% at midterm compared to 93.3% at baseline). This may represent seasonal variation as well as funding shortfalls. There is circumstantial evidence that the government is ‘blanketing’ CCs with supplies and medicines when there is funding, in an attempt to ‘make up’ for the times when there is no funding and thus no coverage. This indicates an overall weakening in the quality of CC services, and presents challenges to health providers unable to meet timeline needs (as with vaccinations) or mitigate health emergencies. COMMUNITY HEALTHCARE Table 9: Community healthcare characteristics Healthcare characteristics Average (s.d.) Baseline n = 45 Midterm Evaluation n = 47 CC-approved midwife 2.4 (1.5) 2.7 (1.5) Community facilitator 1.1 (0.4) 1.2 (0.4) CHV 4.9 (4.0) 4.5 (3.6) Percent with a health commission 97.8% 97.9% Number of members 5.4 (1.4) 6.3 (2.7) CC-approved midwife 2.4 (1.5) 2.7 (1.5) No significant changes in relation to community healthcare characteristics at midterm compared to baseline are reported (see Table 9). There is a slight decrease in the number of CHWs at CCs (average 4.5 at midterm compared to 4.9 at baseline), and a slight increase in the number of members (average 6.3 at midterm compared to 5.4 at baseline). 11 Institutional teams must have at least one doctor or nurse 29 HOUSEHOLDS Table 10: Household characteristics A total of 942 households were included in the midterm household survey, with a total of 3,245 household members. According to program data, the average household size is 5.23. The male to female ratio was 1:1 (49.1% males and 50.9% females). Slightly over half of the sample population were aged 18 and above (53.0%). Overall, there were 1,484 children under the age Characteristics Baseline Midterm Evaluation Frequency (n = 1,307) Percentage (%) Frequency (n = 942) Percentage (%) Type of floor Dirt 1,120 85.7 774 82.2 Concrete 182 13.9 159 16.9 Tile, Wood, and other 9 1 Type of wall Corrugated sheets 9 1 Reed, palm, bamboo, cane 190 14.5 124 13.2 Clay, cane 16 1.7 Wood 809 61.9 582 61.8 Asbestos and aluminum roofing sheets 66 7 Cement, brick, and other 188 14.4 145 15.4 Type of roof Duralita roofing sheets 18 1.9 Palm, wood 38 4.0 Asbestos and aluminum roofing sheets 1,221 93.4 873 92.7 Tile 5 0.5 Cement and other 6 0.6 Other 2 0.2 Kitchen Kitchen in house 689 52.7 653 69.3 Kitchen doubles as bedroom 1,016 77.7 377 40 Number of rooms Mean 2.2 (s.d. 1.9) Only one space 51 5.4 One room 193 14.8 353 37.5 Two rooms 365 38.7 Three rooms 115 12.2 Four or more rooms 58 6.2 Number of bedrooms One space for all 57 6.1 One room 669 71 Two rooms 167 17.7 Three rooms 38 4 Four or more rooms 11 1.2 30 of five (742 males and 742 females), 72 of whom were aged 0-6 months. At baseline, the average household size was 5.3 people, with 3.4 members under 18 years of age, and 1.4 children under 20 months of age. Houses were generally small and of poor quality, indicating families living in moderate to extreme poverty. The average house had 1.8 rooms, with 37.5% of the study sample living in one-roomed houses. In 69.3% of households, the kitchen was located inside the house, and in 40%, the kitchen also served as a bedroom. The majority of the houses had dirt floors (82.2%), wooden walls (61.8%), and aluminum roof (92.7%). Table 11: Home utility characteristics Characteristics Baseline Midterm evaluation Frequency (n = 1,307) Percentage (%) Frequency (n = 942) Percentage (%) Water Source Faucet in the kitchen of bathroom 18 1.9 Faucet in home or yard 220 16.8 195 20.7 Public Faucet or hydrant 22 2.3 Well 48 5.1 Fresh water (river, lake) 25 2.7 Spring water 429 32.8 221 23.5 Collecting tank 24 2.7 Rainwater 578 44.2 386 41.0 Other water source 54 4.1 3 0.3 Sanitation Toilet with manual flush 193 14.8 19 2.0 Latrine 1070 81.9 867 92.0 Don’t use 39 4.1 Don’t know Other 17 1.8 Electricity Electricity 207 15.8 233 24.7 No electricity 1,100 84.2 709 75.3 Most households (92%) used latrines, a a small percentage had a toilet that could be flushed manually by adding water (2%), and 4.1% of the households did not use any sort of latrine at all. The most common sources of water were rainwater (41%) and spring or river water (26%). Only a minority of the households had access to water from a faucet, with 20.7% of the households having a faucet in their home or yard, 1.9% in their kitchen or bathroom, and 2.3% access to a public faucet. Only 24.7% of the households had access to electricity, in an area with ample hydropower infrastructure. 31 MOTHERS Table 12: Mother characteristics Characteristics Mothers with children between 0-59 months old Baseline n = 1,308 Midterm Evaluation n = 942 Age (years) 28.1(7.2) 30.0 (7.6) Has a spouse or partner (percent) 93.2 95.0 Ethnicity and language Maya ethnicity 98.9 99.4 Speaks Q’eqchí 98 96.5 Reads Q’eqchí 35.7 39.1 Understands Spanish 29.1 31.2 Speaks Spanish 20.4 23.3 Reads Spanish 34.9 38.0 Little difference is noted in the characteristics of the mothers, or primary mothers, from baseline to midterm (see Table 12). They average 30 years of age, are of Mayan ethnicity, and primarily speak Q’eqchí (96.5%). Only 31.2% understand Spanish, and 23.3% speak Spanish. Literacy, or the ability to read either Q’eqchí or Spanish, is low and nearly equivalent at 39.1% and 38% respectively. SPECIFIC OBJECTIVE 1: By 2015, pregnant and lactating women, children under 2, and malnourished children under 5 in program areas have improved and sustainable health and nutrition status This strategic objective is primarily focused on the beneficiary. Key program activities include ration distribution and linked educational trainings aimed at improving food consumption and mother knowledge about nutrition and correct health practices. The program assumption is that with rations and knowledge, behavior will change, with positive impact towards reducing malnutrition and stunting in children. It should be noted that it is extremely difficult to change chronic malnutrition in children, particularly those aged 0-24 months, even by 1% per year. Table 13: Distribution of malnourishment among children aged 0-59 months (<-2 z-score weight￾for-age), by sex Baseline (age 0-59 months) Midterm evaluation (age 0-59 months) n % malnourished (<-2 z-score w-a) n % malnourished (<-2 z-score w-a) Total 1,819 235 (12.9%) 1,484 182 (12.3%) Boys 896 131 (14.6%) 742 90 (12.1%) Girls 923 103 (11.2%) 742 92 (12.4%) 32 Table 14: Distribution of stunting among children 6-59 months (<-2 z-score height-for-age), by sex Baseline (age 6-59 months) Midterm evaluation (age 6-59 months) n % stunted (<-2 z-score h-a) n % stunted (<-2 z-score h-a) Total 1,819 1,077 (59.2%) 1,412 792 (56.1%) Boys N/A N/A 703 402 (57.2%) Girls N/A N/A 709 390 (55.0%) From the data, at both baseline and midterm, there were no statistically significant difference (p>0.05) in the percentage of boys and girls who were malnourished or stunted (indicators 1 and 2, see Tables 13 and 14). Figure 6: Mean z-scores for weight-for-age, height-for-age, and weight-for-height, by age group at midterm Of the total 1,412 children aged 6-59 months, 11 (0.8%) showed weight-for-height Z scores of less than -2, indicating wasting. This is still substantially below the 4.0% cut-off point as a trigger indicator (see Figure 6) but it is worth noting that there were no cases of wasting recorded in the baseline survey. Wasting is seasonal and can easily be influenced by recent events, including illness. As expected in conditions of poor diet, the biggest drop in z-scores tend to occur within the first two years of life. -3.0 -2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 0-11 12-23 24-35 36-47 48-59 Mean z-score Age group waz haz whz 33 Table 15: Household hunger and dietary diversity Households with children between 0-59 months (%) Baseline (n = 1,301) Midterm evaluation (n = 942) Household hunger No food in house 16.4 26.7 Went to bed hungry 8.8 10.3 Did not eat for a whole day 6.3 6.1 Household hunger scalea Little or no hunger 91.2 89.7 Moderate hunger 8.8 9.9 Severe hunger 0 0.4 Household dietary diversity HDDS – mean (s.d.) 5.8 (1.6) 7.5 (1.9) Percent with HDDS < 6 40.8 13.4 a household hunger scale (HHS) calculated using FANTA-2 indicator definition and measurement guide. PROCOMIDA provides beneficiaries with a balanced ration to overcome this identified issue of food insecurity: individual rations of CSB or micronutrients (LNS or MNP), and household/family rations of rice, pinto beans and vegetable oil. Food supplementation is an incentive for mothers’ participation and a source of macro and micronutrients for pregnant and lactating women and children between 6-24 months of age. To maximize efficiency in terms of delivery and reduce ration loss, Mercy Corps Guatemala has pioneered a process of repackaging rations into household-sized bags. Repackaging ensures the quality of the food, with very few losses (.01%). Food distribution at the CCs is also faster and more efficient. The experience, though novel, has been positive and the cost per beneficiary per year is only a minimal US$6.25 per household. In addition to flawless ration delivery, 100% of ration distribution events have delivered education sessions to beneficiaries on revolving topics according to PROCOMIDA’s training curriculum. Follow-up home visits reinforce educational BCC messages, as do ‘model’ mothers trained in each community. Additionally, each packaged ration contains printed (graphic) educational messages, which rotate, allowing the program an additional BCC distribution method. In the four weeks preceding the midterm survey, 26.7% of the households had at least one household member skip a meal due to insufficient funds to buy food, which is an increase of 10.3% compared to the baseline measurement (Table 15). In 10.3% of households, at least one member went to bed hungry, and 6.1% of households had at least one member who did not eat for a whole day. Overall, the prevalence of hunger has increased: 0.4% had severe hunger and 9.9% had moderate hunger. Up to 89.7%% of the households reported having little or no hunger, compared to 91.2% reported at baseline. On the household hunger scale of 0 to 6, the average score overall was 0.44 (median = 0), with up to 95% of households reporting a score of 2 or less. The maximum hunger score recorded was 4 (four households). After the exclusion of missing data and accounting for multi-children households, there were a total of 1,287 children for whom the z-scores could be compared. For all three z-score measures (weight-for-age, height-for-age, and weight-for-height), there were no statistically significant difference observed when comparing children from households with little or no hunger and those from households with moderate to severe hunger (see Table 16). It is clear that seasonal differences and periods 34 of food shortage affect household hunger patterns, but both the baseline and midterm assessments occurred during critical months of food shortage intentionally, for greater comparability. The increases are concerning, given the program’s emphasis on ration distribution, and reductions in rations early on during program implementation after it was found that not all rations were being fully utilized. The program team, however, believes they are more related to external factors, including reduced income due to declines in demand for agricultural labor (especially cardamom harvest), and the effects of trigger indicators. Table 16: Average z-scores among children among households with different hunger levels Average Z-scores (s.d.) Hunger levels in householdsa Little or no hunger (n=1155) Moderate to severe hunger (n=132) t-test p-value Weight-for-age -0.971 (sd 0.918) -0.984 (sd 0.923) 0.877 Height-for-age -2.103 (sd 1.044) -2.168 (sd 1.112) 0.498 Weight-for-height 0.293 (sd 0.903) 0.316 (sd 0.867) 0.782 a The total is 1,287 after accounting for missing data and multiple children households Despite increases in hunger, looking at the data from 942 households, HDDS values ranged from a minimum of one to a maximum of 12 (indicator 3). On average, the HDDS value was 7.5 (±s.d. 1.9), an increase from the baseline 5.8 (±s.d. 1.6). In addition, there were substantially less households with a score of less than six at midterm (13.4%), compared to 40.8% at baseline. Figure 7: Comparison of food group consumption from baseline to midterm In the baseline survey, it was noted that families lived in small houses of poor quality and without good access to basic services such as water and electricity. The quality of household 95.0 46.1 42.7 59.9 9.0 76.4 13.1 83.8 95.1 80.6 59.1 92.6 0 10 20 30 40 50 60 70 80 90 100 % Baseline Midterm 35 diets was also found to be poor, and to consist predominantly of staple cereals, oils, and sugar, with some beans and eggs. Less than half of households consumed meats, and fruits, dairy products, vegetables, and fish were rarely eaten. While household hunger was found to be uncommon, the quality of household and child diets was poor. Households at midterm consumed 7.5 food groups out of 12 in the past 24 hours. The most commonly consumed food groups were cereals, sugars, and miscellaneous including coffee, tea, and condiments (see Figure 7). Fish and dairy products were consumed the least (8.6% and 13.2% respectively). Meat was consumed in 42.3% of the households. The consumption of vegetables was relatively high at 80.4% compared to fruits, which were only consumed in 59.2% of the households. It should be noted that dietary patterns of course vary depending on the time of year, reflecting seasonal patterns related to fruit and vegetable availability, and duration of grain reserves in homes. Comparing food consumption according to food groups, there are varying levels of increment in eight out of the 12 main food groups. The three groups with the largest incremental increases were vegetables, fruits, and tubers, which are not part of the donated food ration program. There were slight (insignificant) decreases among the three highest consumed food groups – cereals, sugar, and miscellaneous. Overall, however, midterm consumption patterns indicate that the food rations (cereals, fats, and pulses) combined with BCC messages that emphasize dietary diversity, have benefited households. INTERMEDIATE RESULT 1.1: Increased consumption of energy and nutrient dense foods in households with pregnant/lactating women, a child 6-24 months of age, and/or a child 24-59 months with acute malnutrition The targets set for the provision of food rations in the third year of PROCOMIDA were for food rations to be provided to 10,000 pregnant and lactating women, and to 16,000 children aged 6- 24 months. Based on a PROCOMIDA record review, the target was almost doubled for pregnant and lactating women where food rations were given to a cumulative 19,989 women (Intermediate Result 1.1. - Monitoring Indicator #1). The target for children aged 6-24 months was also exceeded with 20,682 children receiving food rations (Intermediate Result 1.1. - Monitoring Indicator #2). At baseline, 60.1% of households assessed satisfied the minimum acceptable dietary diversity score for children 6-24 months (indicator 5); whereas at midterm the proportion increased only slightly to 63.2%, short of the 70.0% target that was set. This is of concern to the program, as most training sessions (in conjunction with ration distribution, and followed-up at the household level during home visits) are focused on child dietary diversity, health and nutrition issues, and it is clear that knowledge has improved. INTERMEDIATE RESULT 1.2: Improved household knowledge, attitudes and practices for key care behaviors Prior to developing the BCC educational package to improve household and mother knowledge and behavior, formative research was conducted in implementation areas. As one of four research objectives, current maternal and infant and young child care, nutrition, and health￾related practices to help inform the development of the program’s social and BCC (SBCC) strategy were assessed. Based on the findings, key messages were defined to be addressed through training curriculum, and scope and sequence developed. Culturally specific training materials were developed, contextualized to the Q’eqchí population, and are delivered by bilingual (Q’eqchí and Spanish) field staff training teams who are additionally from the same region (local). All materials were extensively validated by field testing, and use self-explanatory images, rather than text, given the high levels of illiteracy. 36 Beneficiary educational training sessions are based on adult education principles (e.g., sessions are only 45 minutes long to ensure beneficiaries do not lose interest; punctual start times to show respect; participatory to increase learning ‘ownership’ as beneficiaries are guided to draw conclusions about good practices themselves). Male and female trainers handle different aspects of the training program, with respect for culture (e.g., female trainers work with mothers. Trainings are separate according to interest group – pregnant women, lactating mothers with children 0-6 months, mothers with children 6-24 months, and mothers with sick children – to ensure information is specific to their needs, and so that pregnant women and those recently delivered do not come into contact, a cultural taboo. Male trainers work with CHCs to oversee CCs, emergency plans, investment plans, etc.). Interest groups are kept small, not exceeding 20-25 mothers, to ensure participants have a sense of belonging, and feel free to express themselves. Messages are cross-fertilized during home visits throughout the month, and on ration distribution packages. All field staff trainers additionally receive monthly training updates on processes and techniques to improve the effectiveness of BCC message delivery. The program has pursued a number of strategies to improve participation in educational training sessions, including allowing women in advanced pregnancy or those who are sick to identify a replacement to receive their ration and attend the training on their behalf. In addition to reasons of the woman’s health, training program attendance has often dropped during crop sewing and harvesting seasons, and when the government’s conditional cash transfer program planning that conflicted with ration distribution. The program is currently developing a communications strategy that will promote the program and improve educational training attendance through promotional local radio spots, identified by formative research as being an effective method of communication. Table 17: Percentage of mothers reporting knowledge of specific feeding practices Mothers of children between 0-23 months Baseline (n = 708) Midterm Evaluation (n = 633) Feeding knowledge: Percent who gave right answer: Children should be breastfed less than one hour after birthb 82.5 84.0 Children should be given colostrum 86.3 94.8 Children < 6 months of age should not drink other liquids 71.6 85.6 Reported age in months at which children should receive liquidsc 7.3 (3.5) Percent women who said 6 months 52.6 60.7 Percent women who said < 6 months 6.8 3.6 Percent women who said > 6 months 40.6 34 Reported age in months at which children should receive semi-solid foodsd 7.4 (3.0) Percent women who said 6 months 49.8 62.9 Percent women who said < 6 months 2.1 1.4 Percent women who said > 6 months 48 34.4 From the data, the majority of mothers had adequate knowledge about feeding practices (see Table 17). Over 80% knew that a newborn should be breastfed within one hour of birth, and 94.8% knew that colostrum should be given to newborns. The majority of women (91.5%) also responded that infants less than 6 months of age should not drink any other liquids than breast milk. The increase in knowledge in breastfeeding mothers is especially reflected in the increase 37 in knowledge of the introduction of liquids and solid foods to infants, which at baseline was only answered correctly by 71.6% of mothers, and increased to 91.5% at midterm. On average, mothers responded that children can start to receive liquids at 7.1 months of age, and start to receive semi-solid foods when they are 7.0 months old. The majority of women reported correctly the age of 6 months for the introduction of liquids (60.7%) and the introduction of semi-solid foods (62.9%). Of those who did not know the correct answer, only a small percentage of women responded that liquids (3.7%) and solid foods (1.4%) should be introduced before the age of six months. Table 18: Percentage of pregnant women reporting knowledge of specific warning signs/dangers of pregnancy Mother’s knowledge of danger signs of pregnancy Mothers of children between 0-23 months Baseline (n = 708) Midterm Evaluation (n = 633) Danger signs of pregnancy: when a pregnant woman should receive medical attention: Percent who responded… Persistent back pain 57.2 35.1% Severe headaches, blurry vision 42.5 46.8 Vaginal bleeding 31.2 58.6 Pelvic or abdominal pain 25.8 30.6 Swelling of the hands/face 24 22.7 Gush of fluid from vagina 3.5 7.0 Regular contractions prior to 37 weeks 2.8 3.6 No fetal movement 2.3 4.6 Total signs mentioned out of eight 1.9 (1.1) 2.1 (1.5) Overall, 34.0% of mothers are aware of the danger signs of pregnancy, a substantial increase from the baseline value of 5.9% and exceeding the midterm target of 20.0%. On average, mothers knew only 2.1 out of eight standard danger signs of pregnancy. The most common danger signs of pregnancy mentioned by women at midterm were vaginal bleeding (58.6%), severe headaches or blurry vision (46.8%), persistent back pain (35.1%), pelvic or abdominal pain (30.6%), and swelling of hands or face (22.7%). Only 7% mentioned the gush of fluid from the vagina, early contractions, or no fetal movement. Table 19: Health and care knowledge of mothersa Responses Mothers of children between 0-23 months (%) Baseline n = 720 Midterm Evaluation n = 633 Preventing diarrhea b,c Wash child’s hands 78.7 78.8 Keep children’s clothes clean 57.3 58.0 Clean fruits and vegetables 28.4 37.1 Don’t let children sit on ground 17.5 25.9 Give child purified water 6.4 8.5 Treating diarrhea c,d 38 Give ORS 67.0 65.2 Give traditional medicine 30.4 22.0 Take to medical center 29.4 49.6 Give purified water 5.2 8.4 Continue breastfeeding 2.8 6.6 Percent who knew of ORS 96.0 92.9 Feeding a sick child Feed less 90.5 86.1 Feed the same 4.9 6.5 Feed more 4.5 6.6 Giving liquid to a sick child Less liquids 43.7 43.1 Same amount of liquids 6.1 11.7 More liquids 50.3 44.7 Feeding a child recovering from sickness Feed less 29.8 28.3 Feed the same 30.9 26.4 Feed more 39.3 44.7 a Values are mean (s.d.) or percent b 43 mothers responded that they did not know c Questions were open-ended and mothers could provide multiple answers d 13 mothers responded that they did not know Knowledge on how to prevent diarrhea in children was limited (see Table 19). Mothers mentioned washing the child’s hands (78.8%), keeping the child’s clothes clean (58%), and washing fruits and vegetables before eating them (37.1%). Only 8.5%, however, mentioned the importance of giving the child clean water, and no one mentioned washing their own hands. Very little improvement can be seen in the health and care knowledge of mothers on preventing diarrhea. When asked how to care for a child with diarrhea, 65.2% of the mothers said that they should be given oral rehydration salts (ORS) - although as many as 92.9% of mothers knew what ORS was, 22% mentioned that children should be given local or traditional remedies, and 49.6% mentioned that a child should be taken to a local healthcare facility. Only a few women mentioned that children should be given purified water (8.8%) and breastfeeding continued (6.6%). More women mentioned that children should be taken to a local healthcare facility, given purified water, and breastfed compared to the baseline measurement. Of particular concern is that fewer than 50% of women, and less than baseline, mentioned giving children more liquids (44.7% compared to 50.3%). Table 20: Use of prenatal care servicesa Prenatal care for mothers with children between 0-23 months (%) Baseline n = 720 Evaluation n = 646 Had prenatal care: Percent who used…a 96.8 98.6 CHV 2.4 1.5 39 Convergence center 90.7 86.1 Government funded medical center 18.9 26.0 Private hospital or clinic 4.2 4.9 Health posts N/A 2.2 Health centers N/A 22.0 IGGS N/A 1.4 APROFAM N/A 2.5 Others N/A 1.1 Number of prenatal care visits All visits b 5.5 (2.6) 6.0 (2.7) Visits in medical facility b 5.4 (2.5) 5.8 (2.5) Services provided at prenatal visits: Percent who… Received a tetanus shot 61.2 15.5 Had blood pressure taken 94.5 95.5 Percent who took supplements of… 95.7 Iron 87.4 91.0 Folic acid 84.3 94.3 Other prenatal vitamins 20.7 32.4 Newborns who received essential newborn care Percent of children born in the last 23 months who were put to the breast within one hour of birth 75.0 77.9 Percent of children born in the last 23 months who were dried (wiped) immediately after birth before the placenta was delivered 98.8 91.0 Percent of children born in the last 23 months who were wrapped in an arm cloth or blanket immediately after birth before the placenta was delivered 99.0 92.7 a Mothers could provide multiple answers b Values are mean (s.d.) Prenatal healthcare seeking by woman was high; almost all women (98.6%) visited a medical professional during their pregnancy (see Table 20). The majority of women met with medical professionals at a CC (86.1% - a slight decline from baseline, but against an increase in attendance at medical centers). Other healthcare facilities visited by pregnant women include government funded medical centers (26%) and private clinics (1.9%). Hardly any women met with a CHV (1.5%), a possible indication their knowledge and services are not valued at the community level. Almost all pregnant women (95.5%) who had prenatal health care had their blood pressure measured, which is similar to the percentage of women at the baseline measurement (94.5%). The percentage of woman who received a tetanus shot (15.5%) is alarmingly lower than at baseline (61.2%), despite a 5% increase in availability compared to the previous year. 40 The majority of women took nutritional supplements during their pregnancy, 91% of the women took iron supplements, and 94.3% took folic acid supplements, an increase from 87.4% and 84.3% respectively at the baseline measurement. The percentage of women who took other prenatal vitamins also increased from 20.7% to 32.4%. Ninety-one percent of the newborns were wiped immediately after birth and 92.7% of the newborns were wrapped in a cloth or blanket, both slightly reduced from baseline. Taking into consideration cultural preferences, there is a noticeable trend towards reduced care that can partially be explained by the previously noted reductions in CC staff (revisit Tables 8 and 9, i.e., fewer doctors, nurses, approved midwives, CHVs, etc.). INTERMEDIATE RESULT 1.3: Increased engagement of households in reducing vulnerability to food insecurity Through PROCOMIDA, CHCs are strengthened in a variety of ways. One of these is through the creation of community emergency health funds, managed by the CHC with amounts defined by the community, for the community, and compiled from voluntary contributions by community members. These funds are vitally important and not limited to program beneficiaries. Towards the establishment of emergency health funds, PROCOMIDA holds a community assembly when a new CC is identified for program participation, and circulates the idea of the fund. The program does not handle any of the funds, and does not have access to them; rather they train the CHCs to manage the funds and help with auditing, establishing regulations, and defining investment plans. Four situations qualify to access the funds: (i) mother and/or child emergencies; (ii) support to improve the CC; (iii) improvement or creation of community store rooms; and (iv) loans to buy seeds for household gardens to encourage greater food diversity (as a revolving fund). There are only a handful of examples where community health funds have not been handled transparently and required intervention, first through dialogue, and when that failed, with threat of program withdrawal. For this reason, transparency of funds between CCs, CHCs, and community members, is essential. PROCOMIDA is also implementing household management or action plans to assure healthy houses. This is tied into ration distribution and an assurance that high energy and diverse foods are available for families, to improve self-consumption. It also includes Model Mothers with kitchen gardens that are to be reproduced by other mothers, and trained in cooking healthy and nutritious foods that are taught to other mothers. During 2012, PROCOMIDA hired community strengthening workers to introduce and promote the kitchen gardens. While household action plans are not exclusively an idea of Mercy Corps, these plans take into consideration three things: (i) what is necessary to keep families healthy and happy; (ii) what is needed to keep houses and kitchens clean; and (iii) how backyards can be made more productive. There has been considerable achievement in the target to increase the engagement of households in reducing their vulnerability to food insecurity. The percentage of households that possess household action plans almost doubles the target set for midterm (5.8% households with action plans compared to the target of 3%). Based on information obtained from PROCOMIDA documentation, by the third year of project operations, 270 CCs and 14 HPs have created emergency funds, meeting the midterm target for the project. However, from the sample of the 47 centers surveyed, only 40 (85.1%) reported that they had an emergency fund, specifically with regards to needs of emergency transportation. 41 SPECIFIC OBJECTIVE 2: By 2015, health care service providers at community through municipal levels have improved service quality and delivery This strategic objective primarily addresses strengthening health providers, structures, and infrastructure to provide strong MNCH care. PROCOMIDA actively works to strengthen local NGO Health Implementers identified and contracted through the MoH.12 The program’s main focus is BCC, with food distribution being a motivator for attendance to educational sessions (consistent with PM2A approach). In addition to training beneficiary mothers, PROCOMIDA has sub-grants with NGO Health Implementers, through which educators are hired and trained by the program in order to conduct home visits, work with lead/model mothers, and train CHVs as part of the health implementation structure. This structure is in fact two teams: (i) an institutional team comprised of a doctor or professional nurse and an educator/facilitator, and (ii) a community team with the CHVs, health guardians, and traditional midwives. Both teams, in theory, receive training with MoH support to manage the CCs and ensure the health needs of satellite communities are met. PROCOMIDA works directly with the NGO Health Implementers to strengthen their technical ability at both the organizational level, and the community level. NGO Health Implementers are reliant upon funding, supplies (medicines, vaccines, etc.), and other training support from the MoH. Since program initiation, the departmental ministry has been able to improve local NGO Health Implementer visibility, to the program’s advantage. Reporting remains a weakness, however, particularly the quality of growth monitoring data, with implications for program monitoring data and evaluation. This is acknowledged to be partly due to the fact that the program does not directly train the CHVs. It is also a result of frequent changes to ministry staff, and subsequently changes in focus and priorities. PROCOMIDA is addressing reporting weaknesses through education focused on standardized anthropometric measurements, delivered to implementing NGOs, combined with institutional strengthening at the CCs. Changes in reporting procedures have also been recently affected. Program data will no longer be collected and uploaded by implementing NGOs, but recorded monthly by program field staff directly from the child’s growth charts and uploaded to the database during the training sessions that coincide with ration distribution. Entered on the spot into the portable Tablet, it will be used immediately to identify if the child is growing well. If there is a delay in growth, the CHV will be alerted and mothers will be taken for counseling. In cases where a child is considered at risk, after the training session, his or her weight and height will be measured together with the CHV and entered into ENA or ANTHRO13 to identify acute malnutrition. If a child is identified with acute malnutrition, he or she is immediately referred to the closest health center as per MoH protocols. Amongst and between these NGOs, PROCOMIDA shares good practices and lessons learned, and facilitates networking and cross learning. PROCOMIDA is also working to address recommendations from implementing NGOs, one of which is that the program needs to be better involved in directly coordinating activities between CHVs and CHCs. This is of particular importance for sustainability of program inputs. If NGO Health Implementers are to continue to reach beneficiaries following program closeout, their need to be active linkages between all those trained under the program. Local NGO Health Implementers, CHVs, and CHCs are the correct channels to reach beneficiaries and make an impact. 12 PROCOMIDA has no input in NGO selection 13 WHO software for assessing growth of the world’s children and adolescents, consisting of three modules: (i) anthropometric calculator; (ii) individual assessment; and (iii) nutritional survey 42 The three impact indicators to measure improved service quality and delivery by health care service providers at the community through municipal levels relate to: (i) the knowledge of health facility staff and community volunteers; (ii) minimum standards for health and nutrition services and practices of health facilities; and (iii) minimum standards for performance by local CHVs. Table 21: Health care worker knowledge of danger signs that require medical attention Percentage correct response (%) Baseline n = 109 Midterm Evaluation n = 47 Danger signs of childhood illnesses Child not able to drink or breastfeed 32.1 40.4 Child becomes sicker 12.8 31.9 Child develops a fever 72.5 70.2 Child has fast breathing 50.5 53.2 Child has difficulty breathing 52.3 40.4 Child has blood in the stool 1.8 40.4 Average total signs mentioned out of six – mean (s.d.) 2.2 (1.2) 2.8 (1.5) Baseline n = 115 Midterm Evaluation n = 47 Danger signs of pregnancy Vaginal bleeding 89.6 89.4 Pelvic or abdominal pain 56.5 61.7 Persistent back pain 6.9 21.3 Gush or fluid from vagina 26.9 42.6 Swelling of the hand/face 34.8 27.7 Severe headaches, blurry vision 81.7 83.0 Regular contractions prior to 37 weeks 6.9 10.6 No fetal movement 3.5 21.3 Average total signs mentioned out of eight – mean (s.d.) 3.1 (1.1) 3.6 (1.6) While the targets for achieving minimum standards for the health facilities and are met, it must be noted that the targets set are relatively low. The knowledge level of health facility staff and community volunteers - measured in terms of their ability to identify the minimum number of core health and nutritional practices – lag behind as one of the poorest performing indicators. Not only was the target of 20% not met, the percentage of staff and volunteers who were able to identify minimum core health and nutritional practices dropped to 4.3%, lower that what was recorded at baseline (6.5%). On average, a health care worker was only able to name less than three warning signs out of six childhood illnesses, and less than four out of eight pregnancy danger signs. Table 21 shows a breakdown of the surveyed health care workers’ responses to danger signs indicating the need for medical attention, for childhood illnesses and during pregnancies. INTERMEDIATE RESULT 2.1: Increased communication and interaction between community members and health service providers The targets for health commissions to conduct regular meetings and demonstrate progress on their action plans was set at 270 to cover all the program CCs. By the midterm evaluation all 43 270 CCs and 14 HPs reporting having regular meetings and demonstrating progress on their action plans. Thus, the targets for the first two monitoring indicators are exceeded. For the third monitoring indicator (the number of pregnant women in health facility orientation visits) the target set was 540; however, as no activities were implemented for this indicator, the data is zero. The program is rethinking how to approach this indicator with a focus on exposing TBAs to health facilities, rather than mothers. Table 22: Birth options and attendance of medical staffa Births of children between 0-23 months (%) Baseline n = 720 Midterm Evaluation n = 646 Location of birth: Percent who… Delivered at home 64.1 65.2 Delivered at health facilities 35.9 34.8 Medical Staff at birth: Percent who had presence of… CC approved midwife 52.5 47.5 Doctor or nurse 35.1 43.8 Local CHVs 7.5 4.9 Untrained midwife 4.7 3.5 a Values are mean (s.d.) or percent At both baseline and midterm, the majority of women delivered at home (65.0% and 63.8% respectively) compared to at a health facility (34.4% and 35.1% respectively, see Table 22). Deliveries were mainly attended by a CC-approved midwife (47.5%), or by a medical staff (43.81%), such as a doctor or a nurse. Only 4.1% of the births were attended by local CHVs, and 0.9% by a traditional midwife. At baseline, 4.7% of the women reported the presence of a traditional midwife. Furthermore, it can be seen that more women had a doctor or nurse present and less had a CC-approved midwife present, compared to the women at baseline (35.1% and 52.5% respectively), which is very encouraging. INTERMEDIATE RESULT 2.2: Increased and improved provision of minimum standards in health services to women and children As part of the comprehensive training package, program staff visit participating CCs every month for training and distribution, and also to assess the physical and economic infrastructure at the CC. In recognition of reporting weaknesses, and their impact on program monitoring data, all CCs have been provided measure boards, infant scales, and adult scales as part of a basic package. Other efforts are underway to advocate for a more efficient supply chain with access to, in particular, timely and sufficient vaccinations and other essential medications. It is acknowledged that MoH budgetary issues is reflected in the availability of funding for local implementing NGOs, and affects the availability of vaccines, medications, and micronutrients. Micronutrient and vaccination coverage in particular are very stationary. When the government has funding, they ‘blanket’ communities with vaccinations. Unfortunately, this means that many children are not receiving vaccines within the correct timeframe, reducing their efficacy. Additionally, during emergency cases (particularly diarrhea and respiratory-related), there are often inadequate essential medicines available at CCs. Families living in extreme poverty must then decide, in the absence of free medicines, whether they can afford to transfer sick household members long distances to hospitals, purchase medicines from private pharmacies, or do nothing and hope for the best. 44 It is encouraging to note that indicator 27 (the number of health facility staff trained in health and nutrition best practices) exceeded the midterm target of 60 by slightly more than double at 121. This is related to both the expansion and inclusion of educators and staff at the health posts. Additionally, as per program monitoring data, 94% of SAM cases (indicator 29) were referred following the protocols of the MoH, exceeding the target of 90%. INTERMEDIATE RESULT 2.3: Increased promotion and planning by health care providers to meet community health care needs The midterm target set for the number of persons trained in planning and advocacy around food security and health was 1,680. At midterm evaluation, program monitoring data suggest that 1,988 persons had been trained. This is directly related to the expansion of the program. 5. CONCLUSIONS AND RECOMMENDATIONS Overall, the program has shown success, with important improvements noted to all three anthropometric impact indicator. This is important given that there are two red and one yellow triggers out of four trigger indicators measured, indicating that they have worsened in the last year. Despite supplement Title II rations, household hunger also increased over baseline. Clearly something has been going on that has adversely affected household diet. Yet despite the worsening of these external factors, the program has been able to show improvements in some important areas. Unfortunately, the midterm evaluation does reveal a concerning gap between improved knowledge, and actual behavior change. It has to be noted that BCC theory and theory of change do recognize that one has to acquire knowledge in order to change behavior (practice) and attitudes. It is also known that the step from knowledge to actual practice, especially with behavior, is more difficult. That said, the program did expect to be more advanced in this area at this stage. It is yet to be seen if this is a factor of time, or of household decision-making. This gap in knowledge is evident from the analysis of IR 1.2, where indicators that are related to knowledge all far exceeded midterm targets, demonstrating that the program has successfully transferred knowledge to participating mothers. For example, the percentage of mothers demonstrating increased nutritional knowledge exceeded the target of 10% by more than four￾fold. Unfortunately, among these mothers demonstrating increased nutritional knowledge, there was no significant association with better average HDDS, dietary diversity of children aged 6-24 months, or in the practice of exclusively breastfeeding children aged 0-6 months. Rather, the percent of newborns who received essential newborn care, the percent of children between 0-6 months that were exclusively breastfed, and the percent of children aged 6-24 months with respiratory diseases that received adequate treatment were all not only lower than midterm targets, but lower than their baseline values. Despite rations and BCC, 36.8% of children 6-24 months were found to have below the minimum acceptable dietary diversity, and demonstrated only a moderate improvement in overall dietary diversity from baseline to midterm. Additionally, in the four weeks preceding the midterm survey, in 10.3% of households, at least one member went to bed hungry, and 6.1% of households had at least one member who did not eat for a whole day. Overall, the prevalence of hunger has increased slightly from baseline to midterm: 0.4% had severe hunger, and 9.9% had moderate hunger, despite access to rations. The overarching recommendation of this midterm evaluation is that PROCOMIDA needs to redirect programmatic efforts on translating improved knowledge and access to rations into improved practice and health seeking behavior. 45 Towards addressing this recommendation, several suggestions or implementing recommendations are proposed. 1. Conduct extensive anthropological ‘action learning’ research. Formative research conducted during IY1 highlights several interesting points that appear to have been overlooked or forgotten during program implementation. These include the fact that mothers expressed the need to get permission from their husbands to partake in some program components. They also include that mothers, fathers, and grandmothers all expressed willingness to learn from the program’s health and nutrition professionals, as combined caregivers. Despite this, the program appears to have focused on mothers as caregiver, with several important consequences: (i) the roles in inter-household power dynamics and decision-making that husbands, grandmothers, and other household members play in effecting positive behavior change around nutrition and health practices were ignored; (ii) nutrition and health behavior, which are family and household issues, were inadvertently relegated to those of ‘mother’s issues’, and presumably accorded lesser importance by households. Anthropological ‘action learning’ research is important to gain a deeper and more comprehensive understanding of the broader cultural, social, and economic context of nutrition, care-seeking, and health behavior. This is necessary in order to remain innovative and engaged in the non-technical dynamics surrounding demand, supply, and utilization, and adoption of knowledge. It is also necessary to shed light on how innovations are stimulated in society. In this case, the innovations are improved nutrition and behavior, and even acknowledgement at the household level that nutrition (diet) and behavior (care seeking and associated practices) can and should be improved. The importance of creating and sustaining a learning environment throughout the program process is fundamental, particularly given the difficulties translating knowledge into positive action. Unlike barrier analysis, which is limited, action learning research will provide a fuller picture for the program by looking at the positive enablers as well, with potential lessons to be learned both from within and outside the health sector. At best, this research would involve a team of anthropologists, not enumerators, to do in situ participant observation and qualitative interviews specific to when and where household caregivers, including but not limited to mothers, are translating knowledge into behavior, and how decisions regarding nutrition and behavior are traditionally made and by whom. 2. Pursue a stronger educational focus. This is particularly important for adolescent boys and girls (i.e., before marriage), for whom nutrition and behavior change information provided in schools will have the most impact on the next generation of children. This is in line with the program’s preventive approach to malnutrition and stunting. The focus on education must not, however, be restricted to school-age children. It should include adult literacy components that engage and empower both women and men in decision-making processes. All members of the household must be convinced with the ease and importance of good nutrition, particularly the traditional decision-makers. It is suggested that health facility orientation visits could be incorporated into educational opportunities (indicator 28), as exposure to health infrastructure is the first of many steps necessary to address cultural and linguistic preferences when making decisions about care seeking behaviors. 3. Reconsider the role of CHVs. The formative research conducted in IY1 notes that CHVs expressed frustration about their position. This included feeling of obligation because they were ‘chosen’ by communities (as opposed to wanting the job), and resentment because their jobs take time and energy but provide little compensation (Q500/month) or training. As the CHVs are the primary interface with beneficiary communities at the household level, their lack of motivation and frustrations negatively affect the delivery of program activities. 46 As noted by the data, the percent of health facility staff and CHVs able to identify a minimum number of core health and nutrition practices was significantly unable to meet the midterm target, and in fact dropped below the baseline value. This is partly due to high CHV turnover, which might also be due to the same frustrations and lack of motivation. Current the program is working to involve more CHVs in training sessions, in addition to holding separate quarterly training sessions specifically for CHVs. Additionally, the program is designing specific training materials for CHVs on danger signs and nutrition practices. CHVs are and can be further involved in field activities, and NGO Health Implementers encouraged to further strengthen CHV support. For sustainability purposes, strong linkages between NGO Health Implementers, CHVs, and the Community Health Commissions is important. Beyond trainings, it is suggested that the program should raise the issue of some kind of compensation for this important grassroots-level outreach workforce with the MoH. Additionally, the program might consider, through USAID, engaging Peace Corps or other volunteers with nutrition and health strengths, and who speak Spanish and possibly even Q’uechí, to work directly in the villages with CHVs at the household level. In addition to this overarching recommendation, it is noted that a number of factors affecting program performance are outside of the program’s control. These include access to essential blood pressure monitors, stethoscopes, and thermometers by CCs (which decreased from baseline), necessary to conduct anthropometric measurements and ensure child nutritional health. It also includes access to essential medications and vaccinations. Many of these are linked to MoH budgetary and supply chain management issues. The formative research in IY1 noted frustration from respondents based on the inconsistent availability of supplies, and these frustrations clearly continue. It is important that the program continue to address these issues with the MoH. The program should consider renegotiating those indicators of access and quality of health services outside of programmatic control, or propose to change the indicators entirely to better measure direct interventions. The availability of community health funds, a program innovation to improve the CC structure and function, is not sufficient, as it does not affect the availability of supplies and medications. 47 REFERENCES Ballard, T., Coates, J., Swindale, A., Deitchler, M. 2011. Household Hunger Scale: Indicator Definition and Measurement Guide. Washington, DC: FANTA. Carranza, R., Jackson, J., Janssen, M. 2012. Behavior Change Communication Strategy. Guatemala: Mercy Corps PROCOMIDA Program. Cogill, B. Anthropometric Indicators Measurement Guide. 2003 Revised Edition. Food and Nutrition Technical Assistance Project (FANTA). Washington DC: Academy for Educational Development. Deitchler, M., Ballard, T., Swindale, A., Coates, J. 2010. Validation of a Measure of Household Hunger for Cross-Cultural Use. Food and Nutrition Technical Assistance Project II (FANTA-2). Washington D.C.: Academy for Educational Development. FANTA-2 Project. 2009. Alternative Sampling Designs for Emergency Settings: A Guide for Survey Planning, Data Collection and Analysis. Food and Nutrition Technical Assistance Project II (FANTA-2). Washington D.C.: Academy for Educational Development. Instituto de Nutrición de Centro América y Panamá. (INCAP). 2008. Evaluación del Componente de Monitoreo y Promoción del Crecimiento de la Estrategia AIEPI AINM-C en el Programa de Extensión de Cobertura en Guatemala. Guatemala. Magnani, R. 1997. Sampling Guide. Food and Nutrition Technical Assistance Project (FANTA). Washington DC: Academy for Educational Development. Mercy Corps Guatemala. 2010. Fiscal Year 2010 Annual Results Report. Guatemala: PROCOMIDA Program. Mercy Corps Guatemala. 2011. Fiscal Year 2011 Annual Results Report. Guatemala: PROCOMIDA Program Mercy Corps Guatemala. 2012. Fiscal Year 2012 Annual Results Report. Guatemala: PROCOMIDA Program. Mercy Corps Guatemala. 2012. Pipeline and Resource Estimate Proposal (PREP). Guatemala: PROCOMIDA Program. Mercy Corps. 2009. Programa Comunitario Materno Infantil de Diversificacion Alimentaria – PROCOMIDA: Final Proposal Revision. Portland: Mercy Corps Headquarters. Ministry of Health and Social Assistance (Guatemala), University of Valle and Division of Reproductive Health, Centers for Disease Control and Prevention (CDC). 2009. Guatemala Reproductive Health Survey 2008-2009. Atlanta, United States: CDC. MKT. 2012. Final Report PROCOMIDA 2012 Midterm Evaluation. Guatemala. Richter, S., Harris, J., Leroy J., Olney, D., Ruel, M. 2011. Strengthening and Evaluating the ‘Preventing Malnutrition in Children Under Two years of Age Approach’ (PM2A) in Guatemala: Cross-Sectional Baseline Report. Poverty, Health, and Nutrition Division International Food Policy Research Institute (IFPRI). Washington DC. Richter, S., Harris, J., Leroy, J., Olney, D., and Ruel, M. 2011. Strengthening and Evaluating the “Preventing Malnutrition in Children Under Two Years of Age Approach” (PM2A). Food and Nutrition Technical Assistance II (FANTA-2). Washington DC: Academy for Educational Development Stukel, D., Deitchler, M. 2012. Addendum to FANTA Sampling Guide by Robert Magnani 48 (1997): Correction to Section 3.3.1 FHI 360 (FANTA-2 Bridge). Washington DC: Academy for Educational Development. Swindale, A., Bilinsky P. 2006. Household Dietary Diversity Score (HDDS) for Measurement of Household Food Access: Indicator Guide, Version 2. Food and Nutrition Technical Assistance Project (FANTA). Washington DC: Academy for Educational Development. WHO. 2010. Indicators for Assessing Infant and Young Child Feeding Practices: Part II Measurement. Geneva. 49 APPENDICES Appendix A: Terms of Reference: Estadística y Opiniones MKT Midterm Evaluation PROCOMIDA MERCY CORPS GUATEMALA FEBRUARY 2012 Introduction The purpose of the Field Study for the Midterm Evaluation of PROCOMIDA Program (Community Food Diversification Program for Mother and Child) is to measure progress in program objectives. This assessment is an opportunity to measure actual achievements compared to goals. The objective of this activity is to identify problems and constraints that influence the achievement of the goals and to develop recommendations to improve the design, within the proposal framework, and program execution in order to achieve sustainable results. PROCOMIDA is a six-year program that started in July 2009, funded by USAID and seeks to improve the nutritional status than 227,000 people in 750 vulnerable communities in the department of Alta Verapaz. The goal is to improve nutritional status and health of women and children vulnerable to food insecurity in northern Guatemala. PROCOMIDA provides nutritional and health education to empower mothers and other mothers to adopt best practices, including seeking health services. PROCOMIDA works with NGOs and MOH health units to establish community structures organized to improve the provision of culturally and technically appropriate health services. PROCOMIDA has an important research component, which is coordinated with FANTA-2 and IFPRI. It also provides beneficiaries a balanced ration of food that contains corn-soy blend (CSB) rice, beans, vegetable oil and micronutrients either in lipid based or powder form. The program has two objectives: 1. In 2015, pregnant or nursing women, children under 2 years and children under 5 malnourished in the program area have improved sustainable health and nutrition. 2. In 2015, service providers, community health and municipal level have improved their service quality and delivery. Purpose of Evaluation: Measure the progress of the project in view of the indicators set out in the program proposal and IPTT (Indicator Performance Tracking Table) (Annex 1) and assess the scope and compliance of the program’s processes, results and impacts as planned in the proposal and operational plans. Survey context This study will be conducted through the hiring of a consultant or external consulting firm and will be conducted within PROCOMIDA, implemented by Mercy Corps Guatemala (MCG), in the municipalities of Cobán, San Pedro Carchá, Cahabon, Lanquin and Senahú in the department of Alta Verapaz. PROCOMIDA is a six-year Title II program, funded by USAID, which aims to improve the nutritional status of 227,000 vulnerable people in 750 communities from the department of Alta Verapaz. 50 Parameters of the study The consultancy will consist of data collection, digitization, analysis and reporting of the program midterm evaluation, which will serve as a measure of performance and progress of the program and also evaluates the effectiveness of the processes and strategies implemented. The study should measure IPTT indicators and other indicators that measure program performance and implementation processes. The study should contain the following topics:  Family composition  Diet diversity (see FANTA)  Hunger Scale (see FANTA)  Knowledge of mothers and health workers (pregnancy, childbirth, postpartum, neo-born, children under two years)  Pre-and postnatal health  Infant feeding (including exclusive breastfeeding)  Preventive health (mother and child)  Morbidity and care seeking  House conditions  Resilience strategies  Anthropometry of children under 5 years  Consumption of donated food and supplements  Coverage of other programs in the area  Levels of participation in the program  Access to health services  Conditions and infrastructure of Convergence Centers and the services provided  Equipment and supplies available in the Convergence Centers The program reserves the right to include some additional items to assess specific aspects, provided they do not have the greatest impact on the duration of the survey Study size The sample (and the methodology for determining it) will be defined by the consultant hired, under the supervision and approval of the program. It will take into consideration that the universe involves all active (15.874) and graduated (6.857) beneficiaries of the program within the 269 convergence centers served. Two types of surveys will be held: Household survey:  Sample to be defined  Includes anthropometry in boys/girls under five years  The survey will take approximately 1:30 hours per household  The household sample will be determined in two stages (two-staged cluster sample), first at convergence center level and then at beneficiary families level 51 Community and health services survey:  Sample to be defined  The study of health services includes: interview s to Community Facilitators (FC) in each convergence centers (CC); CC survey; interview with health personnel and a review of the infrastructure (equipment, infrastructure and drugs) of the CC The baseline study surveys will be used as a basis, subject to review by the consultant and the program and its subsequent approval by the Monitoring and Evaluation Unit. Additional items will be added to assess consumption of the products provided by the program and the influence of other food security social assistance programs recently implemented in the area. By mutual agreement, qualitative questionnaires may be added, especially at the community / CC level. Location: Rural areas of Alta Verapaz, Guatemala, in the CCs where the program is implemented, in the municipalities of Cobán, San Pedro Carchá, Cahabon, Lanquin and Senahú. Schedule: The consultant shall submit a detailed timetable which will start the week after hiring and must include:  Online and onsite coordination for setting operational and programmatic details. Review of survey instruments, programming of surveying equipment (PDA or tablet), recruitment of field staff and survey pilot to validate the survey (lasting approximately two to three weeks)  Training surveyors, including standardization and field practice. (Approximately two to three weeks).  Data collection. (Approximately 5 weeks)  Data cleaning and quality control. (3 weeks)  Delivery of end products, including the survey report. (2 weeks) Field methodology:  The data collection will be conducted in digital form by using PDA (Personal Digital Assistant) or Tablet.  The programming of the tablets / PDA will be carried out using appropriate software for the equipment used, defined jointly with the consultant and the program;  The program will provide the height boards, scales and PDA or tablet for this study.  The consultant will define the assessment team, including number of field teams (enumerators, supervisors, editors, anthropometrists) according to the stipulated time for data collection and geographic coverage. It should take into account that will be held at two levels (family and CC/community)  There will be a rigorous training of surveyors. This should include field practice and anthropometric standardization.  Household surveys will be conducted in Q’eqchí, while surveys with health staff, as appropriate, may be in Spanish. Field staff should be standardized in survey methods and the formulation of questions in Q eqchi. 52  The field staff must be 100% Q'eqchí, subject to language assessment by the program.  The field team should include one or various supervisors/editors to oversee surveyors during the interviews and review all surveys before being delivered to the field coordinator.  The consultant should describe the quality controls implemented throughout the process to ensure the accuracy of the information and the completion of the survey sample.  The result tables will be determined jointly between the consultant and the program. The parameters used in the baseline will be taken into account.  Data cleaning, statistical analysis and production of the final report will be made by the consultant. Deliverables:  Detailed plan of study, including:  General methodology  Sampling framework  Formation of teams  Q'eqchí standardization  Detailed schedule  Anthropometric standardization plan for enumerators. The standardization should follow MOH guidelines.  Field survey plan by municipality, CC and families to be surveyed. It should be noted that, at the requirement of some indicators, the survey will be done 7 days a week. The consultant may consider including short rest periods, provided it does not affect the timing and in accordance with the Monitoring and Evaluation Unit.  Quality control plan to ensure high quality of data  Other relevant items.  Training and anthropometric standardization report, including details of the adjustments made to the questionnaires.  Weekly field progress report.  Final field report, including response rate, number of surveys per segment of the population, observations and issues, any other information necessary for the interpretation of the data.  Databases in a format suitable for use in common software for data analysis (SPSS). The databases will be accompanied by a dictionary of variables, including the name of each variable, label, type of variable, the values and labels (if it is a discrete variable) and method of calculation.  Presentation of results to the Technical Support Unit, managers and program direction. In addition to a presentation to the Donor and National Partners.  Final report in English and Spanish 53 Appendix B: Terms of Reference: Health and Development Consulting International (HDCi) LLC Midterm Evaluation Results Review and Reporting (Final Midterm Report Team) PROCOMIDA MERCY CORPS GUATEMALA DECEMBER 2012 Introduction The purpose of the Midterm Evaluation of PROGRAMA COMUNITARIO MATERNO INFANTIL DE DIVERSIFICACIÓN ALIMENTARIA (PROCOMIDA) is to measure progress in program objectives. This assessment is an opportunity to measure actual achievements compared to goals. The objective of this activity is to identify problems and constraints that influence the achievement of the goals and to develop recommendations to improve the design, within the proposal framework, and program execution in order to achieve sustainable results. PROCOMIDA is a six-year program that started in July 2009, funded by USAID and seeks to improve the nutritional status than 266,000 people in 936 vulnerable communities in the department of Alta Verapaz. The goal is to improve nutritional status and health of women and children vulnerable to food insecurity in northern Guatemala. PROCOMIDA provides nutritional and health education to empower mothers and other mothers to adopt best practices, including seeking health services. PROCOMIDA works with NGOs and MOH health units to establish community structures organized to improve the provision of culturally and technically appropriate health services. PROCOMIDA has an important research component, which is coordinated with FANTA-2 and IFPRI. It also provides beneficiaries a balanced ration of food that contains corn-soy blend (CSB) rice, beans, vegetable oil and micronutrients either in lipid based or powder form. The program has two objectives: (1) In 2015, pregnant or nursing women, children under 2 years and children under 5 malnourished in the program area have improved sustainable health and nutrition; (2) In 2015, service providers, community health and municipal level have improved their service quality and delivery. Purpose of Evaluation: Measure the progress of the project in view of the indicators set out in the program proposal and IPTT (Indicator Performance Tracking Table) and assess the scope and compliance of the program’s processes, results and impacts as planned in the proposal and operational plans. Purpose of this consultancy: Interpret the results of the evaluation and produce a final narrative report with statistical findings, conclusions and recommendations. Context PROCOMIDA had contracted a local consultant to conduct the midterm evaluation in the municipalities of Cobán, San Pedro Carchá, Cahabon, Lanquin and Senahú in the department of Alta Verapaz, Guatemala. PROCOMIDA aims to improve the nutritional status of 266,000 vulnerable people in 936 communities from the department of Alta Verapaz. The midterm consultancy consisted of data collection, digitization, analysis and reporting of the program 54 midterm evaluation to evaluate the effectiveness of the processes and strategies implemented through IPTT and other indicators and included the following topics:  Family composition  Household diet diversity scale (HDDS, see FANTA website for definitions)  Hunger Scale (see FANTA website for definitions)  Knowledge of mothers and health workers (pregnancy, childbirth, postpartum, new-born, children under two years)  Pre-and postnatal health  Infant feeding (including exclusive breastfeeding)  Preventive health (mother and child)  Morbidity and care seeking  Housing conditions  Resilience strategies  Anthropometry of children under 5 years  Consumption of Title II donated food and micronutrient supplements  Coverage of other programs in the area  Levels of participation in the program  Access to health services  Conditions and infrastructure of Convergence Centers and the services provided  Equipment and supplies available in the Convergence Centers The sample was calculated from the universe of all active (15,874) and graduated (6,857) beneficiaries of the program within the 269 convergence centers served, as per January 2012. Sample size was defined at 1,000 households and 50 Convergence Centers. The Midterm consultancy report describes the sampling framework. Two types of surveys were collected: Household survey:  1,000 households/families  Includes anthropometry in boys/girls under five years;  The household sample was determined in two stages (two-staged cluster sample), first at convergence center level (50, probability proportionate to size sampling) and then at beneficiary families level (20 per cluster, for a total of 1,000 families). Community and health services survey:  50 CCs, as were defined in the cluster selection of the household survey  The study of health services included: interview s to Community Facilitators (FC) in each convergence centers (CC); CC survey; interview with health personnel and a review of the infrastructure (equipment, infrastructure and drugs) of the CC. 55 The baseline study survey modules were used as a basis for the midterm, reviewed by the consultant and the program. Additional modules were incorporated to measure indicators not included in the baseline. Data collection was conducted in digital form by using Tablets. After reviewing the report of the data collection midterm consultancy, it was considered necessary to contract a separate consultant to review the data and write a more comprehensive report that could be shared with the donor and other partners. Description of this consultancy Based on the midterm results, PROCOMIDA requires the services of a consultant to convert these findings into a well written report in English, and preferably also in Spanish, to be shared with the donor and other actors/partners. The report should contain:  Verify midterm results, compare with baseline results and midterm targets, as presented in the IPTT. This includes probable explanation of targets not met or exceeded  Analysis of correlation/dependence between key indicators  Work with the program staff to produce conclusions and recommendations that are plausible and practical For the interpretation, the IPTT and SPSS databases will provide all inputs. For each indicator the consultant will analyze statistical relevance with regards to the baseline results. In addition, results will be compared with the midterm targets. A correlation of the following indicators will be analyzed by the consultant:  Average Household Diet Diversity Score (HDDS, indicator 3) and % Children 6 – 24 months with minimum acceptable dietary diversity (indicator 5)  Average HDDS (indicator 3) and % mothers demonstration increased nutritional knowledge (indicator 7)  % Children 6 – 24 months with minimum acceptable dietary diversity (indicator 5) and % mothers demonstration increased nutritional knowledge (indicator 7)  % children 0 – 6 months exclusively breastfed (indicator 9) and % mothers demonstration increased nutritional knowledge (indicator 7)  % mothers receiving minimum recommended antenatal care (indicator 14) and % mothers receiving minimum recommended post natal care (indicator 16) The consultant is asked to propose additional pertinent correlations, identified through a correlation matrix. Based on midterm findings, analysis and review of earlier reports, the consultant will work with PROCOMIDA TSU staff to draw plausible conclusions and recommendations for PROCOMIDA, with the purpose of improving program implementation to achieve final targets and goals. The consultant will receive from Mercy Corps Guatemala the following documents as input:  IPTT with results from mi-term evaluation included  Draft final report from midterm consultant (in Spanish)  Table outlines  Program proposal  Annual Result Reports for years 2 and 3.  Cleaned databases in SPSS 56  Survey modules in MS Word Additional information and documents can be provided if needed. Deliverables: The following deliverables are expected:  Tables of indicators showing statistical relevance in comparison with baseline  Tables of indicators comparing midterm results with midterm targets  Tables showing correlations between key indicators, as defined in these ToR.  Final report in English describing findings in statistical relevance, results comparison and correlations, as well as conclusions and recommendations  If possible, translation of the final report to Spanish Supervision: Direct supervision of all processes will be in charge of the PROCOMIDA Technical Support Unit. Final approval of the report is under responsibility of the PROCOMIDA Chief of Party. Timeframe and cost The consultancy is expected to finalize between January 10 and 15, 2013 and is hence required to start as soon as possible. The consultant will present a work plan with specific deliverables (see list above) and a total cost. Mercy Corps will cancel the negotiated total cost at reception and approval of the final product. 57 Appendix C: List of Sampled Convergence Centers Convergence Center List (‘replacement’ CC’s are highlighted in grey) No. Name of the Convergence Center Municipality 1 Belén Cahabón 2 Champerico Cahabón 3 Julhix Cahabón 4 San Martin Chinantal Cahabón 5 Saquihá Cahabón 6 Chichaic Cobán 7 Chicuxab Cobán 8 Chinasayub Cobán 9 Chirrepec Cobán 10 Guadalupe Cobán 11 Las Promesas Cobán 2 Nuevo Porvenir Cobán 13 Ostúa Cobán 14 Plan Nuevo Amanecer Cobán 15 San José La Colonia Cobán 16 San Lucas Samox Cobán 17 San Luis Vista Hermosa Cobán 18 Sayaxut I Cobán 19 Semuy I Cobán 20 Uculá Cobán 21 Chinama Lanquín 22 Jobchacob Lanquín 23 San Javier Lanquín 24 Candelaria Yalicar San Pedro Carchá 25 Chaimal San Pedro Carchá 26 Chicojl San Pedro Carchá 27 Chiquisis San Pedro Carchá 28 Chiquixji San Pedro Carchá 29 Chirreacte San Pedro Carchá 30 Chitaña Esquipulas San Pedro Carchá 31 Cipresales San Pedro Carchá 32 El Rosario San Pedro Carchá 33 Esperanza Chilatz San Pedro Carchá 34 Pequicuch San Pedro Carchá 35 Quiha Esperanza San Pedro Carchá 36 San Antonio I San Pedro Carchá 37 San Vicente San Pedro Carchá 38 San Vicente Chicatal San Pedro Carchá 39 Secaranilá San Pedro Carchá 0 Seconon San Pedro Carchá 41 Semox Setinta San Pedro Carchá 42 Senimlaha San Pedro Carchá 43 Sequilá San Pedro Carchá 44 Sesajal San Pedro Carchá 45 Sesaquiquib San Pedro Carchá 46 Tontem San Pedro Carchá 47 Vista Hermosa Xalihá San Pedro Carchá 58 48 Alpes Senahú 49 La Montañesa Senahú 50 Los Naranjales Senahú 51 San Antonio Semarac Senahú 52 San Francisco I Senahú 53 Secuachil Senahú 54 Sepamac Senahú 55 Seritquiche Senahú 56 Seyuc Tuila Senahú 59 Appendix D: Data Collection Tools (Questionnaires and Surveys) Community Survey ‘Ecomunidat’ Project VARIABLES NAME QUESTION RESPONSE CODE GENERAL INFORMATION SURVEY ECDI01 1. Survey CODE [__ | __ | __ | __ | __ | __] ECOM02 2. SUPERVISOR CODE [__ | __] ECOM03 3. EDITOR CODE [__ | __] ECOM04 4. INTERVIEWER CODE [__ | __] CODCC 7. Convergence Center code [__ | __ | __ | __] ECOM05 5. CC municipality location [__ | ___] [___ | ___] ECOM06 6. CC Community location [___ | ___] [___ | ___] [___ | ___ | ___] Nombredemunicipio Municipality name Pre-coded. No full visual aid to field team FarmName Community Name Pre-coded. No full visual aid to field team Information of Interview Text Box VARIABLES NAME QUESTIONS CODES ANSWERS Survey General Information ECOM08.A 8. DATE OF 1st INTERVIEW [__ | __] / [__ | __] / 2010 Day Month ECOM08. B 8. DATE OF 2nd INTERVIEW [__ | __] / [__ | __] / 2010 Day Month ECOM08.C 8. DATE OF 3rd INTERVIEW [__ | __] / [__ | __] / 2010 Day Month ECOM09.A 9. START TIME OF 1st VISIT (24 hour format) (24 hour format) [__: __] Min Time ECOM09. B 9. START TIME OF 2nd VISIT (24 hour format) (24 hour format) [__: __] Min Time ECOM09. C 9. START TIME OF 3rd VISIT (24 hour format) [__: __] Min Time ECOM10 10. INTERVIEWER should introduce itself and ask acceptance of CF Allowed to ask 1 = 2 = Not allowed to ask [___] --- NEXT QUESTION interviewee not want to answer the questions. You cannot continue the interview in this case, talk to your supervisor ECOM11 11. Informant's name ECOM11A 11a. Charge 1 = FC 2 = VS 3_ Midwife 4 = Other [___] --- Conditional (jump other) ECOM11B 11b. Specify other charges 60 ECOM12 12. THIS name ECOM12 A 12.a. Charge 1 = Community Facilitator 2 = Health Guardian 3 = Midwife 4 = institutional Facilitator 5 = Educator 6 = Itinerant NUrse / Itinerant Doctor 7 = Other (specify) [___] CARGO Conditional (jump other) ECOM12B 12b. Specify other charges ECOM 13 13. THIS name ECOM 13A 13.a. Charge 1 = CF 2 = HG 3 = Midwife 4 = institutional Facilitator 5 = Educator 6 = IN/ ID 7 = Other (specify) [___] --- Conditional (jump other) ECOM 13B 13b. Specify other charges ECOM 14 14. THIS name ECOM 14A 14.a. Charge 1 = CF 2 = HG 3 = Midwife 4 = institutional Facilitator 5 = Educator 6 = Intinerant Nurse / Itinerant Doctor 7 = Other (specify) --- Conditional (jump other) ECOM 14B 14b. Specify other charges SECTION 2 Link next section n VARIABLES NAME QUESTIONS CODES ANSWER Seccià ³ n 2. Health infrastructure of the town ECOMS201A 2.1.A Is there a private practice in the town? 1 = 2 = NO [___ | ___] 61 88 = Do not know 99 = No answer CARGO1 JUMP: response ECOMS201B 2 = No ECOMS201C ECOMS201 B 2.1.B private practice quantity 88 = NS, 99 = NR amount 88 = Do not know 99 = No answer [___] CARGO10 JUMP ECOMS202A ECOMS201C 2.1.C A Distance in km is the most s private practice nearby km 88 = Do not know 99 = No answer [___] ECOMS201D 2.1.d. How much time takes in public transportation --- Time? (8888 = NS; 9999 = NR) time in 24-h format 8888 = Do not know 9999 = No answer [__ | __] [__ | __] ECOMs 202A 2.2. A. Is there a local Midwife or Health Assistant? 1 = YES 2 = NO 88 = Do not know 99 = No answer [___ | ___] Charge2 JUMP: response ECOMS202B 2 = No ECOMS202C ECOMs 202B 2.2.B Number of Midwife or Health Assistant 88 = NS, 99 = NR amount 88 = Do not know 99 = No answer [___] CARGO1 1 SALTO ECOMS203A ECOMS202C 2.2.C Distance in km is the Assistant Health Midwife or more nearby km 88 = Do not know 99 = No answer [___] ECOMS202D 2.2.D. How much takes in public transportation - -- Time? (8888 = NS; 9999 = NR) Time in 24-h format 8888 = Do not know 9999 = No answer [__ | __] [__ | __] ECOMs 203A 2.3. A Is there a healer or other traditional practitioner? 1 = YES 2 = NO 88 = Do not know 99 = No answer [___ | ___] CARGO3 JUMP: response ECOMS203B 2 = No ECOMS203C ECOMs 203B 2.3.B Healer quantity, or other traditional practitioner 88 = NS, 99 = NR amount 88 = Do not know 99 = No answer [___] CARGO12 SALTO ECOMS204A ECOMS203C 2.3.C Distance in km to healer or other traditional practitioner nearby km 88 = Do not know 99 = No answer [___] ECOMS203D 2.3.D. How much time takes in public transportation --- Time? (8888 = NS; 9999 = time in 24-h format 8888 = Do not [__ | __] [__ | __] 62 NR) know 9999 = No answer ECOMs 204A 2.4. A. There is a pharmacy in the town to be addressed? 1 = YES 2 = NO 88 = Do not know 99 = No answer [___ | ___] Count 4 JUMP: response ECOMS204B 2 = No ECOMS204C ECOMs 204B 2.4.B. Quantity of pharmacy 88 = NS, 99 = NR Quantity 88 = Do not know 99 = No answer [___] CARGO1 3 JUMP ECOMS205A ECOMS204C 2.4.C. Distance in km to the pharmacy? km 88 = Do not know 99 = No answer [___] ECOMS204D 2.4.D. How much time takes in public transportation --- Time? (8888 = NS; 9999 = NR) time in 24-h format 8888 = Do not know 9999 = No answer [__ | __] [__ | __] ECOMs 205A 2.5. A. There is a Dispensary locally? 1 = YES 2 = NO 88 = Do not know 99 = No answer [___ | ___] Count 5 JUMP: response ECOMS205B 2 = No ECOMS205C ECOMs 205B 2.5.b Number of Dispensary 88 = NS, 99 = NR Quantity 88 = Do not know 99 = No answer [___] CARGO1 4 JUMP ECOMS206A ECOMS205C 2.5.C. Distance in km to Dispensary km 88 = Do not know 99 = No answer [___] ECOMS205D 2.5.D. How much time takes in public transportation --- Time? (8888 = NS; 9999 = NR) time in 24-h format 8888 = Do not know 9999 = No answer [__ | __] [__ | __] ECOMs 206A 2.6. A. Exists in the village health center? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] Count 6 JUMP: response ECOMS206B 2 = No ECOMS206C ECOMs 206B 2.6.b Number of Health Center 88 = NS, 99 = NR amount 88 = Do not know 99 = No answer [___] CARGO1 5 SALTO ECOMS207A ECOMS206C 2.6.C. Distance in Km to health center km 88 = Do not know [___] 63 99 = No answer ECOMS206D 2.6.D. How much time takes in public transportation --- Time? (8888 = NS; 9999 = NR) time in 24-h format 8888 = Do not know 9999 = No answer [__ | __] [__ | __] ECOMs 207A 2.7. A exists in the village health post? 1 = 2 = NO 88 = Do not know 99 = No answer [___ | ___] CARGO 7 JUMP: response ECOMS207B 2 = No ECOMS207C ECOMs 207B 2.7.B Number of Health post 88 = NS, 99 = NR Quantity 88 = Do not know 99 = No answer [___] CARGO1 6 JUMP ECOMS208A ECOMS207C 2.7.C. Distance in km to health post km 88 = Do not know 99 = No answer [___] ECOMS207D 2.7.D. How much time takes in public transportation --- Time? (8888 = NS; 9999 = NR) time in 24-h format 8888 = Do not know 9999 = No answer [__ | __] [__ | __] ECOMs 208A 2.8. A. Exist a public hospital in the town? 1 = YES 2 = NO 88 = Do not know 99 = No answer [___ | ___] CARGO 8 JUMP: response ECOMS208B 2 = No ECOMS208C ECOMs 208B 2.8.b Number of public hospital 88 = NS, 99 = NR Quantity 88 = Do not know 99 = No answer [___] CARGO1 7 JUMP ECOMS209A ECOMS208C 2.8.C. Distance in km to public hospital km 88 = Do not know 99 = No answer [___] ECOMS208D 2.8.D. How much time takes in public transportation --- Time? (8888 = NS; 9999 = NR) Time in 24-h format 8888 = Do not know 9999 = No answer [__ | __] [__ | __] ECOMs 209A 2.9. I there other health service locally? 1 = YES 2 = NO 88 = Do not know 99 = No answer [___ | ___] Count 9 JUMP: response ECOMS209B 2 = No ECOMS209C ECOM209Aesp Other health service 2.9A (Specify) ECOMs 209B 2.9.b Number of other health service 88 = NS, Quantity [___] 64 99 = NR 88 = Do not know 99 = No answer CARGO18 JUMP SECTION 3 ECOMS209C 2.9.C. Distance in km's another health service s more close km 88 = Do not know 99 = No answer [___] ECOMS209D 2.9.D. How much time takes in public transportation --- Time? (8888 = NS; 9999 = NR) Time in 24-h format 8888 = Do not know 9999 = No answer [__ | __] [__ | __] SECTION 3 Link next section n VARIABLES NAME QUESTIONS CODES ANSWER Section 3. Health personnel available in the Community ECOMS301A 3.1.A. Number of trained midwives in community (total) [___ | ___] ECOMS301 B 3.1.B. Number of trained midwives present during the visit [___ | ___] ECOMS302A 3.1.A. Number of traditional midwives in the community (total) [___ | ___] ECOMS302B 3.1.B. Number of traditional midwives present during the visit [___ | ___] ECOMs 303A 3.1.A. Number of community facilitators in the community (total) [___ | ___] ECOMs 303B 3.1.B. Number of community facilitators present during the visit [___ | ___] ECOMs 304A 3.1.A. Number of health guardians in the community (total) [___ | ___] ECOMs 304B 3.1.B. Number of health guardians present during the visit [___ | ___] ECOM305 3.5 There are other people working on health issues in the community? [___ | ___] CHARGE 20 JUMP: response ECOMS305A.A 2 = No Section 4 ECOMS305A.A CHARGE 3.5.AA ECOMS305A.B Quantity 3.5.AB [___ | ___] ECOMS305B.A 3.5. BA CHARGE ECOMS305B. B 3.5.b. B. Quantity [___ | ___] ECOMs 305C.A 3.5.c. A. CHARGE ECOMS305C. B 3.5.c. B. Quantity [___ | ___] ECOMs 305D.A 3.5.D. A. CHARGE ECOMS305D. B 3.5.D. B. Quantity [___ | ___] SECTION 4 Link next section n VARIABLES NAME QUESTIONS CODES ANSWER Section 4. Community Participation ECOMS401 4.1.Is there a health committee / 1 = YES [___ | ___] 65 commission of health in the community? 2 = NO 88 = Do not know 99 = No answer ECOMS401 A 4.1.A. How many members in the health commission --- 88 = NS, 99 = NR Number 88 = Do not know 99 = No answer [___ | ___] ECOMS401B 4.1.B. Is in operation? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] ----- 4.1.C. ¿What are the functions of them? TEXT I ECOMS401C 4.1.Ci. Ensure the health of the residents and make health promotion and education 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] Ii ECOMS401C 4.1.C.ii. To ensure a healthy environment? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] ECOMS401Ciii 4.1.C.iii. Proper handling of garbage? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] ECOMS401Civ 4.1.C.iv. Supervise the proper use of health projects and environment? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] ECOMS401Cv 4.1.Cv Ensure a healthy school? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] ECOMS401Cvi 4.1.C.vi. Having a community emergency plan? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] ECOMS401Cvii 4.1.C.vii. Report on the health of the community? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] ECOMS401Cviii 4.1.C.viii. Managing health projects? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] ECOMS401Cix 4.1.C.ix. Identify where to go in an emergency? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] ECOMS401Cx 4.1.Cx Manage resources to authorities? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] ECOMS401Cxi 4.1.C.xi. Collaborate in the Organization of the community? 1 = yes 2 = NO [___ | ___] 66 88 = Do not know 99 = No answer 41Cxii 4.1.C.xii. Other? Specify ECOMS402 4.2. The community has a health community plan? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] CARGO19 JUMP: response 2, 88.99 = NO RECORD ---- its information passing knowledge survey. ECOMS402A 4.2.A. The health commission is providing Community Emergency plans? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] ECOMS402B 4.2.B. Health commission has established links do with the health service more s nearby? 1 = yes 2 = NO 88 = Do not know 99 = No answer [___ | ___] 67 Convergence Center Surveys # QUESTION RESPONSE CODES CODCC Convergence Center Code [__ | __ | __ | __] CCMI01 1. # OF SURVEY [__ | __ | __ | __ | __ | __] CCMI02 2. SUPERVISOR CODE [__ | __] CCMI03 3. EDITOR CODE [__ | __] CCMI04 4. INTERVIEWER CODE [__ | __] CCMI0 5 5. CC municipality location [__ | ___] [___ | ___] CCMI0 6 6. CC community location [___ | ___] [___ | ___] [___ | ___ | ___] CCMI0 7 7. CC NGO responsible for? [___] CCMI08 8. CC jurisdiction location [__ | __ | __] Interview information VISIT NUMBER A. 1st B. 2nd C. 3rd CC MI09 9. DATE OF INTERVIEW [__ | __] [__ | __] [__ | __] [__ | __] [__ | __] [__ | __] month day month day month day CC MI10 10. START TIME OF THE VISIT (24 hour format) [__: __] [__: __] [__: __] Hour Min Hour Min Hour Min CC MI11 11. The survey was carried out at the same day that the CC is open for medical assistance? 1 = Yes 2 = No [___] CC MI12 12. Where the survey was done? 1 = CC, 2 = CF House, 3 = HG House, 4 = Other place [___] CC MI13 1 3. INTERVIEWER INTRODUCE IT SELF AND ASK FOR ACCEPTANCE TO ASK RHE QUESTIONS 1 = Accepts answer questions--------NEXT QUESTION 2 = Not accept answer questions ( interviewee not want to answer the questions). You cannot continue the interview in this case, talk to your supervisor. [___] SECTION 1 QUESTION CODE QUESTIONS CODES ANSWER CCS101 1. Name of Informant, - Must be Community Facilitator –CF￾CCS102 2. ¿What other people is present in the survey? CCS102A 2a) Record name CCS102B 2b) Record Charge 1 = Community Facilitator 2 = Ambulatory Nurse 3 = Ambulatory Doctor 4 = institutional Facilitator 5 = Midwife 6 = Other ---- 2b1 [___] CCS102B1 2b.1) Other specify CCS102C 2c) Record Name 68 CCS102D 2d) Record charge 1 = Community Facilitator 2 = Ambulatory Nurse 3 = Ambulatory Doctor 4 = institutional Facilitator 5 = Midwife 6 = Other ------- 2d1 [___] CCS102D1 2d.1) other Specify CCS102E 2e) Record Name CCS102F 2f) Record charge 1 = Community Facilitator 2 = Ambulatory Nurse 3 = Ambulatory Doctor 4 = institutional Facilitator 5 = Midwife 6 = Other -------- 2f1 [___] CCS102F1 2f.1) other Specify SECTION 2 Now I'd like to ask some questions related as people working here and the services they offer. Table 1. Personnel serving in the Convergence Center QUESTION CODE QUESTIONS CODES ANSWER CCS201 1. Does the convergence center have an ambulatory doctor? 1 = Yes 2 = Yes, and is present 3 = No 3 [___] CCS202 2. What is the name of? CCS203 3. Does the convergence center have an ambulatory nurse? 1 = Yes 2 = Yes, and it is present 3 =No 5 [___] CCS204 4. What is the name of? CCS205 5. Does the convergence center have an institutional facilitator? 1 = Yes 2 = Yes, and it is present 3 = No [___] CCS206 6. Does the convergence center have technicians? 1 = Yes 2 = Yes, and this present 3 =No 8 [___] CCS207 7. How many technicians have? [__ | __] QUESTION CODE QUESTIONS NUMBER (TOTAL) Number (present during the visit) CCS208 8. How many educators have the convergence center? [__ | __] [__ | __] CCS209 9. How many trained midwives have the convergence center? [__ | __] [__ | __] CCS210 10. How many traditional midwives have the convergence center? [__ | __] [__ | __] CCS211 11. How many community facilitators have the convergence center? [__ | __] [__ | __] CCS212 12. How many Health Guardians have convergence center? [__ | __] [__ | __] CCS213 13. Do you have a commission of health at the center of convergence? 1 = Yes 2 = No 15 [____] 69 CCS214 14. Record how many members at the health commissions [__ | __] [__ | __] CCS215 15. Are there other people who work in the center of convergence? 1 = Yes 2 = No Table 2 [____] QUESTION CODE CHARGE NUMBER (TOTAL) Number (present during the visit) CCS215A 15a. [__ | __] [__ | __] CCS215B 15b. [__ | __] [__ | __] CCS215C 15c. [__ | __] [__ | __] CCS215D 15d. [__ | __] [__ | __] CCS215E 15e. [__ | __] [__ | __] Section 3 Ask the community facilitator that this information is to complete the following questions (note): Table 2 Equipment available in the Convergence Center The CC have the following equipment and materials: QUESTION CODE QUESTIONS CODES ANSWER CCS301 1. Is there a person in charge of measuring the weight of children? 1 = Yes 2 = No 4 [____] CCS302 2. Record Name CCS303 3. Record charge 1 = Community Facilitator 2 = Educator 3 = Ambulatory Nurse 4 = Ambulatory Doctor 5 = Institutional Facilitator 6 = Other (ESP) 3A [____] CCS303A 3A. Specify other CCS304 4. Is there a person in charge of measuring the size of children? 1 = Yes 2 = No 7 [____] CCS305 5. Record Name CCS306 6. Record charge 1 = Community Facilitator 2 = Educator 3 = Ambulatory Nurse 4 = Ambulatory Doctor 5 = Institutional Facilitator 6 = Other (ESP) 6A [____] CCS306A 6A. Specify other CCS307 7. How many floor scales are used for weighing adults? IF NO RECORD 0 and move to the P9. Record the # of units [____] CCS30 7A 7A. It was observed 1 = Yes 2 = yes (BHT bring in to) 3 = No SKIP TO Q9 4 = not (BHT bring in to) SKIP TO Q9 [____] 8. Observe the status of each (evaluate up to four units ) CCS3081 Unit 1 G = Good F = Fair C = Poor [____] CCS3082 Unit 2 G = Good F = Fair C = [____] 70 Poor CCS3083 Unit 3 G = Good F = Fair C = Poor [____] CCS3084 Unit 4 G = Good F = Fair C = Poor [____] CCS309 9. How many hanging scales are used to weigh children? IF NO RECORD 0 and move to the Q11. Record the # of units [____] CCS309A 9A. It was observed 1 = Yes 2 = yes (BHT bring in to) 3 = No Go to Q12 4 = not (BHT bring in to) SKIP TO Q12 [____] 10. Note the status of each (evaluate up to four units) GO TO P12 CCS3101 Unit 1 G = Good F = Fair C = Poor [____] CCS3102 Unit 2 G = Good F = Fair C = Poor [____] CCS3103 Unit 3 G = Good F = Fair C = Poor [____] CCS3104 Unit 4 G = Good F = Fair C = Poor [____] CCS311 11. If there is no weighing scale for children, Do you weigh with mother´s weighing scale? 1 = Yes 2 = No 8 = Do not know [____] CCS312 12. How many special scales for new born are there? (Show PHOTO) IF NO RECORD 0 and move to the Q14. Record the # of units [____] CCS312A 12A. It was observed 1 = Yes 2 = yes (BHT bring in to) 3 = No Go to Q14 4 = not (BHT bring in to) SKIP TO Q14 [____] 13. Observe the status of each (evaluate up to four units ) G works, in good condition, F: It works but is in disrepair. C: It does not work, bad. CCS3131 Unit 1 G = Good F = Fair C = Poor [____] CCS3132 Unit 2 G = Good F = Fair C = Poor [____] CCS3133 Unit 3 G = Good F = Fair C = Poor [____] CCS3134 Unit 4 G = Good F = Fair C = Poor [____] CCS314 14. How many height board (fixed) are used to measure adults? IF NO RECORD 0 and move to the Q16. Record # of units [____] CCS314A 14A. It was observed 1 = Yes 2 = If (run the EBS) 3 = No Go to Q16 4 = not (BHT bring in to) GO TO Q16 [____] 15. Observe the status of each (evaluate up to four units) CCS3151 Unit 1 G = Good F = Fair C = [____] 71 Poor CCS3152 Unit 2 G = Good F = Fair C = Poor [____] CCS3153 Unit 3 G = Good F = Fair C = Poor [____] CCS3154 Unit 4 G = Good F = Fair C = Poor [____] CCS316 16. How many Portable height boards are used to measure children lying and standing? IF NO RECORD 0 and move to the Q18. Record # of units [____] CCS316A 16A. It was observed 1 = Yes 2 = If (BHT bring in to) 3 = No Go to Q18 4 = not (BHT bring in to) GO TO Q18 [____] 17. Observe the status of each (evaluate up to four units) CCS3171 Unit 1 G = Good F = Fair C = Poor [____] CCS3172 Unit 2 G = Good F = Fair C = Poor [____] CCS3173 Unit 3 G = Good F = Fair C = Poor [____] CCS3174 Unit 4 G = Good F = Fair C = Poor [____] CCS318 18. How many tailor meters usable are there? IF NO RECORD 0 AND GO TO Q 20 Record # of units [____] CCS319 19. For what use these meters? CCS319 01 19.1. Measure size of baby 1 = Yes 2 = No 8 = Do not know [____] CCS319 02 19.2. Measure uterine height of pregnant mothers 1 = Yes 2 = No 8 = Do not know [____] CCS319 03 19.3. Measure arm circumference of children 1 = Yes 2 = No 8 = Do not know [____] CCS319 04 19.4. Other (specify) 1 = Yes 2 = No 8 = Do not know [____] CCS320 20. Is there blood pressure monitor? Show PHOTO IF NO RECORD 0 Record # of units [____] CCS321 21. How many Thermometers are there? IF NO RECORD 0 Record # of units [___] CCS322 22. How many stethoscopes are there? IF NO RECORD 0 Record # of units [___] CCS323 23. How many laryngoscopes, to examine the ears, nose and throat? SHOW PHOTO IF NO RECORD 0 Record # of units [___] CCS324 24. How many brachial tapes (Shakir) are there? Show IF NO RECORD 0 Record # of units [___] CCS325 25 Is there a clean delivery kit (in good condition) like this? (Show PHOTO or KIT) 1. yes 2. No 8. Do not know [___] 26. What does midwife use to cut the umbilical cord during labor? NOTE ALL THE ANSWERS. Check the boxes of the answers. DO NOT READ OPTIONS. 72 IF a midwife is present, verify response. How to codes: 1 = Yes 2 = No mentions 8 = Do not know CCS3 2601 1 = new razor blade, without boiling 1 = Yes 2 = No 8 = Do not know [____] CCS3 2602 2 = new razor blade and boiled 1 = Yes 2 = No 8 = Do not know [____] CCS3 2603 3 = Razor blade used, without boiling 1 = Yes 2 = No 8 = Do not know [____] CCS3 2604 4 = Razor blade used and boiled 1 = Yes 2 = No 8 = Do not know [____] CCS3 2605 5 = new Scissors 1 = Yes 2 = No 8 = Do not know [____] CCS3 2606 6 = new and boiled Scissors 1 = Yes 2 = No 8 = Do not know [____] CCS3 2607 7 = Scissors used 1 = Yes 2 = No 8 = Do not know [____] CCS3 2608 8 = Scissors used and boiled 1 = Yes 2 = No 8 = Do not know [____] CCS3 2609 9 = Knife 1 = Yes 2 = No 8 = Do not know [____] CCS3 2610 10 = reed 1 = Yes 2 = No 8 = Do not know [____] CCS3 2611 11 = unboiled scalpel 1 = Yes 2 = No 8 = Do not know [____] CCS3 2612 12 = boiled scalpel 1 = Yes 2 = No 8 = Do not know [____] CCS3 2697 97 = Other (especify) 1 = Yes ---26A 2 = No 8 = Do not know [____] CCS3 2698 98 = Do not know / no answer 1 = Yes 2 = No 8 = Do not know [____] 26A CCS3 26A. Specify other CCS327 27. Do you have a register to control the delivery of medicine? ASK IF YOU CAN SEE. 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = If in charge of BHT, unverified 5 = No 8 = Do not know [____] CCS328 28. Is there a person in charge of registering the distribution of micronutrients? 1 = Yes 2 = No 30 8 = Do not know 30 [____] CCS329 29. Do you know who is it? 1 = IF 2 = AN/AD 3 = CF 4 = Educator 5 = Other (specify) --- 29A [____] CCS329A 29A. Specify other CCS330 30. Is there a person in charge of registering the distribution of the vaccines? 1 = Yes 2 = No -----32 8 = Do not know 32 [____] 73 CCS331 31. Do you know who is it? 1 = IF 2 = AN/AD 3 = CF 4 = Educator 5 = Other (specify ) --- 31A [____] CCS331A 31A. Specify other 32. ¿What vaccines are available on the day of consultation with BHT? NOTE ALL THE ANSWERS. Check the boxes of the answers. READ NO OPTIONS CCS3 321 1. BCG 1 = Yes 2 = No [____] CCS3 322 2. Polio 1 = Yes 2 = No [____] CCS3 323 3. Penta 1 = Yes 2 = No [____] CCS3 324 4. DPT 1 = Yes 2 = No [____] CCS3 325 5. Viral or 3 SPR 1 = Yes 2 = No [____] CCS3 326 6. TDA 1 = Yes 2 = No [____] CCS3 33 33. Do you have disposable syringes for vaccination? (On the day of vaccination) 1 = Yes 35 2 = No [____] CCS3 34 34. How do you to apply vaccines then? _________________________ response, record CCS3 35 35. Is there a record of doses and vaccines coverage (shots)? ASK IF YOU CAN SEE. 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [____] CCS3 36 36. Is there a record of doses and micronutrient coverage? ASK IF YOU CAN SEE. 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [____] CCS3 37 37. Does the record of entries and outputs of micronutrients accessible? ASK IF YOU CAN SEE. 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know 1 = Yes, it loads the FC 2 = Yes, it loads the FC, unverified 3 = Yes, it loads the EBS 4 = If it loads the EBS, unverified [____] 74 5 = No 8 = Do not know CCS3 38 38. Is there a record of doses applied and micronutrient coverage? ASK IF YOU CAN SEE. 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [____] CCS3 39 39. Is there a record of growth monitoring at convergence center level? (Ex CF notebook) ASK IF YOU CAN SEE. 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [____] CCS3 40 40. Are there vaccination card, new, unused? 1 = yes 2 = No 3 = in charge of BHT 8 = Do not know [____] CCS3 41 41. Are there record forms for pregnant women, new unused? 1 = yes 2 = No 3 = in charge of BHT 8 = Do not know [____] CCS3 42 42. Are there record forms of IMCI / AINM-C, new unused? 1 = yes 2 = No 3 = in charge of BHT 8 = Do not know [____] CCS3 43 43. Are there record forms for children, new unused? 1 = yes 2 = No 3 = in charge of BHT 8 = Do not know [____] 44. Do you have promotional posters? RECORD THOSE CCS3 441 1. Exclusive breastfeeding 1 = Yes, remain in the CC 2 = Yes, in charge of BHT 3 = No 8 = Do not know [____] CCS3 442 2. Pregnancy warning signals (symptoms) 1 = Yes, remain in the CC 2 = Yes, in charge of BHT 3 = No 8 = Do not know [____] CCS3 443 3. New born warning signals (symptoms) 1 = Yes, remain in the CC 2 = Yes, in charge of BHT 3 = No [____] 75 8 = Do not know CCS3 444 4. Warning signs of under 5 years childhood illness 1 = Yes, remain in the CC 2 = Yes, in charge of BHT 3 = No 8 = Do not know [____] CCS3 445 5. Vaccination 1 = Yes, remain in the CC 2 = Yes, in charge of BHT 3 = No 8 = Do not know [____] CCS3 446 6. Vitacereal 1 = Yes, remain in the CC 2 = Yes, in charge of BHT 3 = No 8 = Do not know [____] CCS3 447 7.Other 1 = Yes, remain in the CC 2 = Yes, in charge of BHT 3 = No 8 = Do not know [____] 44A CCS3 44A. Specify other Section 4 Are there at convergence center (these conditions are related with time of visit) some of these medicines and materials? Always request to view If consultation day, always request to view, but taking into account that should not interfere with services provision, or with AN / AD activities. Table 3 Convergence Center Inventory of medicines QUESTION CODE QUESTIONS CODES ANSWER CCS 401 1. Is there soap: Liquid or bar? 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 402 2. Is there disinfectants to clean wounds? 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 403 3. Do you have clean water (use cleaning patients, 1 = Yes, in charge of CF [___] 76 such as wounds, taking medications, etc.)? 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know CCS 404 4. ORS sachets 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 405 5. Amoxicillin or ampicillin: pills , capsules, syrup 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 406 6. trimethoprim-sulfamethoxazole: pills , capsules, syrup 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 407 7. Ophthalmic Antibiotic: Dropper 15 ml 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 408 8. Penicillin (procaine, benzathine) 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know 3 = Yes, in charge of BHT [___] CCS 409 9. Erythromycin 1 = Yes, it loads the FC [___] 77 2 = Yes, it loads the FC, unverified 3 = Yes, it loads the EBS 4 = If it loads the EBS, unverified 5 = No 8 = Do not know CCS 410 10. Azithromycin 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 411 11. Malaria tablets recommended (Chloroquine or Primaquine) 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 412 12. albendazole / mebendazole / piperazine: pills, syrup 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 413 13. Paracetamol / aspirin / / Ibuprofen / diclofenac: pills, syrup 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 414 14. Vitamin A 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 415 15. Iron / Ferrous Sulfate: pills, syrup 1 = Yes, in charge of CF 2 = Yes, in charge of [___] 78 CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know CCS 416 16. Folic acid: pills 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 417 17. prenatal supplements 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 418 18. Zinc pills 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 419 19. Chispitas nutritional 1 = Yes, in charge of CF 2 = Yes, in charge of CF, unverified 3 = Yes, in charge of BHT 4 = Yes, in charge of BHT, unverified 5 = No 8 = Do not know [___] CCS 420 20. Benzoate Bencillo solution bottles solution [___] CCS 421 21. Epinephrine 1 = Yes, it loads the FC 2 = Yes, it loads the FC, unverified 3 = Yes, it loads the EBS 4 = If it loads the EBS, unverified 5 = No 8 = Do not know [___] CCS 422 22. Metronidazole tablets or syrup solution [___] CCS 423 23. Feature IVs (for cases of severe dehydration). 1 = Yes, it loads the FC [___] 79 2 = Yes, it loads the FC, unverified 3 = Yes, it loads the EBS 4 = If it loads the EBS, unverified 5 = No 8 = Do not know CCS 424 24. Are there vaccines at CC? (If the BHT handles vaccines, mark NO) 1 = YES 25 2 = No 30 8 = Do not know 30 [___] CCS 425 25. Vaccine BCG 1 = yes 2 = No 3 = yes (unverified) 8 = Do not know [___] CCS 426 26. Vaccine OPV / Polio 1 = yes 2 = No 3 = yes (unverified) 8 = Do not know [___] CCS 427 27. Vaccine DPT / Pentavalent 1 = yes 2 = No 3 = yes (unverified) 8 = Do not know [___] CCS 428 28. Vaccine SPR / 3 viral 1 = yes 2 = No 3 = yes (unverified) 8 = Do not know [___] CCS 429 29. Vaccine TT 1 = yes 2 = No 3 = yes (unverified) 8 = Do not know [___] CCS 430 30. other drugs used in women and children under 5 years? 1 = yes 2 = No Table 4 [___] CCS 431 31. Specify other Section 5 Table 4 Administration (These questions are related with the time of the visit) QUESTION CODE QUESTIONS CODES ANSWER CCS501 1. This month how many days remain opened the CC for consultation with BHT? 1 = one day per month 2 = 2 days per month 3 = 3 days per month 4 = 4 days per month 6 = more than four days per month 7 = Other (specify) - 1A 8 = Do not know / cannot remember 9 = No answer [___] CCS501A 1a. Specify other CCS502 2. How many children under 6 months receive medical attention per month with BHT? [__ | __ | __] 80 CCS503 3. How many children between 6 months and 2 year receive monthly medical attention per month with BHT? [__ | __ | __] CCS504 4. How many pregnant and lactating women receive monthly medical attention with BHT? [__ | __ | __] CCS505 5. How many home visits does the BHT per month? Record number of visits [____] CCS506 6. How many days this month remain opened CC for attention (with the CF)? 1 = Once a month 2 = 2 -4 times a month 3 = 5 - 10 times per month 4 = 10 times per month 6 = always (in the house / HR) 7 =Other---- 6A 8 = Do not know / can not remember 9 = No answer [___] CCS506A 6A. Specify other CCS507 7. How many home visits does the CF per month? REcord number of visits [____] CCS508 8. How many children under 6 months receive health services per month with CF? [__ | __ | __] CCS509 9. How many children between 6 months and 2 year receive health services per month with CF? [__ | __ | __] CCS510 10. How many pregnant and lactating women receive health services per month with CF? [__ | __ | __] CCS511 11. Does CC have own transport, to move any emergency? 1. yes 2. No--- P14 [__] CCS512 12. Where is located the CC's own transport? 1 = In the parking lot of cc (always) P15 2 = CF Home 3 = Other (specify) -- 12A 8 = Do not know [__] CCS512A 12A. Specify other CCS513. 13. What distance of CC is parked? Distance: [________] CCS513A 13A. Measurement unit: (SKIP TO Q15) 1. Meters 2. Kilometers [__] CCS514 14. In case of not having transportation, What is the distance to the particular nearby vehicle who may carry emergency? Distance: [__ | __ | __] CCS514A 14A. Unit of measure: 1. Meters 2. Kilometers [__] CCS515 15. Does the convergence center have an emergency fund for the emergency transportation? 1 = yes 2 = No 8 = Do not know [___] 16. Severe cases, women in emergency situation of pregnancy, childbirth and postpartum. Where does the BHT refer normally? CCS516 1 1 = Health Center 1 = Yes 2 = No [___] CCS516 2 2 = Health Post 1 = Yes 2 = No [___] CCS516 3 3 = public hospital 1 = Yes 2 = No [___] CCS516 4 4 = Clinic or private hospital 1 = Yes 2 = No [___] CCS516 5 5 = Clinic of the church 1 = Yes 2 = No [___] 81 CCS516 6 6 = Do not refer 1 = Yes 2 = No [___] CCS516 7 7 = Other, specify 1 = Yes 2 = No ---16A [___] CCS516 9 9 = Do not know / can not remember 1 = Yes 2 = No [___] CCS516 A 16A. Specify other 17. Severe cases, women in emergency situation of pregnancy, childbirth and postpartum. Where does the CF refer normally? CCS51 71 1 = Health Center 1 = Yes 2 = No [___] CCS51 72 2 = Health Post 1 = Yes 2 = No [___] CCS51 73 3 = public hospital 1 = Yes 2 = No [___] CCS51 74 4 = Clinic or private hospital 1 = Yes 2 = No [___] CCS51 75 5 = Clinic of the church 1 = Yes 2 = No [___] CCS51 76 6 = Do not refer 1 = Yes 2 = No [___] CCS51 77 7 = Other, specify 1 = Yes----17 A 2 = No [___] CCS51 79 9 = Do not know / can not remember 1 = Yes 2 = No [___] CCS51 7A 17A. Specify other CCS518 [___] CCS519 19. In severe cases, to transport the sick woman. How long it takes the transportation? (Ask this question to more place mentioned in questions 16 and 17) Amount [___ | ___] CCS519A 19A. Measurement unit 1 = Minutes 2 = hours [___] 20. Severe cases, emergencies of children. Where the BHT usually referred to? 201 CCS5 1 = Health Center 1 = Yes 2 = No [___] CCS5 202 2 = Health Post 1 = Yes 2 = No [___] CCS5 203 3 = public hospital 1 = Yes 2 = No [___] CCS5 204 4 = Clinic or private hospital 1 = Yes 2 = No [___] CCS5 205 5 = Clinic of the church 1 = Yes 2 = No [___] CCS5 206 6 = Do not refer 1 = Yes 2 = No [___] CCS5 207 7 = Other, specify 1 = Yes 2 = No ---20A [___] CCS5 209 9 = Do not know / can not remember 1 = Yes 2 = No [___] 20A CCS5 20A. Specify other 21. Severe cases, emergencies of children. Where the CF usually referred to? CCS5 211 1 = Health Center 1 = Yes 2 = No [___] CCS5 212 2 = Health Post 1 = Yes 2 = No [___] CCS5 213 3 = public hospital 1 = Yes 2 = No [___] CCS5 214 4 = Clinic or private hospital 1 = Yes 2 = No [___] CCS5 215 5 = Clinic of the church 1 = Yes 2 = No [___] CCS5 216 6 = Do not refer 1 = Yes 2 = No [___] CCS5 217 7 = Other, specify 1 = yes ---21 A 2 = No [___] CCS5 219 9 = Do not know / can not remember 1 = Yes 2 = No [___] 21A CCS5 21A. Specify other 1 = Yes 2 = No CCS522 22. In 10 cases of severe children referrals, Do you know how many of them parents accept the transfer ? [___] CCS523 23. In severe cases, to transfer a child. How long it takes the transportation? (Ask this question for more places mentioned in questions 16 and 17) Amount [___ | ___] CCS523A 23A. Unit of measure: 1 = Minutes 2 = hours CCS524 24. Do they wash medical equipment in the center of convergence? 1 = Yes [___] 82 3 = P27 25. During washing medical equipment, What protection uses the person in charge? DO NOT READ OPTIONS. Check the boxes MENTIONING How to codes: 1 = It mentioned 2 = Not mentioned CCS5251 1 = Service Heavy gloves 1 = Yes 2 = No [___] CCS5252 2 = thin disposable gloves (surgical) 1 = Yes 2 = No [___] CCS5253 3 = plastic apron 1 = Yes 2 = No [___] CCS5257 7 = Other (specify) 1 = yes -- 25 A 2 = No [___] CCS525A 25A. Specify other What uses the person in charge to wash this : _______? Read the three response options READ OPTIONS Check the boxes MENTIONING How to codes: 1 = It mentioned 2 = Not mentioned CCS5261 1 = Running Water 1 = Yes 2 = No [___] CCS5262 2 = Soap or detergent 1 = Yes 2 = No [___] CCS5263 3 = Brush 1 = Yes 2 = No [___] CCS5267 7 = Other (specify) 1 = yes --- 26 A 2 = No [___] CCS526A 26A. Specify other CCS527 27. Where is located the center of convergence? 1 = Building with environments defined 2 = Local inside a building 3 = room inside a house 4 = Other (specify) -- 27 A [___] CCS527A 27A. Specify other CCS528 28. The space allocated to the center of convergence (see previous question) A Is assigned exclusively for that purpose, or shared? 1 = use only for CC (no other activities in ) 2 = Sharing 8 = Do not know [___] CCS529 29.  Does the CC is within the field / the house / the FC? 1 = yes 2 = No [___] OBSERVED DURING THE VISIT, NOT ASK QUESTIONS CCS530 30. How many bedrooms have CC? [___ | ___] CCS531 31. Does the convergence center have access to a toilet? 1 = yes 2 = No P35 [___] CCS532 32. Does the toilet is for the exclusive use of the center of convergence? 1 = Exclusive 2 = Shared 8 = Do not know [___] CCS533 33. What type of toilet is? 1 = toilet washable 2 = latrine washable 3 = traditional latrine 4 = other, ----33A [___] CCS533A 33A. Specify other CCS534 34. The toilet is working? 1 = yes 2 = No 8 = Do not know [___] CCS535 35. Lighted and ventilated physical space 1 = yes 2 = No 8 = Do not know [___] 83 36. The physical space of the front desk service is adequate: CCS536 A 1 = no desk / table 1 = Yes 2 = No 3 = Does not exist [___] CCS536 B 2 = chair 1 = Yes 2 = No 3 = Does not exist [___] 37. Archive space is suitable CCS537 A 1 = no desk / table 1 = Yes 2 = No 3 = Does not exist [___] CCS537 B 2 = chair 1 = Yes 2 = No 3 = Does not exist [___] CCS537 C 3 = File 1 = Yes 2 = No 3 = Does not exist [___] CCS538 38. The area of attention and procedures have furniture equipment in proper condition for use? 1 = yes 2 = No 8 = Do not know [___] CCS539 39. The Education area for health is adequate 1 = yes 2 = No 3 = Does not exist 8 = Do not know [___] CCS540 40. Are there disposable gloves? MUST BE IN CC SHOULD NOT BE TAKEN BY CF 1 = yes 2 = No 8 = Do not know [___] CCS541 41. Is there cotton? 1 = yes 2 = No 8 = Do not know [___] CCS542 42. Do you have a refrigerator that works? 1 = yes 2 = No 8 = Do not know [___] CCS543 43. Do you have thermo and ice for vaccines? 1 = yes 2 = No 8 = Do not know [___] CCS544 44. Do you have electricity? 1 = yes 2 = No 8 = Do not know [___] CCS545 45. Do you have kitchen? 1 = yes 2 = No 8 = Do not know [___] CCS546 46. Do you have gas stove? 1 = yes 2 = No 8 = Do not know [___] CCS547 47. The convergence center floor is: 1 = brick, ceramic, lozeta, granite 2 = Iron cement / concrete 3 = Earth compacted 4 = Loose Soil 5 = Other (specify) -- 47A 8 = Do not know [___] CCS547A 47A. Specify other 48. Is there is running water: CCS5481 1. Sinks 1 = yes 2 = No 3 = Does not exist 6 = Not able to observe [___] CCS5482 2. The sinks / dishwasher 1 = yes 2 = No 3 = Does not exist 6 = Not able to observe [___] CCS5483 3. Stack (laundry) 1 = yes 2 = No 3 = Does not exist 6 = Not able to observe [___] 84 CCS5484 4. Discharges from toilets 1 = yes 2 = No 3 = Does not exist 6 = Not able to observe [___] CCS5485 5. Other (specify) 1 = yes ---48A 2 = No [___] CCS548A 48A. Specify other Do the following areas are free of dust, dirt or contaminated For solid waste? CCS54901 1. External area 1 = yes is clean 2 = Not clean 3 = Does not exist area 6 = Unable to observe [___] CCS54902 2. Admission and Waiting Room 1 = yes is clean 2 = Not clean 3 = Does not exist area 6 = Unable to observe [___] CCS54903 3. Corridor 1 = yes is clean 2 = Not clean 3 = Does not exist corridor 6 = Unable to observe [___] CCS54904 4. Clinics / clinic, procedures area 1 = yes is clean 2 = Not clean 3 = Does not exist area 6 = Unable to observe [___] CCS54905 5. Exam table / stretcher 1 = yes is clean 2 = Not clean 3 = Does not exist area 6 = Unable to observe [___] CCS54906 6. Pharmacy / drug shelf 1 = yes is clean 2 = Not clean 3 = Does not exist area 6 = Unable to observe [___] CCS54907 7. Health Services 1 = yes is clean 2 = Not clean 3 = Does not exist area 6 = Unable to observe [___] CCS54908 8. Kitchen 1 = SA is clean 2 = Not clean 3 = No such à rea 6 = Unable to observe [___] CCS54909 9. Cleaning kit area 1 = yes is clean 2 = Not clean 3 = Does not exist area 6 = Unable to observe [___] CCS54910 10. Another area (specify) 1 = yes ----49A 2 = No--- 50 [___] CCS549A 49A. Specify other CCS549B 49B. Specify the status of another area 1 = yes is clean [___] 85 2 = Not clean 6 = Unable to observe 50. How to collect slightly hazardous waste? Do not read options, mark all that apply. How to codes: 1 = it mentioned 2 = Not mentioned CCS5501 1. In separate bag or container with different color than normal waste or bio hazardous waste 1 = Yes 2 = No [___] CCS5502 2. In separate bag or container, together with the highly hazardous waste 1 = Yes 2 = No [___] CCS5503 3. Bag or container in conjunction with regular trash 1 = Yes 2 = No [___] CCS5504 4. Other (specify): 1 = Yes 2 = No --- 50A [___] CCS550A 50A. Specify other 51. What used to collect medical highly dangerous waste? MARK ALL THAT APPLY (skip all the items marked with 1) CCS5511 1 = plastic bottle 1 = Yes--- P52 2 = No 8 = Do not know [___] CCS5512 2 = Carton Box 1 = Yes ---P53 2 = No 8 = Do not know [___] CCS5513 3 = closed plastic container with a small hole for disposal syringes with needles 1 = Yes ---P54 2 = No 8 = Do not know [___] CCS5514 4 = Guard 1 = Yes ---P55 2 = No 8 = Do not know [___] CCS5515 5 = Other (specify) 1 = Yes ---P56 2 = No 8 = Do not know [___] 52. If Answering “YES” for plastic bottle : CCS552A A. Are there in the following places? CCS552A1 1. Area of cures 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS552A2 2. injections and vaccines area 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS552A3 3. dry place nearby to procedures area 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS552B B. What is their status? B = good R = regular M = bad [___] 53. If Answering “YES” for carton box: CCS553A A. Are there in the following places? CCS553A1 1. Area of cures 1 = yes 2 = No [___] 86 3 = Not able to observe 4 = Does not exist CCS553A2 2. injections and vaccines area 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS553A3 3. dry place nearby to procedures area 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS553B B.What is their status? B = good R = regular M = bad [___] 54. If answering “YES” for plastic container: CCS554A A. Are there in the following places? CCS554A1 1. Area of cures 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS554A2 2. injections and vaccines area 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS554A3 3. dry place nearby to procedures area 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS554B What is their status? B = good R = regular M = bad [___] 55. If you answer “YES” for a Guard CCS555A A. Are there in the following places? CCS555A1 1. Area of cures 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS555A2 2. injections and vaccines area 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS555A3 3. dry place nearby to procedures area 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS555B B. What is their status? B = good [___] 87 R = regular M = bad 56. If you answer YES to other CCS556X 56X. Specify other CCS556A A. Are there in the following places? CCS556A1 1. Area of cures 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS556A2 2. injections and vaccines area 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS556A3 3. dry place nearby to procedures area 1 = yes 2 = No 3 = Not able to observe 4 = Does not exist [___] CCS556B B. What is your status B = good R = regular M = bad [___] CCS557 57. Do you prepare and use Antiseptics for cleaning and sanitizing medical utensils at the center of convergence? 1 = yes 2 = No 3 = not prepared Antiseptics (use alcohol) P60 8 = do not P60 [___] CCS558 58. Antiseptics are prepared in small containers , closed and reusable for everyday 1 = yes 2 = No 8 = Do not know [___] CCS559 59. Reusable containers to prepare Antiseptics are washed with soap and water, dried and made prior washing with the solution to use before refill them with the solution n Antiseptic? 1 = yes 2 = No 8 = Do not know [___] See if the following conditions apply: CCS560 60. Are There general waste container with a plastic bag in the areas of reception, waiting and corridors 1. yes 2. No [___] CCS561 61. The cotton gauze are stored inside special containers 1. yes 2. No [___] CCS562 62. Auxiliary forceps, thermometers, catheter or other instruments are stored in containers with antiseptic solutions? 1. yes 2. No [___] CCS563 63. Is there pot autoclave (for sterilizing pot)? 1 = yes 2. No Table 5 [___] CCS564 64. What type of autoclave have? 1 = Pot autoclave (with Manometer) 2 = pressure pot 3 = electric Autoclave 4 = Other (specify) --- 64A [___] 88 8 = Do not know CCS564A 64A. Specify other 65. Check if the pot autoclave: CCS5651 1. It is clean 1 = Yes 2. No 3 = does not exist 6 = Not able to observe 7 = Other, ---1A [___] CCS5651A 1A. Specify other CCS5652 2. Manometer is working 1 = Yes 2. No 3 = does not exist 6 = Not able to observe 7 = Other, ---2A [___] CCS5652A 2A. Specify other CCS5653 3. The electricity source works (if included) 1 = Yes 2. No 3 = does not exist 6 = Not able to observe 7 = Other, ----3A [___] CCS5653A 3A. Specify other CCS5654 4. Autoclaving tape used 1 = Yes 2. No 3 = does not exist 6 = Not able to observe 7 = Other, ----4A [___] CCS5654A 4A. Specify other CCS5655 5. The person responsible, knows how to use properly the autoclave 1 = yes 2. No 3 = Does not exist 6 = Not able to observe 7 = Other, ----5A [___] CCS5655A 5A. Specify other Section 6 Table 5 Health services provided QUESTION CODE QUESTIONS CODES ANSWER I. Integral Women assistance 1. ¿What are the services or care for a woman during her prenatal care in the CC offered by the BHT? Mention and record 1 = Yes, 2 = No. CCS60101 1. Prenatal 1 = Yes 2 = No [____] CCS60102 2. Complete physical exam 1 = Yes 2 = No [____] CCS60103 3. Weight monitoring 1 = Yes 2 = No [____] 89 CCS60104 4. Application of TDA scheme 1 = Yes 2 = No [____] CCS60105 5. micronutrients: ferrous sulfate tablets, folic acid 1 = Yes 2 = No [____] ¿What are the services or care for a woman during her prenatal care in the CC for the CF? Inquire (not to mention). Record: 1 = mentioned 2 = not mentioned CCS60201 1. Weight Monitoring 1 = Yes 2 = No [____] CCS60202 2. Promotion of exclusive breastfeeding 1 = Yes 2 = No [____] CCS60203 3. AINM-C-IMCI protocols 1 = Yes 2 = No [____] CCS60204 4. Signals of danger and reference 1 = Yes 2 = No [____] CCS60205 5. Explain to the woman the findings of medical history and obstetric exam. 1 = Yes 2 = No [____] CCS60206 6. Nutrition counseling 1 = Yes 2 = No [____] CCS60207 7. Hygiene counseling 1 = Yes 2 = No [____] CCS60208 8. Safe Sex counseling 1 = Yes 2 = No [____] CCS60209 9. Early and exclusive breastfeeding in the first 6 months 1 = Yes 2 = No [____] CCS60210 10. Signs and symptoms of onset of labor (regular uterine contractions and expulsion of mucous) 1 = Yes 2 = No [____] CCS60211 11. Guidance about what to do and Where to go if have: vaginal bleeding 1 = Yes 2 = No [____] CCS60212 12. Guidance about what to do and Where to go if have: severe headache, dizziness or blurred vision 1 = Yes 2 = No [____] CCS60213 13. Guidance about what to do and Where to go if have: Seizures 1 = Yes 2 = No [____] CCS60214 14. Guidance about what to do and Where to go if have: Shortness of breath and fatigue 1 = Yes 2 = No [____] CCS60215 15. Guidance about what to do and Where to go if have: fever 1 = Yes 2 = No [____] CCS60216 16. Guidance about what to do and Where to go if have: Loss of fluid or discharge of odor 1 = Yes 2 = No [____] 3. ¿What are the services or care for a woman in post-partum at CC? REcord: 1 = mentioned 2 = not mentioned CCS60301 1. Any post-partum woman should receive a home visit by MA or EA, with emphasis on the first 15 days after birth and a maximum period more than 40 days postpartum. 1 = Yes 2 = No [____] CCS60302 2. Registration of mother in clinic record 1 = Yes 2 = No [____] CCS60303 3. Follow-up visits by the midwife and / or MA or EA. 1 = Yes 2 = No [____] CCS60304 4. Delivery of micronutrients ferrous sulfate and folic acid (supplement) 1 = Yes 2 = No [____] CCS60305 5. vitamin A sopplement 1 = Yes 2 = No [____] CCS60306 6. Follow-up through the IMCI -AINM-C strategy 1 = Yes 2 = No [____] 90 CCS60307 7. Trigger family and community emergency plan 1 = Yes 2 = No [____] 4. ¿What are the services or care for a new born in this CC? Record: 1 = mentioned 2 = not mentioned CCS60401 1. All new born will receive a home visit by the MA or EA, with emphasis on the first 15 days of birth and maximum at 28 days of age. 1 = Yes 2 = No [____] CCS60402 2. Registering on the child clinic card 1 = Yes 2 = No [____] CCS60403 3. Administration of BCG 1 = Yes 2 = No [____] CCS60404 4. Follow up through IMCI -AINM-C- protocols 1 = Yes 2 = No [____] CCS60405 5. Detection of danger and prompt referral 1 = Yes 2 = No [____] CCS60406 6. Fill and child Card delivery 1 = Yes 2 = No [____] 5. What are the care services for monitoring a child's growth less than ± 2 years? Record: 1 = mentioned 2 = not mentioned CCS60501 1. Children from 0 to under 24 months: monthly weight monitoring using minimal weight expected Table. 1 = Yes 2 = No [____] CCS60502 2. Children from 24 months to 60 months: weight monitoring every two months (bimonthly) using trend curve. 1 = Yes 2 = No [____] CCS60503 3. Early detection and timely reference of children with severe acute maltrutition 1 = Yes 2 = No [____] CCS60504 4. Early detection and timely reference of children classified as “does not grow well for two consecutive months, according to the tables of IMCI AINM-C procedures” 1 = Yes 2 = No [____] CCS60505 5. Follow up of cases of children with growth failure 1 = Yes 2 = No [____] CCS60506 6. mothers counseling on health, nutrition and hygiene 1 = Yes 2 = No [____] 6. What are the services or care for a children 2-5 year in this CC? Record: 1 = mentioned 2 = not mentioned CCS60601 1. mothers counseling on health, nutrition and hygiene 1 = Yes 2 = No [____] CCS60602 2. Deworming : Albendazole 400 mg single dose a year or every six months from the two year old 1 = Yes 2 = No [____] 91 Beneficiary Evaluation of Knowledge, Project EC-1 VARIABLES NAME QUESTION RESPONSE CODE CODCC Convergence Center CODE [__ | __ | __ | __] ECOM05 5. CC municipality location [__ | ___] [___ | ___] ECOM06 6. CC community location [___ | ___] [___ | ___] [___ | ___ | ___] Nameofmunicipality Name of municipality Pre-coded. No full visual aid to field team communityname Community Name Pre-coded. No full visual aid to field team VARIABLES NAME QUESTIONS CODES ANSWER Cial Ina Data ECDI01 Number of Survey [__ | __ | __ | __ | __ | __] ECDI02 Annex to Survey: 1 = CC Survey 2 = Community Survey [___] ECDI03 Date of interview [__ | __] / [__ | __] / 2010 Day Month ECDI04 Starting time [__ | __] Time [__ | __] Minutes ECDI05 To request permission to interview. He received permission 1 = 2 = No received permission [___] ECDI06 Name of Informant 06A ECDI Charge 1 = CF (Community Facilitator) 2 = HG (Health Guardian) 3 = Trained Midwife 4 = IN / ID (Itinerant nurse/Itinerant doctor) [___] ECDI07 THIS name ECDI07A Charge 1 = CF 2 = HG 3 = Midwife 4 = institutional Facilitator 5 = Educator 6 = IN / ID 7 = Other (specify) [___] CARGO Conditional (jump other) ECDI07B Specify another charge ECDI08 THIS name ECDI08A Charge 1 = CF 2 = HG 3 = Midwife 4 = institutional Facilitator 5 = Educator 6 = IN / ID 7 = Other (specify) [___] --- Conditional (jump other) ECDI08B 6a. Specify other charges ECDI09 1. THIS name ECDI9A Charge 1 = CF 2 = HG 3 = Midwife 4 = institutional Facilitator 5 = Educator 6 = IN / ID [___] 92 7 = Other (specify) --- Conditional (jump other) ECDI09B 7a .Specify other charges sec1-educ Link next section n VARIABLES NAME QUESTION CODES ANSWER Section 1. Education and basic knowledge Informant ECS 101 ¿What is its latest level of study? 1 = Primary incomplete 2 = Full primary 3 = Incomplete Basic education 4 = completed Basic Education N 5 = incomplete secondary Education N 6 = completed secondary Education 7 = Some university 8 = Complete University 9 = Higher Education 10 = No Education No formal (literate and self) 88 = Do not know [___ | ___] ECS 102 How Much time has worked in the CC (or community)? 1 = Less than 6 months 2 = Between 6 and 12 months 3 = More than12 months 8 = Do not know [___] ECS 103 How Much time has been in this position? 1 = Less than 6 months 2 = Between 6 and 12 months 3 = More than 12 months 8 = Do not know [___] ECS1F1 PDA FILTER: The Informant is a CF, HG, O IN / ID 1 = yes P4 2 = No ECS1F2 [___] ECS 104 Have you received training in child feed best practices ? 1 = Yes 2 = No P5 8 = Do not know / does not P5 [___] test JUMP: P4 reply 2 = No P5 8 = Do not know / does not P5 [___] 93 ECS 104A From who? 1 = BHT (Basic Health Team) 2 = NGO technician 3 = Other NGOs 8 = Do not know / can not remember [___] ECS 104B When did you receive this training? 1 = the last few 6 months 2 = 7 to 12 months 3 = It’s more than 12 months 8 = Do not know / cannot remember [___] ECS 104C ¿What were the main themes of this training? 1 = Personal Hygiene 2 = proper preparation of food. 3 = Exclusive Breastfeeding 4=Complementary food for children from 6 to 23 months 5 = Other 8 = Do not know / cannot remember 1. [___] 2. [___] 3. [___] 4. [___] 5. [___] 8. [___] ECS 105 Have you received training on care and / or food and nutrition of pregnant women? 1 = Yes 2 = No P6 8 = Do not know / cannot remember P6 [___] Test1 JUMP: P5 response 2 = No P6 8 = Do not know / remember P6 [___] ECS 105A From who? 1 = BHT 2 = NGO technician 3 = Other NGOs 8 = Do not know / cannot remember [___] ECS 105B When did you receive this training? 1 = the last few 6 months 2 = 7 to 12 months 3 = It s more than 12 months 8 = Do not know / can not remember [___] ECS 105C What were the main themes of this training? 1 = Personal Hygiene 2 = Nutrition 3 = Immunizations 4 = Vitamins and micronutrients 8 = Do not know / cannot remember 1. [___] 2. [___] 3. [___] 4. [___] 8. [___] ECS 106 Have you received 1 = Yes [___] 94 training on care and / or food and nutrition of lactating women? 2 = No P7 8 = Do not know / can not remember P7 Test2 JUMP: P6 response 2 = No P7 8 = Do not know / remember P7 [___] ECS 106A From who? 1 = BHT 2 = NGO technician 3 = Other NGOs 8 = Do not know / cannot remember [___] ECS 106B When did you receive this training? 1 = the last few 6 months 2 = 7 to 12 months 3 = It s more than 12 months 8 = Do not know / can not remember [___] ECS 106C What were the main themes of this training? 1 = Personal Hygiene 2 = Food Hygiene 3 = Nutrition 4 = Vitamins and micronutrients 5 = Childhood danger signs 8 = Do not know / cannot remember 1. [___] 2. [___] 3. [___] 4. [___] 5. [___] 8. [___] ECS107 Have you received training on the care and / or food and nutrition of sick children? 1 = Yes 2 = No P8 8 = Do not know / can not remember P8 [___] Test3 JUMP: P7 response 2 = No P8 8 = Do not know / remember P8 [___] ECS107A From who? 1 = BHT 2 = NGO technician 3 = Other NGOs 8 = Do not know / cannot remember [___] ECS107B When did you receive this training? 1 = the last few 6 months 2 = 7 to 12 months 3 = It s more than 12 months 8 = Do not know / can not remember [___] ECS107C What were the main themes of this training? 1 = Personal Hygiene 2 = Nutrition 3 = Food Care (manipulation ) 4 = Childhood 1. [___] 2. [___] 3. [___] 4. [___] 5. [___] 6. [___] 95 danger signs 5 = Oral Hydration 6 = Vaccination 8 = Do not know / cannot remember 8. [___] ECS108 Have you received training on other health issues in general? 1 = Yes 2 = No P9 8 = Do not know / can not remember P9 [___] Prueba4 JUMP: P8 response 2 = No P9 8 = Do not know / does not P9 [___] ECS108A From who? 1 = BHT 2 = NGO technician 3 = Other NGOs 8 = Do not know / cannot remember [___] ECS108B When Did You receive this training? 1 = the last few 6 months 2 = 7 to 12 months 3 = It s more than 12 months 8 = Do not know / cannot remember [___] ECS108C What were the main themes of this training? 1 = Water and basic sanitation 2 = ARI´s 3 = Diarrhea 4 = Skin Infections 5 = Grow monitoring 6 = Other 8 = Do not know / can not remember 1. [___] 2. [___] 3. [___] 4. [___] 5. [___] 6. [___] 8. [___] ECS109 According to IMCI / AINM -C in what cases children less than 2 year should be taken to Convergence Center? 1 = Grow monitoring 2 = For illness 3 = Other 8 = Do not know / cannot remember 1. [___] 2. [___] 3. [___] 8. [___] ECS 110 According to IMCI / AINM -C, What you should look to address in a child less than 2 year during a consultation Convergence Center? 1 = Childhood danger signs 2 = food and nutritional status 3 = Vaccination status 4 = Other 8 = Do not know / cannot remember 1. [___] 2. [___] 3. [___] 4. [___] 8. [___] ECS1111 What nutritional supplements should 1 = Vitamin A 1 [___] prueba5 Conditional ECS1112 96 ECS1111A take a child under 2 year? Not to mention the options. Note 1 in the mentioning boxes. Inquire when finished answering, scoring 2 in boxes not mentioned. In the boxes of “how often” record the number of months. (Ex: if is every 6 months, scoring 6 ) How often? [___] (Months) ECS1112 2 = Iron 2 [___] Test 6 Conditional ECS1113 2A ECS111 How often? [___] (Days) ECS111 3 3 = Folic acid 3 [___] Test 7 Conditional ECS1114 3A ECS111 How often? [___] (Days) ECS111 4 4 = Zinc 4 [___] Test 8 Conditional ECS1115 4A ECS111 How often? [___] (Days) ECS111 5 5 = Sparky 5 [___] Test 9 Conditional ECS11197 5A ECS111 How often? [___] (Days) ECS11 197 97 = Other 97 [___] Test 10 Conditional Test11 ECS11197ESP 97=Another supplement, specify _____________________________ ECS11 197A How often? [___] (Days) Test 11 Conditional test12 Test 12 Conditional Prueba13 Test 13 Conditional ECS111 5 = 1 and ECS11197 = 1 ECS11 198 98 = Do not know 98 [___] ECS 1121 What nutritional supplements should take a pregnant women? Not to mention the options. Note 1 in the mentioning boxes. Inquire when finished answering, scoring 2 in boxes not mentioned. In the boxes of “hoe often” record the number of months. (Ex: if is every 6 months, note 6) 1 = Iron 1 [___] Test14 Conditional ECS1122 ECS 1121A How often? [___] (Days) ECS 1122 2 = Folic acid 2 [___] Test 15 Conditional ECS1123 ECS 1122a How often? [___] (Days) ECS 1123 3 = Calcium 3 [___] Test 16 Conditional ECS1124 ECS 1123A How often? [___] (Days) ECS 1124 4 = Zinc 4 [___] Test 17 Conditional ECS1125 ECS 1124A How often? [___] (Days) ECS 11297 97 = Other 97 [___] Exhibit 19 Conditional Prueba20 ECS 11297ESP 97=Another supplement specify _____________________________ 97 ECS 11297A How often? [___] (Days) Exhibit 20 Conditional Prueba21 Exhibit 21 Conditional Prueba22 Exhibit 22 Conditional ECS1131 ECS 11298 98 = Do not know 98 [___] ECS 1131 What nutritional supplements should take a lactating women? Not to mention the options. Note 1 in the mentioning boxes. Inquire when finished answering, scoring 2 in boxes not mentioned. In the boxes of “how often” record the number of months. (Ex: if is every 6 months, note 6) 1 = Iron 1 [___] Test 18 Conditional ECS1132 ECS 1131A How often? [___] (Days) ECS 1132 2 = Folic Acid 2 [___] Test 23 Conditional ECS1133 ECS 1132A How often? [___] (Days) ECS 1133 3 = Vitamin A 3 [___] Test 24 Conditional ECS1134 ECS 1133A How often? [___] (Months) ECS 1134 4 = Calcium 4 [___] Test 25 Conditional ECS1135 ECS 1134A How often? [___] (Days) ECS 1135 5 = Zinc 5 [___] Test 26 Conditional ECS11397 ECS 1135A How often? [___] (Days) ECS 11397 97 = Other 97 [___] Test 27 Conditional Test11 ECS 11397ESP 97=Another supplement specify _____________________________ ECS 11397A How often? [___] (Days) Test 28 Conditional test12 Test 29 Conditional Prueba13 Test 30 Conditional ECS 1135 = 1 and ECS11397 = 1 ECS 11398 98 = Do not know 98 [___] 98 VARIABLES NAME QUESTION ANSWER CODE CODCC Convergence Center Code [__ | __ | __ | __] ECOM05 CC municipality location [__ | ___] [___ | ___] ECOM06 CC community location [___ | ___] [___ | ___] [___ | ___ | ___] Municipalityname Municipality name Pre-coded. No full visual aid to field team CommunityName Community Name Pre-coded. No full visual aid to field team VARIABLES NAME QUESTION CODES ANSWER 06A ECDI 6a. Charge 1 = CF 2 = HG 3 = Trained Midwife 4 = IN / ID [___] Section 2. Pregnancy danger signs ECS1F 2 Filter PDA, the informant is a (A) midwife, CF, or IN / ID 1 = Section 2 - P1 2 = No Section 2 - P4 [___] 1. Occasionally pregnant women require immediate medical attention (from a doctor or nurse). Do you know what are the warning signs (symptoms) that tell a pregnant woman should receive immediate medical attention? DO NOT READ LIST. NO MENTION ANY DANGER SIGN ( symptom) WRITE ONLY THE SIGNS ( symptoms) referred without reading. WHEN RESPONDANT FINISHES MENTIONING SIGNS, PROBE: Any other sign? WHEN THERE ARE NO MORE SIGNS MENTIONED MARK A 2 IN THE SIGNS NOT MENTIONED AND GO TO QUESTION 2 Codes of answers: 1 = Yes, 2 = not mentioned above ECS201A Bleeding or vaginal bleeding 1 = E 2 = No [___] ECS201 B Severe pain in the stomach 1 = E 2 = No [___] ECS 201C Persistent back pain 1 = E 2 = No [___] ECS 201D Leakage of clear fluid out through the vagina (leakage of amniotic fluid) 1 = E 2 = No [___] ECS201 E Puffiness of hands, face, or body 1 = E 2 = No [___] ECS 201F Severe headache or blurred vision 1 = E 2 = No [___] ECS 201G continuous contractions before 37 weeks 1 = E 2 = No [___] ECS 201H No fetal movement after 5 months onwards 1 = E 2 = No [___] ECS 201I Breathing is difficult 1 = E 2 = No [___] 2. Do you know signs of warning (symptoms) during labor? DO NOT READ LIST. NO MENTION ANY DANGER SIGN (symptom) WRITE ONLY THE SIGNS (symptoms) referred without reading. WHEN RESPONDANT FINISHES MENTIONING SIGNS PROBE: Any other sign? WHEN THERE ARE NO MORE SIGNS MENTIONED MARK A 2 IN SIGNS NOT MENTIONED AND NO GO TO QUESTION 3 Codes of answers: 1 = Yes, 2 = not mentioned above ECS 202A Breathing is difficult 1 = E 2 = No [___] ECS 202B Vaginal bleeding 1 = E 2 = No [___] ECS 202C Fever 1 = E 2 = No [___] ECS 202D Labor pains that last more than 12 hours 1 = E 2 = No [___] 3. Do you know the signs of warning (symptoms) in the post-partum? 99 DO NOT READ LIST. NO MENTION ANY DANGER SIGN (symptom) WRITE ONLY THE SIGNS (symptoms) referred without reading. WHEN RESPONDANT FINISHES MENTIONING SIGNS PROBE: Any other sign? WHEN THERE ARE NO MORE SIGNS MENTIOND MARK A 2 IN THE SIGNS NOT MENTIONED AND SKIP TO QUESTION 4 Codes of answers: 1 = Yes, 2 = not mentioned above ECS 203A Vaginal bleeding 1 = E 2 = No [___] ECS 203B Severe pain that does not go away 1 = E 2 = No [___] ECS 203C Chilling, sweating or fever 1 = E 2 = No [___] ECS2F1 Filter PDA the informant is a HG, CF, IN/ID 1 = YES P4 2 = No ECS2F2 [___] 4. Occasionally the children will suffer from severe illnesses that require immediate medical attention (from a doctor or nurse). Do you know what are the warning signs (symptoms) that indicate that NEW BORN should receive immediate medical attention? DO NOT READ LIST. NO MENTION ANY DANGER SIGN (symptom) WRITE ONLY THE SIGNS (symptoms) referred without reading. WHEN RESPONDANT FINISHES MENTIONING SIGNS PROBE: Any other sign? WHEN THERE ARE NO MORE SIGNS MENTIOND MARK A 2 IN THE SIGNS NOT MENTIONED AND GO TO QUESTION 5 Codes of answers: 1 = Yes, 2 = not mentioned above ECS 204A It is very small 1 = E 2 = No [___] ECS 204B It is cold 1 = E 2 = No [___] ECS 204C It is purple 1 = E 2 = No [___] ECS 204D Breathing is difficult 1 = E 2 = No [___] ECS 204E It cannot breastfeed 1 = E 2 = No [___] ECS 204F It is very hot or feverish 1 = E 2 = No [___] ECS 204G It has red eyes with secretions 1 = E 2 = No [___] ECS 204H Red navel, extending to the skin with bad odor and pus 1 = E 2 = No [___] 5. Occasionally the children will suffer from severe illnesses that require immediate medical attention (from a doctor or nurse). Do you know what are the warning signs (symptoms) that indicate that a child should receive immediate medical attention? DO NOT READ LIST. NO MENTION ANY DANGER SIGN (symptom) WRITE ONLY THE SIGNS (symptoms) referred without reading. WHEN RESPONDANT FINISHES MENTIONING SIGNS PROBE: Any other sign? WHEN THERE ARE NO MORE SIGNS MENTIOND MARK A 2 IN THE SIGNS NOT MENTIONED AND NO GO TO QUESTION 6 Codes of answers: 1 = Yes, 2 = not mentioned above ECS 205A It can not breastfeed, take liquids or eat 1 = E 2 = No [___] ECS 205B No improvement or becomes more ill 1 = E 2 = No [___] ECS 205C Fever 1 = E 2 = No [___] ECS 205D Fast breathing 1 = E 2 = No [___] ECS 205E Shortness of breath, difficult breathing 1 = E 2 = No [___] ECS 205F Blood in the stool (bowel movement) 1 = E 2 = No [___] ECS 205g Vomits everything 1 = E 2 = No [___] ECS 205H Has attacks 1 = E 2 = No [___] ECS 205i Faints 1 = E 2 = No [___] 100 6. Do you know what are the warning signals (symptoms) of severe dehydration? DO NOT READ LIST. NO MENTION ANY DANGER SIGN (symptom) WRITE ONLY THE SIGNS (symptoms) referred without reading. WHEN RESPONDANT FINISHES MENTIONING SIGNS PROBE: Any other sign? WHEN THERE ARE NO MORE SIGNS MENTIOND MARK A 2 IN THE SIGNS NOT MENTIONED AND SKIP TO QUESTION 7 Codes of answers: 1 = Yes, 2 = not mentioned above ECS 206A It is uneasy 1 = E 2 = No [___] ECS 206B It is very thirsty 1 = E 2 = No [___] ECS 206C Sunken eyes 1 = E 2 = No [___] ECS 206D The skin of the belly back very slowly 1 = E 2 = No [___] ECS 206E It cannot breastfeed, take liquids or eat 1 = E 2 = No [___] ECS 206F It is faint 1 = E 2 = No [___] ECS 206g Sunken eyes 1 = E 2 = No [___] 7. Do you know what are danger signals (symptoms) of a serious pneumonia? DO NOT READ LIST. NO MENTION ANY DANGER SIGN (symptom) WRITE ONLY THE SIGNS (symptoms) referred without reading. WHEN RESPONDANT FINISHES MENTIONING SIGNS PROBE: Any other sign? WHEN THERE ARE NO MORE SIGNS MENTIOND MARK A 2 IN THE SIGNS NOT MENTIONED AND SKIP TO QUESTION 8 Codes of answers: 1 = Yes, 2 = not mentioned above ECS 207A the ribs are made prominent when breathing 1 = E 2 = No [___] ECS 207B Difficult breathing or fast breathing 1 = E 2 = No [___] 8. Do you know what are the signals of malnutrition in a child? DO NOT READ LIST. NO MENTION ANY DANGER SIGN (symptom) WRITE ONLY THE SIGNS (symptoms) referred without reading. WHEN RESPONDANT FINISHES MENTIONING SIGNS PROBE: Any other sign? WHEN THERE ARE NO MORE SIGNS MENTIOND MARK A 2 IN THE SIGNS NOT MENTIONED AND SKIP TO QUESTION 9 Codes of answers: 1 = Yes, 2 = not mentioned above ECS 208A It is swollen 1 = E 2 = No [___] ECS 208B It is very thin 1 = E 2 = No [___] ECS 208C Paleness in the palm of hand 1 = E 2 = No [___] QUESTION CODE QUESTION CODES ANSWER ECS 1F3 PDA FILTER the informant is a HG, CF, IN/ID 1 = YES section 4 2 = NO section n 5 [___] Section 4. Child Care 1. What are the recommendations for a pregnant woman? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN RESPONDANT FINISHES TO ANSWERS THE QUESTIONS score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS40101 Eat a meal every day more than when she was not pregnant 1 = E 2 = No [___] ECS401 02 How to solve breastfeeding problems 1 = E 2 = No [___] 101 ECS401 03 How to identify the danger signals 1 = E 2 = No [___] ECS401 97 Other 1 = E 2 = No [___] ECS401 98 Do not know 1 = E 2 = No [___] ECS401 A 1A. Other ,Specify 2. What are the services must have a pregnant woman? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN RESPONDANT FINISHES TO ANSWERS THE QUESTIONS score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above 201 ECS40 Pregnancy Control 1 = E 2 = No [___] ECS40 202 TDA (Tetanus, Diphtheria) vaccination 1 = E 2 = No [___] ECS40 203 Weight Control 1 = E 2 = No [___] ECS40 204 Food and nutritional counseling 1 = E 2 = No [___] ECS40 205 Iron and folic acid supplementation 1 = E 2 = No [___] ECS40 297 Other 1 = E 2 = No [___] ECS40 298 Do not know 1 = E 2 = No [___] 2A ECS40 2A. Other Specify 3. On what age should be given to the following immunizations to the children? Reed the list of vaccines. NO MENTION ANY AGE RELATED TO EACH VACCINE WRITE ONLY AGES ABOVE RIGHT without reading for each vaccine. WHEN NOT MENTION THE RIGHT AGE REDCORD 2 IN THE BOXES WRITE FOR ANSWER AND GO TO NEXT Codes of answers: 1 = Yes, 2 = right age mentions not mentions right age ECS40 301 BCG [0] [1] month 1 = E 2 = No [___] ECS40 302 Polio in [2] to [6] months 1 = E 2 = No [___] ECS40 303 Pentavalent of [2] to [6] months 1 = E 2 = No [___] ECS40 304 MMR vaccines [12] months 1 = E 2 = No [___] ECS40 305 Polio reinforcement 1 of [18] months 1 = E 2 = No [___] ECS40 306 Reinforcement 1 of DPT [18] months 1 = E 2 = No [___] ECS40 307 Polio reinforcement 2 of [48] months 1 = E 2 = No [___] ECS40 308 Reinforcement 2 of DPT [48] months 1 = E 2 = No [___] ECS40 398 Do not know 1 = E 2 = No [___] 4. What services must have a child less than 2 years? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN RESPONDANT FINISHES TO ANSWERS THE QUESTIONS score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS40 401 Vaccination 1 = E 2 = No [___] ECS40 402 Grow monitoring 1 = E 2 = No [___] ECS40 403 Deworming 1 = E 2 = No [___] ECS40 404 Nutritional and / or micronutrient Supplementation 1 = E 2 = No [___] ECS40 405 Chilhood Illness assitance 1 = E 2 = No [___] ECS40 497 Other 1 = E 2 = No [___] ECS40 498 Do not know 1 = E 2 = No [___] 5. What should a mother do when a child have diarrhea? DO NOT READ LIST. WRITE ALL THAT SAID 102 Check the boxes of the answers. READ NO OPTIONS WHEN RESPONDANT FINISHES TO ANSWER THE QUESTIONS score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS40 501 Oral RehydrationSalt (ORS) 1 = E 2 = No [___] ECS40 502 Homemade rehydration serum 1 = E 2 = No [___] ECS40 503 Continue to breastfeed 1 = E 2 = No [___] ECS40 504 Breastfeed more than normal 1 = E 2 = No [___] ECS40 505 Guive syrups 1 = E 2 = No [___] ECS40 506 Guive traditional medicine 1 = E 2 = No [___] ECS40 507 Guive boiled, chlorinated, bottled water 1 = E 2 = No [___] ECS40 508 Guive carrot juice or rice water 1 = E 2 = No [___] ECS40 509 Nothing 1 = E 2 = No [___] ECS40 510 Take him to a hospital 1 = E 2 = No [___] ECS40 511 Breastfeed less than normal 1 = E 2 = No [___] ECS40 597 Other 1 = E 2 = No [___] Otro11 Conditional (jump other) 5A ECS40 5A. Other Specify EC2F23 Conditional (Do not know) ECS40 598 Do not know 1 = E 2 = No [___] 6. What can a mother do to prevent diarrhea in children? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN RESPONDANT FINISHES TO ANSWER THE QUESTIONS score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS40 601 Wash hands 1 = E 2 = No [___] ECS40 602 Clip her fingernails 1 = E 2 = No [___] ECS40 603 The children must wear pants 1 = E 2 = No [___] ECS40 604 Wash fruits and vegetables 1 = E 2 = No [___] ECS40 605 Children should wear sandals or shoes 1 = E 2 = No [___] ECS40 606 Give pure, boiled, SODIS, bottled or chlorinated water 1 = E 2 = No [___] ECS40 607 Keep children´s clothes clean 1 = E 2 = No [___] ECS40 608 Do not sit on the floor 1 = E 2 = No [___] ECS40 609 Not play Water 1 = E 2 = No [___] ECS40 697 Other 1 = yes P6a 2 = No [___] Otro17 Conditional (jump other) EC2F24 Conditional (Do not know) ECS40 698 97. Do not know 1 = yes 2 = No [___] 6A ECS40 6 A. Other Specify VARIABLES NAME QUESTION ANSWER CODES CODCC Convergence Center code [__ | __ | __ | __] ECOM05 5. CC municipality location [__ | ___] [___ | ___] ECOM06 6. CC community location [___ | ___] [___ | ___] [___ | ___ | ___] Municipalityname Municipality name Pre-coded. No full visual aid to field team 103 Communityname Community Name Pre-coded. No full visual aid to field team QUESTION CODE QUESTIONS CODES ANSWER Section 5. Food and nutrition knowledge 06A ECDI 6a. Charge 1 = CF 2 = HG 3 = Trained Midwife 4 = IN/ID [___] ECS501 After the baby is born within what timeframe should it breastfeed the first time? Do not read the options 1 =Immediately 2 = Less than one hour 3 = More than 1 hour but less than 8 hours 4 = 8 hours but less than 24 hours 5 = One day after 6 = More than a one day after 7 = Other, ----P1a 8 = Do not know | ___] ECS2F2 Conditional (jump other) 01A ECS5 1A. Other Specify 1. What should a mother do with first milk or colostrum? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN RESPONDANT FINISHES TO ANSWER THE QUESTIONS score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS50201 Throw it away and start to breastfeed later 1 = E 2 = No [___] ECS50202 Breastfeed 1 = E 2 = No [___] ECS2F4 Conditional (jump other) Conditional ECS2F5 (jump not know) ECS50201 = 1 and ECS50202 = 1 ECS2F3 Conditional ECS2F3 (jump not know) ECS50202 = 1 and ECS50297 ECS50301 ECS502 97 97. Other, specify 1 = Sà P2a 2 = No [___] ECS502 98 98. Do not know 1 = E 2 = No [___] 02A ECS5 2 A. Specify other 2. What happens to a (a) baby if a mother gives colostrum (or first milk)? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN RESPONDANT FINISHES TO ANSWER THE QUESTIONS score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS50 301 Baby gets nutrients 1 = E 2 = No [___] ECS50 302 Baby get sick 1 = E 2 = No [___] ECS50 303 It helps the baby be more healthy 1 = E 2 = No [___] ECS50 304 Will increase baby´s defenses 1 = E 2 = No [___] 104 ECS50 305 It will make de the baby fat 1 = E 2 = No [___] ECS50 306 Nothing 1 = E 2 = No [___] ECS50 397 Other, specify 1 = yes P3a 2 = No [___] 03A ECS5 3A. Other Specify Other1 Conditional (jump other) ECS2F6 Conditional (jump not know) ECS50 398 97. Do not know 1 = yes 2 = No [___] 3. Do you know when a mother should breastfeed a baby? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS50 401 When the baby wants 1 = E 2 = No [___] ECS50 402 When she sees that the baby is hungry 1 = E 2 = No [___] ECS50 403 When the baby cries 1 = E 2 = No [___] ECS50 404 When the baby searches the breast 1 = E 2 = No [___] ECS50 497 Other, specify 1 = yes P4a 2 = No [___] 04A ECS5 4A. Other Specify Otro2 Conditional (jump other) ECS2F7 Conditional (jump not know) ECS50 498 97. Do not know 1 = E 2 = No [___] 4. If a mother of a baby under 6 months does not have or think does not have enough milk, what should she do? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS50 501 Breastfeed more frequently 1 = E 2 = No [___] ECS50 502 Give others the liquid or food 1 = E 2 = No [___] ECS50 503 The mother needs to take more water 1 = E 2 = No [___] ECS50 504 The mother should eat more 1 = E 2 = No [___] ECS50 505 The mother should eat better 1 = E 2 = No [___] ECS50 506 The mother should drink liquids 1 = E 2 = No [___] ECS50 597 Other, specify 1 = yes P5a 2 = No [___] 05A ECS5 5A. Other Specify Otro3 Conditional (jump other) ECS2F8 Conditional (jump not know) ECS50 598 97. Do not know 1 = E 2 = No [___] ECS5 06 Can Mother give water to a child under 6 months of age? 1 = yes 2 = No 8 = Do not know | ___] ECS5 07 Can mother give others liquids to a child under 6 months of age in addition breast milk? 1 = yes 2 = No 8 = Do not know | ___] ECS5 08 Do you think that a mother who is breast-feeding a 1 = yes | ___] 105 child under 6 months should stop breastfeeding if she becomes pregnant again? 2 = No 8 = Do not know 5. If a mother has a baby younger than 6 months and cannot be with the baby always , what can be given to the baby when it gets hungry? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS50 901 Extracted Breast milk 1 = E 2 = No [___] 902 ECS50 Milk pot 1 = E 2 = No [___] 903 ECS50 Cow's milk 1 = E 2 = No [___] ECS50 904 Special formula milk for babies 1 = E 2 = No [___] ECS50 905 Atol (porridge) 1 = E 2 = No [___] ECS50 906 Bread 1 = E 2 = No [___] ECS50 907 Fruits 1 = E 2 = No [___] ECS50 908 Tortilla 1 = E 2 = No [___] ECS50 909 Mass Water 1 = E 2 = No [___] ECS50 997 Other, specify 1 = yes P9A 2 = No [___] 09A ECS5 9A. Other Specify other Another.4 Conditional (jump other) ECS2F9 Conditional (jump not know) ECS50 998 97. Do not know 1 = E 2 = No [___] ECS5 10 Besides breast milk, At what age should you start feeding and food (on) baby? WRITE THE ANSWER IN MONTHS. 98 = DO NOT KNOW [___ | ___] 6. Besides breast milk what should be the first foods you should give a (a) baby? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS5 1101 Porridge (mass, incaparina and Vitacereal) 1 = E 2 = No [___] ECS5 1102 Fruit 1 = E 2 = No [___] ECS5 1103 Vegetables 1 = E 2 = No [___] ECS5 1104 beans 1 = E 2 = No [___] ECS5 1105 Rice 1 = E 2 = No [___] ECS5 1106 Tortilla 1 = E 2 = No [___] ECS5 1107 Cereals 1 = E 2 = No [___] ECS5 1108 Eggs 1 = E 2 = No [___] ECS5 1109 Soup / Broth 1 = E 2 = No [___] ECS5 1197 Other, specify 1 = yes P11a 2 = No [___] 11A ECS5 11A. Other Specify Another5 Conditional (jump other) ECS2F10 Conditional (jump not know) ECS5 1198 97. Do not know 1 = E 2 = No [___] 106 7. Do you know for what reasons a mother may stop breastfeeding a baby? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS5 1201 Cracked nipples 1 = E 2 = No [___] ECS5 1202 Pregnancy 1 = E 2 = No [___] ECS5 1203 Birth of another baby 1 = E 2 = No [___] ECS5 1204 Baby´s interest in another foods 1 = E 2 = No [___] ECS5 1205 Illness of Mother 1 = E 2 = No [___] ECS5 1206 Strong feelings of the mother (which can be passed to your baby ) 1 = E 2 = No [___] ECS5 1207 Mastitis 1 = E 2 = No [___] ECS5 1208 The baby is big 1 = E 2 = No [___] ECS5 1209 The baby does not want to 1 = E 2 = No [___] ECS5 1297 Other, specify 1 = yes P12a 2 = No [___] 12A ECS5 12A. Specify other Otro6 Conditional (jump other) ECS2F11 Conditional (jump not know) ECS5 1298 97. Do not know 1 = E 2 = No [___] ECS5 13 Do you know till what age a mother should continue to breastfeed a baby? READ NO OPTIONS RECORD ANSWER IN MONTHS RECORD # OF MONTHS (0 to 95) 96 = Until the baby stops asking 97 = Other------ P13a 98 = Do not know [___ | ___] Other Conditional (jump other) 13A ECS5 13A. Specify other ECS5 14 Do you know if there is any reason why an infant under six months receives only breast milk? 1 = yes 2 = No------ P16 8 = Do not know ---- P16 [___] ECS2F21 Conditional (ECS514 = 2â † 'P16 and ECS514 = 8â †' P16) 8. What are the reasons? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS5 1501 Protect the baby from illness 1 = E 2 = No [___] ECS5 1502 To help baby to grow better 1 = E 2 = No [___] ECS5 1503 Breast milk contains everything the baby needs in the first 6 months 1 = E 2 = No [___] ECS5 1504 Mothers Are less likely to become pregnant 1 = E 2 = No [___] ECS5 1505 Withholds the mothers period 1 = E 2 = No [___] ECS5 1506 Breast milk is clean, safe, and convenient 1 = E 2 = No [___] 107 ECS5 1507 Breastmilk is economic 1 = E 2 = No [___] ECS5 1508 Reduce medical bills 1 = E 2 = No [___] ECS5 1597 Other, specify 1 = yes P15a 2 = No [___] 15A ECS5 15A. Specify other Otro7 Conditional (jump other) ECS2F12 Conditional (jump not know) ECS5 1598 97. Do not know 1 = E 2 = No [___] 9. Who decides when your child starts eating solid food, either whole or in pieces? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS5 1601 The child 1 = E 2 = No [___] ECS5 1602 The mother 1 = E 2 = No [___] ECS5 1603 Midwife / community facilitator / BHT 1 = E 2 = No [___] ECS5 1604 Mother in law 1 = E 2 = No [___] ECS5 1605 Husband 1 = E 2 = No [___] ECS5 1697 Other, specify 1 = YES P16a 2 = No [___] Otro8 Conditional (jump other) ECS2F13 Conditional (jump not know) ECS5 1698 Do not know 1 = E 2 = No [___] 16A ECS5 16A. Specify other ECS5 17 How many times a day should eat a child of 6-8 months? 1 = # of times --- P17a 2 = meals and snacks --- P17b 8 = Do not know ---- P18 [___] descr2 Conditional (ECS517 = 1 â † 'P17a and hides and ECS517c ECS517B) Descr1 Conditional (ECS517 = 8 â † 'P18) descr Conditional (ECS517 = 2 â † 'P17b) WRITE 1ON QUESTION 17 IF ANSWER BY # OF TIMES. SKIP TO 17th AND RECORD TOTAL MEALS. WRITE 2 IF ANSWER TO QUESTION 17 FOR meals and snacks. SKIP TO QUESTION 17b and 17c and enter the total FOOD AND TOTAL snacks 17A ECS5 TOTAL: # TIMES A DAY AFTER scoring RESPONSE SKIP TO Q 18 | ___] 17B ECS5 MEALS # TIMES A DAY | ___] 17C ECS5 SNACKS: # TIMES A DAY | ___] ECS5 18 During each meal, how much food you give to a child of 6-8 months? WHAT TO ANSWER WITH MEASURING CUP READ NO OPTIONS 1 = 1/4 cup 2 = 1/2 cup 3 = 3/4 cup 4 = 1 cup 7 = Other, specify. | ___] 108 P18a 8 = Do not know Descr3 Conditional (jump other) 18A ECS5 18 A. Specify other ECS5 19 Is there a food that is damage or bad for child of 6-8 months? 1 = yes 2 = No 8 = Do not know | ___] ECS5 20 How many times a day should eat a child of 9 to 11 months? 1 = # of times --- P20a 2 = Meal and snacks---- P20B 8 = Do not know ---- P21 | ___] Descr5 Conditional (ECS520 = 1 â † 'P20a and hides and ECS520c ECS520B) Descr6 Conditional (ECS520 = 8 â † 'P21) Descr4 Conditional (ECS520 = 2 â † 'P20B) WRITE 1IF ANSWER QUESTION 20 # OF TIMES. SKIP to 20a TOTAL MEALS AND WRITE. WRITE 2 IF ANSWER TO QUESTION 20 meals and snacks. SKIP TO QUESTION 20b and 20c and enter the total MEALS AND TOTAL SNACKS 20A ECS5 TOTAL: # TIMES A DAY AFTER scoring RESPONSE SKIP A P21 | ___] 20B ECS5 MEALS: # TOTAL A DAY | ___] 20C ECS5 SNACKS: # TOTAL A DAY | ___] ECS5 21 During each meal, how much food you give to a child 9 to 11 months? WHAT TO ANSWER WITH MEASURING CUP READ NO OPTIONS 1 = 1/4 cup 2 = 1/2 cup 3 = 3/4 cup 4 = 1 cup 7 = Other, --P21a 8 = Do not know | ___] Descr7 Conditional (jump other) 21A ECS5 21A. Specify other ECS5 22 Is there food that is damage or bad for child from 9 to 11 months? 1 = yes 2 = No 8 = Do not know | ___] ECS5 23 How many times a day should eat a child of 12 to 24 months? 1 = # of times -- P23a 2 = Meals and snacks---- P23b 8 = Do not know --- P24 | ___] Descr9 Conditional (ECS523 = 1 â † 'P23a and hides and ECS523c ECS523B) Descr10 Conditional (ECS523 = 8 â † 'P24) Descr8 Conditional (ECS523 = 2 â † 'P23b) WRITE 1 IF THE ANSWER FOR QUESTION 23 TOTAL # OF TIMES. 109 SKIP to question 23a TOTAL MEALS AND WRITE. WRITE 2 IF ANSWER TO QUESTION 23 meals and snacks. SKIP TO QUESTION 23b and 23c and enter the total MEALS AND SNACKS. 23A ECS5 TOTAL: # TIMES A DAY AFTER scoring RESPONSE SKIP TO P24 | ___] 23B ECS5 MEALS: # TIMES A DAY 23C ECS5 PARTS: # TIMES A DAY | ___] ECS5 24 During each meal, how much food you give to a child 12 to 24 months? MEASURING CUP WITH ANSWERING. READ NO OPTIONS 1 = 1/4 cup 2 = 1/2 cup 3 = 3/4 cup 4 = 1 cup 5 = Other, specify -- -P24a 8 = Do not know | ___] Descr11 Conditional (jump other) 24A ECS5 24 A. Specify other ECS52 6 There is a food that damage or bad for of 12 to 24 months 1 = yes 2 = No 8 = Do not know | ___] 26. What could happen to a child do not have enough iron (in your diet or through iron supplements)? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS5 2701 disorder or learning disabilities 1=yes 2=No [___] ECS5 2702 Inadequate mental development 1=yes 2=No [___] ECS5 2703 Inadequate physical development 1=yes 2=No [___] ECS5 2704 Short stature 1=yes 2=No [___] ECS5 2705 Low defenses against deseases 1=yes 2=No [___] ECS5 2706 Feeling tired 1=yes 2=No [___] ECS5 2707 Can be anemic 1=yes 2=No [___] ECS5 2797 Other, specify 1 = yes -- P27a 2=No [___] ECS5 27A 27A. Specify other Otro9 Conditional (jump other) ECS2F14 Condicional (salto no sabe) ECS5 2798 97. Do not know 1=yes 2=No [___] 27. Do you know some foods that contain vitamin A? (Nutrient that protects the body against disease.) DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS5 2801 orange or yellow fruits and vegetables 1=yes 2=No [___] ECS5 2802 Green leaves 1=yes 2=No [___] ECS5 2803 Eggs 1=yes 2=No [___] ECS5 2804 Liber 1=yes 2=No [___] ECS5 2805 Breast milk 1=yes 2=No [___] 110 ECS5 2806 Cow milk 1=yes 2=No [___] ECS5 2807 Meat 1=yes 2=No [___] ECS5 2808 Noodles 1=yes 2=No [___] ECS5 2809 Vegetables (non organge colered) 1=yes 2=No [___] ECS5 2897 Other, specify 1 = yes -- P28a 2=No [___] ECS5 28A 28A. Specify other Otro10 Conditional (jump other) ECS2F15 Conditional (do not know jump) ECS5 2898 97. Do not know 1=yes 2=No [___] ECS5 29 Do you know if the salt is fortified with some vitamins or minerals? 1 = yes 2=No ---P30 8=Do not know-- P30 | ___] ECS2F22 Condicional ( ECS529= 2â†'P30 y ECS529= 8â†'P30 ) --- 29a .Wich? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS5 29A 01 Iodine 1=yes 2=No [___] ECS5 29A 02 Vitamin A 1=yes 2=No [___] ECS5 29A 03 Iron 1=yes 2=No [___] ECS5 29A04 Fluor 1=yes 2=No [___] ECS5 29A97 Other, specify 1 = yes ---P29b 2=No [___] ECS5 29B Specify other Otro12 Conditional (jump other) ECS2F16 Conditional (do not know jump) ECS5 29A98 29 A 1 Do not know 1=yes 2=No [___] 28 How can a mother encourage her children to eat? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS5 3001 speaks to them constantly 1=yes 2=No [___] ECS5 3002 Look at them while eating 1=yes 2=No [___] ECS5 3003 singing and caressing 1=yes 2=No [___] ECS5 3004 Offering different food combinations 1=yes 2=No [___] 111 ECS5 3005 Offering several flavors food 1=yes 2=No [___] ECS5 3006 Offering foods of different texture 1=yes 2=No [___] ECS5 3007 Feed them slowly and patiently 1=yes 2=No [___] ECS5 3008 Force the child to eat 1=yes 2=No [___] ECS5 3009 Avoid distractions 1=yes 2=No [___] ECS5 3097 Other, specify 1 = yes ---P30a 2=No [___] ECS5 30A 30A. Specify other Otro13 Conditional (jump other) ECS2F17 Conditional (do not know jump) ECS5 3098 97. Do not know 1=yes 2=No [___] 29 What are the main causes of malnutrition in children? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS5 3101 Do not eat enough / poor appetite 1=yes 2=No [___] ECS5 3102 Do not eat frequently 1=yes 2=No [___] ECS5 3103 The child is sick (diarrhea, sickness, etc..) 1=yes 2=No [___] ECS5 3104 abrupt weaning 1=yes 2=No [___] ECS5 3105 The child is not being given food with love / affection 1=yes 2=No [___] ECS5 3106 Do not eat balanced / Not feeding well 1=yes 2=No [___] ECS5 3107 The food is insufficient 1=yes 2=No [___] ECS5 3108 Lack of hygiene 1=yes 2=No [___] ECS5 3197 Other, specify 1 = yes----P31a 2=No [___] ECS5 31A 31A. Specify other Otro14 Conditional (jump other) ECS2F18 Conditional (do not know jump) ECS5 3198 97. Do not know 1=Sà 2=No [___] 30. When should a person wash their hands? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS5 3201 Before eating 1=yes 2=No [___] ECS5 3202 After using the toilet or latrine 1=yes 2=No [___] ECS5 3203 Before giving food to the child 1=yes 2=No [___] ECS5 3204 After changing diapers or clean his poop 1=yes 2=No [___] ECS5 3205 Before preparing and handling food 1=yes 2=No [___] ECS5 3206 After a child has crawled 1=yes 2=No [___] ECS5 3297 Other specify 1 = yes -- P32a 2=No [___] ECS5 32A 32A. Specify other Otro15 Conditional (jump other) 112 ECS2F19 Conditional (do not know jump) ECS5 3298 97. Do not know 1=yes 2=No [___] 31. What forms do you known to purify water? DO NOT READ LIST. WRITE ALL THAT SAID Check the boxes of the answers. READ NO OPTIONS WHEN THERE ARE NO MORE ANSWERS MENTIONED score 2 in boxes ABOVE AND GO TO NEXT QUESTION Codes of answers: 1 = Yes, 2 = not mentioned above ECS5 3301 Strain or filter water 1=yes 2=No [___] ECS5 3302 Boil 1=yes 2=No [___] ECS5 3303 Treat with chlorine 1=yes 2=No [___] ECS5 3304 SODIS method (solar) 1=yes 2=No [___] ECS5 3305 Iodine 1=yes 2=No [___] ECS5 3306 Nothing 1=yes 2=No [___] ECS5 3397 Other, specify 1 = yes -- P33a 2=No [___] ECS5 33A 33A. Specify other Otro16 Conditional (jump other) ECS2F20 Conditional (do not know jump) ECS5 3398 97. Do not know 1=yes 2=No [___] 113 Household Surveys – Section 1 Metadata SECTION: Metadata start survey BASELINE QUESTIONNAIRE 2010 SECTION 1: Members of the family BASELINE QUESTIONNAIRE - 2010 QUESTION CÓDE QUESTION RESPONSE CODE HOMECODE Say Có home [__ | __ | __ | __] [__ | __ | __ | __] [__ | __ | __ | __] [__ | __] MUNICIPALITY CODE COMMUNITY CODE SECTOR CODE HOUSEHOLD number. CODENC SURVEY Code [__ | __ | __ | __] MI01 1. HOUSEHOLD number. [__ | __] MI02 2. Monitor code [__] MI03 3. EDITOR CODE [__] MI04 4. INTERVIEWER CODE [__ | __] MI05 5. CONVERGENCE CENTER CODE [__ | __ | __ | __] MI06 6. HOME MUNICIPALITY LOCATION? [__ | __ | __ | __] MI0 7 7. HOME COMMUNITY LOCATION? [__ | __ | __ | __] MI08 8. HOME SECTOR LOCATION? [__ | __ | __ | __] Interview information Visit number A. 1 st B. 2 nd C. 3 rd MI0 9 9. DATE OF INTERVIEW [__ | __] [__ | __] [__ | __] [__ | __] [__ | __] [__ | __] gave to month gave to month gave to month MI10 10. START TIME OF THE VISIT (24 hour format) [__: __] [__: __] [__: __] Min Time Min Time Min Time MI11 11. INTERVIEWER MUST OCCUR AND ORDER ACCEPTANCE OF MOTHER OR RESPONDENT 1 = Accepts answer questions 2 = accept answer questions not want to answer the questions. You can not continue the interview in this house, talk to your supervisor. MI12 12. TYPE THE NAME OF THE MOTHER OF THE SAMPLE _______________________________________ 114 A. COLLECT INFORMATION IN THIS SECTION ON NUCLEAR FAMILY MEMBERS B. COMPLETE THIS SECTION IN EVERY FAMILY SAMPLE C. QUESTIONS TO THE MOTHER OF THE SAMPLE I need to list the names of all the people in their family Ms [NAME OF MOTHER SHOWS], including their children / as, stepchildren / as, stepchildren / as, or adopted / as, and the father of them / as (if dad), who live in this house. 1 Please, list game gave the names of all members of the nuclear family? Complete the list before moving on to the next question LIST OF MEMBERS OF THE NUCLEAR FAMILY # FIRST NAME SECOND NAME LAST NAME LAST NAME PERSONAL IDENTIFICATION CODE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 No 01 MEMBER IN THE FAMILY MEMBERSHIP LIST PERSONAL IDENTIFICATION CODE QUESTION CODE QUESTIONS CODE ANSWER S102M01 2 ¿[NAME # 1] is male or female? 1 = M 2 = F [__] S103M01 3 Wha l is the relationship of [NAME # 1] with the head / a family? 1 = Head / a family 2 = couple of head 3 = Son or daughter 4 = Parent 5 = Brother / sister 6 = Uncle / 7 = Cousin / 8 = Nephew / 9 = Grandfather / Grand mother 10 = Grandson / Grand sister 11 = Brother in law / sister in law 12 = Father in law / mother 13 = Son / Daughter 14 = Stepson / a 15 = Other relative 16 = Other relative 98 = Do not know [__] S104M01 4 how old is [NAME # 1]? 00 = less than 1 year or 95 = 95 or more [__] [__] S105 M01 5 The age of [NAME # 1], 1 = 0 to 6 an OS [__] 115 is: S106 M01 6 Who? N is the caretaker of [NAME # 1]? DO NOT READ OUT, ONLY READ ALOUD When in doubt 88 = Passed 66 = Not living at home WRITE PERSONAL IDENTIFICATION NUMBER [__] [__] [__] [__] [__] [__] [__] [__] S107 M01 7 Who? N is the biological mother of [name # 1]? DO NOT READ OUT, ONLY READ ALOUD When in doubt 88 = Passed 66 = Not living at home WRITE PERSONAL IDENTIFICATION NUMBER [__] [__] [__] [__] [__] [__] [__] [__] S108 M01 8 Who? N is the biological father of [name # 1]? DO NOT READ OUT, ONLY READ ALOUD When in doubt 88 = Passed 66 = Not living at home WRITE PERSONAL IDENTIFICATION NUMBER [__] [__] [__] [__] [__] [__] [__] [__] S109M01 9 date of birth of [NAME # 1]? WRITE WHAT IT SAYS ON THE DATE THE REAL MOTHER WRITE Tell, month, and year Enter "98" if there is no day or month. Enter "9998" MISSING YEAR. [__ | __] Gave a [__ | __] Months [__ | __ | __ | __] Year S110M01 10 Do you have a vaccination card to confirm the date of birth of [NAME # 1]? 1 = Yes 2 = No P11b [__] S111AM01 11th Do I see the vaccination card? 1 = Yes, and the date is the same date P12 2 = Yes, but it is date P11b 3 = No P11b S111 BM01 11b Do you have another document to confirm the date of birth [NAME # 1]? 1 = Yes 2 = No P12 [__] S111C M01 11c What is the other document to confirm the date of birth [NAME # 1]? 1 = P12 2 = P12 Carné 3 = P12 Ballot 4 = P12 Certification 7 = other document P11D [__] S111D M01 11d Other, Specify ______________ [__] S112M01 12 How many months has [NAME # 1]? Number. months [__] S113M01 13 ¿[NAME # 1] is less than 60 months? 1 = Yes p14 and note for anthropometry 2 = No P23 [__ | __] S114M01 14 ¿[NAME # 1] is less than 24 months? 1 = Yes P23 and note to sections aimed at <24m 2 = No P23 [__] AM01 S114 14th ¿[NAME # 1] is the mother's home or is a carer? 1 = Yes P15 2 = No P23 S11 5M01 15 What is the status of [NAME # 1]? 1 = Kingdom / a 2 = Married / a 3 = Separated / divorced ao / a 4 = Widowed / a [__] 116 5 = Single / a 7 = Other 8 = Do not know S11 6M01 16 What Indian group belongs [NAME # 1]? 1 = Maya 2 = Ladinos 7 = A P16a 8 = Do not know [__] S11 6AM01 16th other Specify ________________________ [__] S11 7M01 17 What language does speak [NAME # 1] at home? 1 = not yet spoken P23 2 = Spanish P20 3 = Speak another language 4 = Q'eqchi ' 5 = Poqomchi 8 = Do not know [__] S11 8M01 18 ¿[NAME # 1] understand Spanish? 1 = Yes 2 = No [__] S11 9M01 19 ¿[NAME # 1] speaks Spanish? 1 = Yes 2 = No [__] S1 20M01 20 besides Spanish, does [NAME # 1] know another language? 1 = Yes P20a 2 = No [__] S1 20AM01 20th Wich? 1 = not talking yet 2 = Spanish 3 = Speak another language 4 = Q'eqchi ' 5 = Poqomchi 8 = Do not know [__] S1 21M01 21 ¿[NAME # 1] can read in Spanish? 1 = Yes 2 = No [__] S1 22M01 22 ¿[NAME # 1] can read in Q'eqchi '? 1 = Yes 2 = No [__] S1 23M01 23 INFORMATION Shortness of another family? 1 = Yes 2 = No P24 [__] So that we are sure that the list is complete S1 24M01 24 Are there other people (whether children or adults) who have not been listed, which are part of the family and live at home? 1 = Yes return to the last row that filled in the initial list and then fill from question 2 for people who needed 2 = No [__] S125 M01 25 How many mothers (guardians and mothers) there with children / as under 60 months? [___ | ___] MOTHERS # OF TIMES APPLICABLE SECTION 4 AND # OF PEOPLE IN SECTION 11 (ANTHROPOMETRY MOTHER) S125A M01 25a How Many mothers (guardians and mothers) there with children / as less than 24 months? [___ | ___] MOTHERS # OF TIMES APPLICABLE SECTION 4 S126 M01 26 How many boys / girls under 60 months there? [___ | ___] CHILDREN # OF PEOPLE IN SECTION 10 (ANTHROPOMETRY CHILDREN) S127 27 How Many boys / girls [___ | ___] CHILDREN 117 M01 under 24 months there? # OF TIMES MUST apply Sections 5, 6, 7, and 8 ACTIVE FILTER FOR DISTINGUISHING HOMES S128 28 Does anyone in the family who is currently receiving PROCOMIDA program? 1 = Yes pass the section 12 PROCOMIDA food consumption. 2 = No [__] FILTER FOR DISTINGUISHING households participating in another program S129 29 Is anyone in the family participating in some other project INSTITUTION? 1 = Yes pass Section 13 of the presence of other projects. 2 = No [__] 118 Household Surveys – Sections 2 and 3 Dietary Diversity and Food Security SECTION 2: Dietary Diversity Household BASELINE QUESTIONNAIRE - 2010 SECTION 3: Food Security BASELINE QUESTIONNAIRE - 2010 S2 CODENC SURVEY CODE [__ | __ | __ | __] S2CODPER PERSONAL IDENTIFICATION CODE the cook more often in the nuclear family [__ | __ | __ | __ | __ | __] A. THESE QUESTIONS GATHER INFORMATION ON THE family dietary diversity during the day and last night. B. COMPLETE THIS SECTION IN EVERY FAMILY SAMPLE C. QUESTIONS TO THE PERSON MOST OFTEN IN KITCHEN HOUSE (MUST BE PART OF THE NUCLEAR FAMILY): [NAME OF PERSON IN KITCHEN HOUSE FREQUENTLY]. S201 1 Who? Nuclear family n kitchen more often? PERSON TO BE PART OF THE NUCLEAR FAMILY WRITE NAME _____________ S202 2 Is this [NAME OF PERSON KITCHEN]? 1 = Yes → Continue with the interview 2 = No → ask when will you return? and appointment [__] Now I would like to ask some questions [NAME OF PERSON KITCHEN] on the types of food that you or any member of his family ate during the day and last night. READ THE LIST OF FOODS. MUST COMPLETE LIST AND ASK FOR ALL FOOD. DO NOT MODIFY THE QUESTIONS. The answer is "yes" if a household member APPOINTED EAT FOOD. THE ANSWER IS "NO" IF no household member APPOINTED ATE THE FOOD. QUESTION CODE READ LIST OF FOOD CODE ANSWER You ate [FOOD], during the day and last night S2A A Some Bread, tortillas, pasta, rice, crackers or other food made from sorghum, maize, rice, or wheat? 1 = Yes 2 = No [___] S2B B Zuccini, carrots, squash, sweet potatoes or other vegetables that are yellow or orange inside? 1 = Yes 2 = No [___] S2C C Potatoes, Taro, cassava, or any other food ichíntal from roots or tubers? 1 = Yes 2 = No [___] S2D D ? Dark green leafy vegetables such as cassava leaves, bean leaves, kale, spinach, pepper? 1 = Yes 2 = No [___] S2E E Do other vegetables? 1 = Yes 2 = No [___] S2F F Yellow or orange fruits? Inside and ripe mangoes, ripe papayas, sapota Melo? 1 = Yes 2 = No [___] S2G G Any other fruit? 1 = Yes 2 = No [___] S2H H ? Beef, pork, lamb, goat, rabbit, wild game, chicken, duck or other poultry, liver, kidney, heart or other giblets? 1 = Yes 2 = No [___] S2I I Eggs? 1 = Yes 2 = No [___] S2J J Fish or shellfish? Fresh, fried, or dried? 1 = Yes 2 = No [___] S2K K Food? Like beans, peas, lentils, beans or nuts? 1 = Yes 2 = No [___] S2L L Cheese, cottage cheese, cream, yogurt 1 = Yes 2 = No [___] 119 or other foods made from milk? S2M M Did you use and / or given oil, margarine, shortening, butter or foods with these things? 1 = Yes 2 = No [___] S2N N Sugar or honey? 1 = Yes 2 = No [___] S2O O Do other foods, such as condiments, coffee, tea? 1 = Yes 2 = No [___] A. GATHER THESE QUESTIONS ON FOOD SAFETY INFORMATION FAMILY IN THE LAST 4 WEEKS B. COMPLETE THIS SECTION IN EVERY FAMILY N SAMPLE C. QUESTIONS TO THE PERSON MOST OFTEN IN KITCHEN HOUSE: [NAME OF PERSON IN KITCHEN HOUSE FREQUENTLY]. Now I would like to ask some questions [NAME OF PERSON KITCHEN] about what happened in the past 4 weeks. QUESTION CODE QUESTION CODE ANSWER S301 1 In last four weeks, there was ever anything or absolutely any food, whether for lunch, breakfast or dinner in your home due to lack of money to buy them? 1 = Yes 2 = No → P2 [___] S301A 1A How many times someone has this happened? READ NO OPTIONS 1 = Rarely (1 or 2 times in the last 4 weeks) 2 = Sometimes (3 to 10 times in the last 4 weeks) 3 = Often (more than 10 times in the last 4 weeks) [___] S302 2 In last four weeks, did you or any member of the family went to sleep at night hungry because there was not enough food? 1 = Yes 2 = No → P3 [___] S302A 2A How many times someone has this happened? READ NO OPTIONS 1 = Rarely (1 or 2 times in the last 4 weeks) 2 = Sometimes (3 to 10 times in the last 4 weeks) 3 = Often (more than 10 times in the last 4 weeks) [___] S303 3 In last four weeks, did you or any household member go a whole day without eating anything because there was not enough food? 1 = Yes 2 = No → Next section [___] S303A 3A How many times someone has this happened? READ NO OPTIONS 1 = Rarely (1 or 2 times in the last 4 weeks) 2 = Sometimes (3 to 10 times in the last 4 weeks) 3 = Often (more than 10 times in the last 4 weeks) [___] 120 121 Household Surveys – Section 4 Knowledge of Mother S4CODENC [__ | __] [__ | __ | __ | __] A. These questions are about KNOWLEDGE OF THE MOTHER OF CHILDREN UNDER 24 MONTHS. B. PDA FILTER: Is there a child under 24 months old? 1. → CONTINUE IF, 2. NO → NEXT SECTION C. QUESTIONS TO THE MOTHER OF A CHILD UNDER 24 MONTHS: [NAME OF THE MOTHER OF THE CHILD / A] Now I would like to ask some questions [NAME OF MOTHER CHILD] on how to care for the health of mothers and their children QUESTION CODE QUESTION ANSWER Code ANSWER 1 Occasionally pregnant women require immediate medical attention (a doctor or nurse). Do you know what are the warning signs (symptoms) that tell a pregnant woman should receive immediate medical attention? DO NOT READ LIST. DO NOT MENTION ANY DANGER SIGNS (SYMPTOM) WRITE ONLY SIGNS (SYMPTOMS) MENTIONED WITHOUT READING. WHEN THE MOTHER FINISHES MENTIONING SIGNS, -> PROBE: ANY OTHER SIGN? WHEN THERE ARE NO MORE SIGNS MENTIONED, MARK A 2 IN THE SIGNS NOT MENTIONED AND GO TO QUESTION 2 Response code: 1 = Yes, 2 = not mentioned S401A 1a Hemorrhage or vaginal bleeding 1 = Yes 2 = No [___] S401B 1b Severe pain in the stomach 1 = Yes 2 = No [___] S401C 1c Persistent back pain 1 = Yes 2 = No [___] S401D 1d Leakage of clear fluid out through the vagina (leakage of amniotic fluid) 1 = Yes 2 = No [___] S401E 1e Puffiness of hands, face, or body 1 = Yes 2 = No [___] S401F 1f Severe headache or blurred vision 1 = Yes 2 = No [___] S401G 1g Continuous contractions before 37 weeks 1 = Yes 2 = No [___] S401H 1h No fetal movement in pregnancies of 5 months and older 1 = Yes 2 = No [___] S401i 1i Breathing is difficult 1 = Yes 2 = No [___] 2 Occasionally the children will suffer from severe illnesses that require immediate medical attention (from a doctor or nurse). Do you know what the warning signs 122 (symptoms) are that indicate that a newborn child should receive medical attention? DO NOT READ LIST. DO NOT MENTION ANY DANGER SIGNS (SYMPTOM) WRITE ONLY SIGNS (SYMPTOMS) MENTIONED WITHOUT READING. WHEN THE MOTHER FINISHES MENTIONING SIGNS, -> PROBE: ANY OTHER SIGN? WHEN THERE ARE NO MORE SIGNS MENTIONED, MARK A 2 IN THE SIGNS NOT MENTIONED AND GO TO QUESTION 3 Response codes: 1 = Yes, 2 = not mentioned S402A 2a It is very small 1 = Yes 2 = No [___] S402B 2b It is very cold 1 = Yes 2 = No [___] S402C 2c It is purple 1 = Yes 2 = No [___] S402D 2d Breathing is difficult 1 = Yes 2 = No [___] S402E 2e It cannot breastfeed 1 = Yes 2 = No [___] S402F 2f It is very hot or feverish 1 = Yes 2 = No [___] S402G 2g It has red eyes with secretions 1 = Yes 2 = No [___] S402H 2h Red navel, extending to the skin, with bad odor and pus 1 = Yes 2 = No [___] 3 Occasionally the children will suffer from severe illnesses that require immediate medical attention (from a doctor or nurse). Do you know what are the warning signs (symptoms) that indicate that a child should receive immediate medical attention? DO NOT READ LIST. DO NOT MENTION ANY DANGER SIGNS (SYMPTOM) WRITE ONLY SIGNS (SYMPTOMS) MENTIONED WITHOUT READING. WHEN THE MOTHER FINISHES MENTIONING SIGNS, -> PROBE: ANY OTHER SIGN? WHEN THERE ARE NO MORE SIGNS MENTIONED, MARK A 2 IN THE SIGNS NOT MENTIONED AND GO TO QUESTION 4 Response codes: 1 = Yes, 2 = not mentioned S403A 3a It cannot breastfeed, take in liquids or eat 1 = Yes 2 = No [___] S403B 3b No improvement or becomes more ill 1 = Yes 2 = No [___] S403C 3c Fever 1 = Yes 2 = No [___] S403D 3d Fast breathing 1 = Yes 2 = No [___] S403E 3e Shortness of breath, difficult breathing 1 = Yes 2 = No [___] S403F 3f Blood in the stool (bowel movement) 1 = Yes 2 = No [___] S403G 3g Vomits everything 1 = Yes 2 = No [___] S403H 3h Has attacks 1 = Yes 2 = No [___] S403I 3i Faints 1 = Yes 2 = No [___] 123 S404 4 Do you think that when a child is sick, should it be given less food, same amount, or more than usual? DO NOT READ OPTIONS 1 = Less than usual 2 = the same amount 3 = More than usual 8 = Do not know [___] S405 5 Do you think that when a Nin or / is sick / a, should be given less fluids, the same amount or more than usual? DO NOT READ OPTIONS 1 = Less than usual 2 = the same amount 3 = More than usual 8 = Do not know [___] S406 6 Do you think that when a Nin or / a is recovering from an illness, should be given less food, same amount, or more than usual? DO NOT READ OPTIONS 1 = Less than usual 2 = the same amount 3 = More than usual 8 = Do not know [___] 7 In addition to what I mentioned about food and fluids [MENTION Answers Questions 4 and 5], when the child is sick, what else should a mother do when a (a) child / has diarrhea WRITE ALL ANSWERS THAT THE MOTHER MENTIONS CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOTMENTIONED AND GO TO QUESTION 8 Response codes: 1 = Yes, 2 = not mentioned S40701 1) Oral Rehydration Salts (ORS) 1 = Yes 2 = No [___] S40702 2) Home made rehydration serum 1 = Yes 2 = No [___] S40703 3) Continue to breastfeed 1 = Yes 2 = No [___] 124 S40704 4) Breastfeed more than normal 1 = Yes 2 = No [___] S40705 5) Give syrups 1 = Yes 2 = No [___] S40706 6) Give traditional medicine 1 = Yes 2 = No [___] S40707 7) Give boiled, chlorinated or bottled water 1 = Yes 2 = No [___] S40708 8) Give carrot juice or rice water 1 = Yes 2 = No [___] S40709 9) Nothing 1 = Yes 2 = No [___] S40710 10) Take you to a health center 1 = Yes 2 = No [___] S40711 11) Breastfeed less than usual 1 = Yes 2 = No [___] S40797 97) Other, specify 1 = Yes P7a 2 = No [___] S40798 98) Do not know 1 = Yes 2 = No [___] S407A 7a Specify other ________________ [___] S408 8 Have you heard talk about a product called serum (Oral Rehydration Salts ORS-) which is available for the treatment of diarrhea? 1 = Yes 2 = No [___] S408A 8a Have you ever seen an envelope like this one? SHOW THE ORS ENVELOPE 1 = Yes 2 = No [___] 11 What can a mother do to prevent diarrhea in children? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOTMENTIONED AND GO TO QUESTION 12 Response codes: 1 = Yes, 2 = not mentioned S41101 1) Wash hands 1 = Yes 2 = No [___] S41102 2) Keep their nails short 1 = Yes 2 = No [___] S41103 3) The child must wear 1 = Yes 2 = No [___] 125 pants S41104 4) Wash fruits and vegetables 1 = Yes 2 = No [___] S41105 5) Child should wear sandals or shoes 1 = Yes 2 = No [___] S41106 6) Giving the children boiled, SODIS, bottled or chlorinated water 1 = Yes 2 = No [___] S41107 7) Keep the child’s clothes clean 1 = Yes 2 = No [___] S41108 8) Don’t have children sit on the floor 1 = Yes 2 = No [___] S41109 9) Don’t have children play with water 1 = Yes 2 = No [___] S41197 97) Other, specify 1 = Yes 2 = No [___] S41198 98) Do not know 1 = Yes 2 = No [___] S411A 11th Specify other ________________ [___] S412 12 After the baby is born, within what timeframe should it breastfeed the first time? READ NO OPTIONS 1 = Immediately 2 = Less than one hour 3 = More than one hour but less than 8 hours 4 = More than 8 hours but less than 24 hours 5 = One day 6 = More than a day 7 = Other, P12a 8 = Do not know | ___] S412A 12a Specify other ________________ [___] 13 What should a mother do with the first milk or colostrum? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 14 Response codes: 1 = Yes, 2 = not mentioned S41301 1) Throw it away and start breastfeeding later 1 = Yes 2 = No [___] S41302 2) Breastfeed 1 = Yes 2 = No [___] S41307 7) Other, specify 1 = Yes 2 = No [___] S41308 8) Do not know 1 = Yes 2 = No [___] S413A 13a Specify other ________________ [___] 14 What happens to a (a) baby if a mother gives colostrum (or first milk)? WRITE ALL THE ANSWERS. 126 CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 15 Response codes: 1 = Yes, 2 = not mentioned S41401 1) Baby gets nutrients 1 = Yes 2 = No [___] S41402 2) Baby gets sick 1 = Yes 2 = No [___] S41403 3) It helps baby to be more healthy 1 = Yes 2 = No [___] S41404 4) will increase baby’s defenses 1 = Yes 2 = No [___] S41405 5) It will make the baby fat 1 = Yes 2 = No [___] S41406 6) Nothing 1 = Yes 2 = No [___] S41407 7) Other, specify 1 = Yes 2 = No [___] S41408 8) Do not know 1 = Yes 2 = No [___] S414A 14a Specify other ________________ [___] 15 Do you know when a mother should breastfeed a baby? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 17 Response codes: 1 = Yes, 2 = not mentioned S41501 1) When the baby wants 1 = Yes 2 = No [___] S41502 2) When she sees that the baby is hungry 1 = Yes 2 = No [___] S41503 3) When the baby cries 1 = Yes 2 = No [___] S41504 4) When the baby searches the breast 1 = Yes 2 = No [___] S41507 7) Other, specify 1 = Yes 2 = No [___] S41508 8) Do not know 1 = Yes 2 = No [___] S415A 15a Specify other ________________ [___] 17 If a mother of a baby under 6 months does not have or think does not have enough milk, what should she do? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 18 Response codes: 1 = Yes, 2 = not mentioned S41701 1) Breastfeed more frequently 1 = Yes 2 = No [___] 127 S41702 2) Give other liquids or foods 1 = Yes 2 = No [___] S41703 3) The mother needs to take more water 1 = Yes 2 = No [___] S41704 4) The mother should eat more 1 = Yes 2 = No [___] S41705 5) The mother should eat better 1 = Yes 2 = No [___] S41706 6) The mother should drink liquids 1 = Yes 2 = No [___] S41707 7) Other, specify 1 = Yes 2 = No [___] S41708 8) Do not know 1 = Yes 2 = No [___] S417A 17a Specify other ________________ [___] S418 18 Can you give water to children under 6 months of age? 1 = Yes 2 = No 8 = Do not know | ___] S419 19 Can you give other liquids to children under 6 months of age in addition to breast milk? 1 = Yes 2 = No 8 = Do not know | ___] S420 20 Do you think a mother who is breastfeeding a child under 6 months should stop breastfeeding if she becomes pregnant again? 1 = Yes 2 = No 8 = Do not know | ___] 21 If a mother has a child younger than 6 months and cannot always be with the baby, what can be given to the baby when it gets hungry? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 22 Response codes: 1 = Yes, 2 = not mentioned S42101 1) Extracted breast milk 1 = Yes 2 = No [___] S42102 2) Milk pot 1 = Yes 2 = No [___] S42103 3) Cow milk 1 = Yes 2 = No [___] S42104 4) special formula milk for baby s 1 = Yes 2 = No [___] 128 S42105 5) Atol (porridge) 1 = Yes 2 = No [___] S42106 6) Pan 1 = Yes 2 = No [___] S42107 7) Fruit 1 = Yes 2 = No [___] S42108 8) Tortilla 1 = Yes 2 = No [___] S4210 9 9) Water mass 1 = Yes 2 = No [___] S42197 97) Other, specify 1 = Yes 2 = No [___] S42198 98) Do not know 1 = Yes 2 = No [___] S421A 21a Specify other ________________ [___] S422 22 Besides breast milk, At what age should you start feeding and food (on) baby? WRITE THE ANSWER IN MONTHS. 98 = DO NOT KNOW [_ 0__ | 6___] 23 Besides breast milk what should be the first foods you should give a (a) baby? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 25 response codes: 1 = Yes, 2 = not mentioned S42301 1) Porridge (including Incaparina and Vitacereal) 1 = Yes 2 = No [___] S42302 2) Fruit 1 = Yes 2 = No [___] S42303 3) Vegetables 1 = Yes 2 = No [___] S42304 4) Beans 1 = Yes 2 = No [___] S42305 5) Rice 1 = Yes 2 = No [___] S42306 6) Tortilla 1 = Yes 2 = No [___] S42307 7) Cereals 1 = Yes 2 = No [___] S42308 8) Eggs 1 = Yes 2 = No [___] S42309 9) Soup / Broth 1 = Yes 2 = No [___] S42397 97) Other, specify 1 = Yes 2 = No [___] S42398 98) Do not know 1 = Yes 2 = No [___] S423A 23a Specify other ________________ [___] 25 Do you know for what reasons a mother may stop breastfeeding a baby? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 27 response codes: 1 = Yes, 2 = not mentioned S42501 1) cracked nipples 1 = Yes 2 = No [___] S42502 2) Pregnancy 1 = Yes 2 = No [___] S42503 3) The birth of 1 = Yes 2 = No [___] 129 another baby S42504 4) Baby’s interests in other foods 1 = Yes 2 = No [___] S42505 5) Illness of mother 1 = Yes 2 = No [___] S42506 6) Strong feelings of the mother (which can be passed to her baby) 1 = Yes 2 = No [___] S42507 7) Mastitis 1 = Yes 2 = No [___] S42508 8) The baby is big 1 = Yes 2 = No [___] S42509 9) The baby does not want to 1 = Yes 2 = No [___] S42597 97) Other, specify 1 = Yes P25a 2 = No [___] S42598 98) Do not know 1 = Yes 2 = No [___] S425A 25a Specify other ________________ [___] S427 27 Do you know till what age a mother should continue to breastfeed a baby? READ NO OPTIONS WRITE ANSWER IN MONTHS WRITE # OF MONTHS (0 to 95) 96 = Until the baby stops asking 97 = Other → P27a 98 = Do not know | ___ | ___] S427A 27a Specify other ________________ [___] S428 28 Do you know if there is any reason why an infant under six months receives only breast milk? 1 = Yes 2 = No → P30 8 = Do not know → P30 | ___] 29 What are the reasons? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 30 response codes: 1 = Yes, 2 = not mentioned S42901 1) Protect the baby from illness 1 = Yes 2 = No [___] S42902 2) To help the baby grow better 1 = Yes 2 = No [___] 130 S42903 3) Breast milk contains everything a baby needs in the first 6 months 1 = Yes 2 = No [___] S42904 4) Mothers are less likely to become pregnant 1 = Yes 2 = No [___] S42905 5) Withholds the mothers period 1 = Yes 2 = No [___] S42906 6) breast milk is clean, safe, and convenient 1 = Yes 2 = No [___] S42907 7) breast milk is economical 1 = Yes 2 = No [___] S42908 8) Reduce the medical bills 1 = Yes 2 = No [___] S42997 97) Other, specify 1 = Yes 2 = No [___] S42998 98) Do not know 1 = Yes 2 = No [___] S429A 29a Specify other ________________ [___] 30 Who decides when your child starts eating solid food, either whole or in pieces? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 31 response codes: 1 = Yes, 2 = not mentioned S43001 1) The child 1 = Yes 2 = No [___] S43002 2) The mother 1 = Yes 2 = No [___] S43003 3) Midwife 1 = Yes 2 = No [___] S43004 4) Mother in law 1 = Yes 2 = No [___] S43005 5) Spouse 1 = Yes 2 = No [___] S43007 7) Other, specify 1 = Yes P30A 2 = No [___] S43008 8) Do not know 1 = Yes 2 = No [___] S430A 30a Specify other ________________ [___] S431 31 If a mother is ill (eg influenza, diarrhea, or cough) and has a baby less than two years, can she continue to breastfeed? 1 = Yes 2 = No 8 = Do not know | ___] S432 32 Do you know if a child under 1 = Yes 2 = No | ___] 131 12 months can eat without help? 8 = Do not know S433A 33a Besides breast milk, At what age should you start giving a baby liquids? IF ANSWER IS IN YEARS, CONVERT TO MONTHS WRITE THE ANSWER IN MONTHS 96 = When it wants 98 = Do not know [___ | ___] S433B 33b Besides breast milk, At what age can a baby eat soft foods? IF ANSWER IS IN YEARS, CONVERT TO MONTHS WRITE ANSWER IN MONTHS 96 = When it wants 98 = Do not know [___ | ___] S433C 33c Besides breast milk, At what age can a baby eat the same foods as the family eats? IF ANSWER IS IN YEARS, CONVERT TO MONTHS WRITE ANSWER IN MONTHS 96 = When it wants 98 = Do not know [___ | ___] S434 34 How many times should a child of 6-8 months eat per day? 1 = # of times → P34a 2 =Meals and snacks → P34b 8 = Do not know → P35 | ___] Enter "1" in question 34 IF# OF TIMES IS ANSWERED. SKIP TO 34a AND RECORD TOTAL MEALS. Enter "2" IF ANSWER TO QUESTION 34 was given in meals and snacks. SKIP TO QUESTION 34b and enter total MEALS and 34c the TOTAL SNACKS. S434A 34a TOTAL: # TIMES per day AFTER RESPONSE → P35 | ___] S434B 34b MEALS: TOTAL # PER DAY | ___] S434C 34c SNACKS: TOTAL # PER DAY | ___] S435 35 During each meal, how much food you give to a child of 6-8 months? SHOW MEASURING CUP FOR ANSWER READ NO 1 = 1/4 cup 2 = 1/2 cup 3 = 3/4 cup 4 = 1 cup 7 = Other, specify. P35A 8 = Do not know | ___] 132 OPTIONS S435A 35a Specify other ________________ [___] S440 40 How many times you should a child 9 to 11 months eat per day? 1 = # of times → P40A 2 =Meals and snacks →P40B 8 = Do not know → Q41 | ___] Enter "1" in question 40 IF# OF TIMES IS ANSWERED. SKIP TO 40a AND RECORD TOTAL MEALS. Enter "2" IF ANSWER TO QUESTION 40 was given in meals and snacks. SKIP TO QUESTION 40b and enter total MEALS and 40c the TOTAL SNACKS. S440A 40a TOTAL: # TIMES per day AFTER RESPONSE → P41 | ___] S440B 40b MEALS: TOTAL # PER DAY | ___] S440C 40c SNACKS: TOTAL # PER DAY | ___] S441 41 During each meal, how much food you give to a child 9 to 11 months? SHOW MEASURING CUP FOR ANSWER READ NO OPTIONS 1 = 1/4 cup 2 = 1/2 cup 3 = 3/4 cup 4 = 1 cup 7 = Other, → P41a 8 = Do not know | ___] S441A 41a Specify other ________________ [___] S446 46 How many times should a child / a 12 to 24 months eat per day? 1 = # of times 2 = Parts → P46a and P46b luncheons → 8 = Do not know → P47 | ___] Enter "1" in question 46 IF# OF TIMES IS ANSWERED. SKIP TO 46a AND RECORD TOTAL MEALS. Enter "2" IF ANSWER TO QUESTION 46 was given in meals and snacks. SKIP TO QUESTION 46b and enter total MEALS and 46c the TOTAL SNACKS. S446A 46a TOTAL: # TIMES Tell RESPONSE AFTER WRITE, SKIP TO P47 | ___] S446B 46b TIMES FOOD # Tell | ___] S446C 46c PARTS: # of times gave | ___] S447 47 During each meal, how much food you give to a child 12 to 24 months? SHOW MEASURING CUP FOR ANSWER READ NO OPTIONS 1 = 1/4 cup 2 = 1/2 cup 3 = 3/4 cup 4 = 1 cup 7 = Other, specify → P47a 8 = Do not know | ___] 133 S4 47TH 47a Specify other ________________ [___] 50 What could happen to a (a) child (a) do not have enough iron (in your diet or through iron supplements)? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 51 response codes: 1 = Yes, 2 = not mentioned S45001 1) disorder or learning disabilities 1 = Yes 2 = No [___] S45002 2) Inadequate mental development 1 = Yes 2 = No [___] S45003 3) Inadequate physical development 1 = Yes 2 = No [___] S45004 4) Short stature 1 = Yes 2 = No [___] S45005 5) low defenses against diseases 1 = Yes 2 = No [___] S45006 6) Feeling tired 1 = Yes 2 = No [___] S45007 7) Can be anemic 1 = Yes 2 = No [___] S45097 97) Other, specify 1 = Yes 2 = No [___] S45098 98) Do not know 1 = Yes 2 = No [___] S450A 50a Specify other ________________ [___] 51 Do you know some foods that contain vitamin A? (Nutrient that protects the body against disease.) WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 52 response codes: 1 = Yes, 2 = not mentioned S45101 1) orange or yellow fruits and vegetables 1 = Yes 2 = No [___] S45102 2) Green leaves 1 = Yes 2 = No [___] S45103 3) Eggs 1 = Yes 2 = No [___] S45104 4) Liver 1 = Yes 2 = No [___] S45105 5) Breast milk 1 = Yes 2 = No [___] S45106 6) Cow milk 1 = Yes 2 = No [___] S45107 7) Meat 1 = Yes 2 = No [___] S45108 8) Noodles 1 = Yes 2 = No [___] S45109 9) Vegetables (non orange 1 = Yes 2 = No [___] 134 colored) S45197 97) Other, specify 1 = Yes 2 = No [___] S45198 98) Do not know 1 = Yes 2 = No [___] S451A 51a Specify other ________________ [___] S452 52 Do you know if the salt is fortified with some vitamins or minerals? 1 = Yes 2 = No → P53 8 = Do not know → P53 | ___] 52a Which? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 53 response codes: 1 = Yes, 2 = not mentioned S452A01 1) Iodine 1 = Yes 2 = No [___] S452A02 2) Vitamin A 1 = Yes 2 = No [___] S452A03 3) Iron 1 = Yes 2 = No [___] S452A04 4) Fluor 1 = Yes 2 = No [___] S452A07 7) Other, specify 1 = Yes P52B 2 = No [___] S452A08 8) Do not know 1 = Yes 2 = No [___] S452B 52b Specify other ________________ [___] 53 How can a mother encourage her children to eat? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 55 response codes: 1 = Yes, 2 = not mentioned S45301 1) speaks to them constantly 1 = Yes 2 = No [___] S45302 2) Look at them while eating 1 = Yes 2 = No [___] S45303 3) singing and caressing 1 = Yes 2 = No [___] S45304 4) Offering different food combinations 1 = Yes 2 = No [___] S45305 5) Offering several flavors food 1 = Yes 2 = No [___] S45306 6) Offering foods of different texture 1 = Yes 2 = No [___] S45307 7) Feed them slowly and patiently 1 = Yes 2 = No [___] 135 S45308 8) Force the child to eat 1 = Yes 2 = No [___] S45309 9) Avoid distractions 1 = Yes 2 = No [___] S45397 97) Other, specify 1 = Yes P53a 2 = No [___] S45398 98) Do not know 1 = Yes 2 = No [___] S453A 53a Specify other ________________ [___] 55 What are the main causes of malnutrition in children? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 56 response codes: 1 = Yes, 2 = not mentioned S45501 1) Do not eat enough / poor appetite 1 = Yes 2 = No [___] S45502 2) Do not eat frequently 1 = Yes 2 = No [___] S45503 3) The child is sick (diarrhea, sickness, etc..) 1 = Yes 2 = No [___] S45504 4) abrupt weaning 1 = Yes 2 = No [___] S45505 5) The child is not being given food with love / affection 1 = Yes 2 = No [___] S45506 6) Do not eat balanced / Not feeding well 1 = Yes 2 = No [___] S45507 7) The food is insufficient 1 = Yes 2 = No [___] S45508 8) Lack of hygiene 1 = Yes 2 = No [___] S45597 97) Other, specify 1 = Yes P55A 2 = No [___] S45598 98) Do not know 1 = Yes 2 = No [___] S455A 55a Specify other ________________ [___] 56 When should a person wash their hands? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO QUESTION 57 response codes: 1 = Yes, 2 = not mentioned S45601 1) Before eating 1 = Yes 2 = No [___] S45602 2) After using the toilet or latrine 1 = Yes 2 = No [___] 136 S45603 3) Before giving food to the child 1 = Yes 2 = No [___] S45604 4) After changing diapers or clean his poop 1 = Yes 2 = No [___] S45605 5) Before preparing and handling food 1 = Yes 2 = No [___] S45606 6) After a child has crawled 1 = Yes 2 = No [___] S45607 7) Other, specify 1 = Yes P56a 2 = No [___] S45608 8) Do not know 1 = Yes 2 = No [___] S456A 56a Specify other ________________ [___] 57 What forms do you known to purify water? WRITE ALL THE ANSWERS. CHECK THE BOXES OF THE ANSWERS. READ NO OPTIONS DO NOT READ LIST. WHEN THERE ARE NO MORE ANSWERS MENTIONED, MARK A 2 IN THE ANSWERS NOT MENTIONED AND GO TO NEXT SECTION Có response codes: 1 = Yes, 2 = not mentioned above S45701 1) Strain or filter water 1 = Yes 2 = No [___] S45702 2) Boil 1 = Yes 2 = No [___] S45703 3) Treat with chlorine 1 = Yes 2 = No [___] S45704 4) SODIS method (solar) 1 = Yes 2 = No [___] S45705 5) Iodine 1 = Yes 2 = No [___] S45706 6) Nothing 1 = Yes 2 = No [___] S45707 7) Other, specify 1 = Yes P57a 2 = No [___] S45708 8) Do not know 1 = Yes 2 = No [___] S457A 57a Specify other ________________ [___] 137 Household Surveys – Section 5 Pre and Postnatal Health SECTION 5: pre and postnatal health BASELINE QUESTIONNAIRE -2010 - S5CODENC SURVEY CODE [__ | __ | __ | __] S5CODPER PERSONAL IDENTIFICATION CODE [__ | __ | __ | __ | __ | __] S5NM Type the name of the mother of the sample [___] S5NN Type the name of the Child Of 24 months [___] A. These questions are about health and postnatal OF THE MOTHER OF A CHILD FROM 0 TO 24 MONTHS B. PDA FILTER: IS THERE A CHILD FROM 0 TO 24 MONTHS IN THE FAMILY? 1. YES → CONTINUE, 2. NO → NEXT SECTION C. QUESTIONS TO THE MOTHER OF THE SAMPLE IF A CHILD UNDER 24 MONTHS: <% S5NM%> Now I would like to ask you to <% S5NM%> about the care provided before, during, and after the birth of <% S5NN%> QUESTION CODE QUESTION ANSWER CODE ANSWER S501 1 When you was pregnant of <% S5NN%>, you went to prenatal care? 1 = Yes 2 = No → P6 [___] 3 Where You look for prenatal care during pregnancy of <% S5NN%>? DO NOT READ LIST. When the mother finished answering polled Any other place? NO LONGER ANSWER WHEN OTHERWISE SKIP TO QUESTION 4 When Mrs. MENTION COMPLETE ANSWERS score 2 in boxes and move to P4 MENTIONED Có response codes: 1 = Yes, 2 = not mentioned above S503A 3a House of the Midwife, Vigilante or Facilitator Community Health 1 = Yes 2 = No → P3c [___] S503B 3b How many times you been? 98 = Do not know [___ | ___] S503C 3c Convergence Center 1 = Yes 2 = No → P3e [___] S503D 3d How many times you been? 98 = Do not know [___ | ___] S503E 3e Health post 1 = Yes 2 = No → P3G [___] S503F 3f How many times you been? 98 = Do not know [___ | ___] S503G 3g Health Center 1 = Yes 2 = No → P3i [___] S503H 3h How many times you been? 98 = Do not know [___ | ___] S503I 3i Public hospital 1 = Yes 2 = No → P3K [___] S503J 3j How many times you been? 98 = Do not know [___ | ___] S503K 3k IGSS (or Social Security) 1 = Yes 2 = No → P3M [___] S503L 3l How many times you been? 98 = Do not know [___ | ___] S503M 3m APROFAM 1 = Yes 2 = No → P3O [___] S503N 3n How many times you been? 98 = Do not know [___ | ___] S503O 3o Private Hospital (private or 1 = Yes 2 = No → P3q [___] 138 unique clinical-hospital) S503P 3p How many times you been? 98 = Do not know [___ | ___] S503Q 3q Private or unique clinical practice 1 = Yes 2 = No → P3s [___] S503R 3r How many times you been? 98 = Do not know [___ | ___] S503S 3s Other, specify 1 = Yes 2 = No → P4 [___] S503T 3t Other, specify ________________ [___] S503U 3u How many times you been? 98 = Do not know [___ | ___] S504 4 How many months of pregnant were you when you went to your first prenatal care? WRITE THE NUMBER OF WEEKS The maximum number is 40 WEEKS RESPOND IF MOTHER RECORD NUMBER IN MONTHS HERE TO BECOME THE MACHINE WEEKS: (MONTHS) _____ (WEEKS) _____ 98 = Do not know [___ | ___] S505 5 How many months of pregnant were you when you went to your last prenatal care? WRITE THE NUMBER OF WEEKS The maximum number is 40 WEEKS RESPOND IF MOTHER RECORD NUMBER IN MONTHS HERE TO BECOME THE MACHINE WEEKS: (MONTHS) _____ (WEEKS) _____ ANSWER THIS QUESTION AFTER PASSING A P7 98 = Do not know num ber of times [___ | ___] 6 What was the reason why you did not come to control her pregnancy <% S5NN%>? NOTE ALL THE ANSWERS. Check the boxes ANSWERS READ NO OPTIONS When Mrs. MENTION COMPLETE ANSWERS score 2 in boxes ABOVE AND GO TO Q7 Có response codes: 1 = Yes, 2 = not mentioned above S50601 1) Distance to spot 1 = Yes 2 = No [___] S50602 2) Controls at home 1 = Yes 2 = No [___] S50603 3) Lack of confidence 1 = Yes 2 = No [___] S50604 4) She think the attention is bad 1 = Yes 2 = No [___] 139 S50605 5) Long wait for attention 1 = Yes 2 = No [___] S50606 6) health facility was closed or time of attention was shortly 1 = Yes 2 = No [___] S50607 7) My husband not allowed me 1 = Yes 2 = No [___] S50608 8) The family would not let me 1 = Yes 2 = No [___] S50609 9) Cost of attention 1 = Yes 2 = No [___] S50610 10) Do not speak my language 1 = Yes 2 = No [___] S50611 11) Lack of time (homemaker) 1 = Yes 2 = No [___] S50612 12) Not a behaviour 1 = Yes 2 = No [___] S50697 97) Other, specify 1 = Yes P6a 2 = No [___] S50698 98) Do not know 1 = Yes 2 = No [___] S506A Other, specify ________________ [___] S507 7 Did you receive a visit from a midwife, doctor clinic, health guardian, or other person to help manage her pregnancy <% S5NN%>? 1 = Yes 2 = No → P8A [___] 7.1. Who? Visited and how many times did it? DO NOT READ LIST. When the mother finished answering polled Any others? NO LONGER ANSWER WHEN OTHER, AFTER PASSING TO ANSWER THIS QUESTION P8A When Mrs. MENTION COMPLETE ANSWERS score 2 in boxes ABOVE AND GO TO P8A Có response codes: 1 = Yes, 2 = not mentioned above S507A 7a Healer 1 = Yes 2 = No → P7C [___] S507B 7b How many visits had? 98 = Do not know [___ | ___] S507C 7c Guard Health 1 = Yes 2 = No → P7E [___] S507D 7d How many visits had? 98 = Do not know [___ | ___] S507E 7e Community Facilitatator 1 = Yes 2 = No → P7G [___] S507F 7f How many visits had? 98 = Do not know [___ | ___] S507G 7g Trained midwife 1 = Yes 2 = No → P7i [___] S507H 7h How many visits had? 98 = Do not know [___ | ___] S507I 7i Midwife unspecified 1 = Yes 2 = No → P7k [___] S507J 7j How many visits had? 98 = Do not know [___ | ___] S507K 7k Traditional Midwife 1 = Yes 2 = No → P7M [___] S507L 7l How many visits had? 98 = Do not know [___ | ___] S507M 7m Roving doctor 1 = Yes 2 = No → P7o [___] S507N 7n How many visits had? 98 = Do not know [___ | ___] S507O 7o Roving nurse 1 = Yes 2 = No → P7q [___] S507P 7p How many visits had? 98 = Do not know [___ | ___] S507Q 7q Health Promoter 1 = Yes 2 = No → P7s [___] 140 S507R 7r How many visits had? 98 = Do not know [___ | ___] S507S 7s Other, specify 1 = Yes 2 = No → P8A [___] S507 T 7t Specify other ________________ [___] S507 U 7u How many visits had? 98 = Do not know [___ | ___] S508A 8a When was pregnant of <% S5NN%> gave him a vaccine to a child / a not suffer tetanus (convulsions after birth)? 1 = Yes 2 = No → P9A 8 = Do not know → P9A [___] S508B 8b How many times you received the vaccine during pregnancy <% S5NN%>? AFTER PASSING THIS QUESTION ANSWER QUESTION 10 98 = Do not know [___ | ___] S509A 9a In some time before pregnancy <% S5NN%>, did you receive any tetanus vaccine to protect you or another child? 1 = Yes 2 = No → P10 8 = Do not know → Q10 [___] S509B 9b Before pregnancy <% S5NN%>, how many times have been vaccinated against tetanus? 98 = Do not know [___ | ___] S510 10 When you were pregnant with <% S5NN%>, you took iron pills or tablets, or prenatal folic acid? 1 = Yes 2 = No → P14 8 = Do not know → P14 [___] S511A 11A When you were pregnant with <% S5NN%>, you took ferrous sulfate / iron? 1 = Yes 2 = No → P12a 8 = Do not know → P12a [___] S511B 11B How often did you take iron pills during pregnancy <% S5NN%>? NOT READ OPTIONS 1 = Once a gave a 2 = 2 times per day 3 = Once a week 4 = Twice a week 7 = Other, esp. P11C 8 = Do not know [___ | S511C 11C Specify other _____________________________ S511D 11D How long did you take iron pills during pregnancy <% S5NN%>? RESPOND IF MOTHER RECORD NUMBER IN MONTHS HERE TO BECOME THE MACHINE WEEKS: (MONTHS) _____ (WEEKS) _____ RECORD NUMBER OF WEEKS (1 to 40) 98 = Do not know [___ | ___ | S512A 12A When You were pregnant with <% S5NN%>, did you take folic acid? 1 = Yes 2 = No → P13a 8 = Do not know → P13a [___] S512B 12B How often did you take folic acid tablets during pregnancy 1 = Once a gave a 2 = 2 times per day [___ | 141 <% S5NN%>? READ NO OPTIONS 3 = Once a week 4 = Twice a week 7 = Other, esp. P12C 8 = Do not know S512C 12C Specify other _____________________________ S512 D 12 D How long did you take folic acid tablets during pregnancy <% S5NN%>? RESPOND IF MOTHER RECORD NUMBER IN MONTHS HERE TO BECOME THE MACHINE WEEKS: (MONTHS) _____ (WEEKS) _____ RECORD NUMBER OF WEEKS (1 to 40) 98 = Do not know [___ | ___ | S513A 13A Did you take prenatal pills? 1 = Yes 2 = No → P15a 8 = Do not know → P15a [___] S513B 13B How often did you take prenatal pills during pregnancy <% S5NN%>? READ NO OPTIONS 1 = Once a gave a 2 = 2 times per day 3 = Once a week 4 = Twice a week 7 = Other, esp. P13C 8 = Do not know [___ | S513C 13C Specify other _____________________________ S513D 13D How long did you take prenatal pills during pregnancy <% S5NN%>? RESPOND IF MOTHER RECORD NUMBER IN MONTHS HERE TO BECOME THE MACHINE WEEKS: (MONTHS) _____ (WEEKS) _____ ANSWER THIS QUESTION AFTER PASSING P15A RECORD NUMBER OF WEEKS (1 to 40) 98 = Do not know [___ | ___ | 14 Why not take any of these things during pregnancy <% S5NN%>? NOTE ALL THE ANSWERS. Check the boxes ANSWERS READ NO OPTIONS When Mrs. MENTION COMPLETE ANSWERS score 2 in boxes ABOVE AND GO TO P15a response codes: 1 = Yes, 2 = not mentioned above S51401 1) Stomach pain 1 = Yes 2 = No [___] S51402 2) It was not available 1 = Yes 2 = No [___] S51403 3) I forgot 1 = Yes 2 = No [___] S51404 4) Believe that baby fat 1 = Yes 2 = No [___] S51405 5) It is a "hot food" 1 = Yes 2 = No [___] S51406 6) No need 1 = Yes 2 = No [___] S51407 7) Do not usually 1 = Yes 2 = No [___] S51408 8) She does not like to take medicine 1 = Yes 2 = No [___] S51409 9) Do not know that it is 1 = Yes 2 = No [___] 142 necessary S51497 97) Other, specify 1 = Yes P14a 2 = No [___] S51498 98) Do not know / no answer 1 = Yes 2 = No [___] S 514A 14 Other, specify ________________ [___] S515A 15a When You were pregnant with <% S5NN%>, was your blood pressure reviewed with this device? [PICTURE SHOW AND EXPLAIN] 1 = Yes 2 = No → P16 8 = Do not know → P16 [___ | S515B 15b How many times were your bllod pressure reviewed with this device during pregnancy <% S5NN%>? 98 = Do not know [___ | ___] 16 Who Attended You during labor <% S5NN%>? NOTE ALL THE ANSWERS. Check the boxes ANSWERS READ NO OPTIONS PROBE Anyone else? PROBE WHAT PEOPLE WERE AND CIRCLE ALL MENTIONED PERSONS MOTHER. If you mention midwife PROBE TO DETERMINE IF "trained or trained" (CAT) or "empirical" (unskilled or untrained). When Mrs. MENTION COMPLETE ANSWERS score 2 in boxes ABOVE AND GO TO P17 or P19 AS THE JUMPS response codes: 1 = Yes, 2 = not mentioned above S51601 1) Nurse 1 = Yes 2 = No [___] S51602 2) Roving Nurse 1 = Yes 2 = No [___] S51603 3) Roving Medical (Doctor) 1 = Yes 2 = No [___] S51604 4) Medical (Doctor) 1 = Yes 2 = No [___] S51605 5) trained Midwife 1 = Yes 2 = No [___] S51606 6) Healer 1 = Yes 2 = No [___] S51607 7) Guardian Health 1 = Yes 2 = No [___] S51608 8) Facilitator / a Community 1 = Yes 2 = No [___] S51609 9) Housband 1 = Yes 2 = No [___] S51610 10) No 1 = Yes 2 = No [___] S51611 11) Health Promoter 1 = Yes 2 = No [___] S51612 12) Family / friends 1 = Yes 2 = No [___] S51613 13) Midwife unspecified 1 = Yes 2 = No [___] S5161 4 14) Traditional Midwife 1 = Yes 2 = No [___] S51697 97) Other, specify 1 = Yes P16a 2 = No [___] S51698 98) Do not know 1 = Yes 2 = No [___] S516A 16a Other, Specifye ________________ [___] S51600 1600 Verify if <% S5NM%> answered "yes" to at least one of the questions from the 16.5 and 16.97 1 = There is at least one answer "yes" Q17 2 = There is not an answer "YES" Q19 [___] S517 17 Was used a proper and hygienic kit like this, during delivery of <% S5NN%>? 1 = Yes 2 = No 8 = Do not know 143 S518 18 What is it used for cutting the cord at delivery of <% S5NN%>? READ NO OPTIONS 1 = new razor blade 2 = new razor blade and boiled 3 = Razor blade used 4 = Razor blade used and boiled 5 = new Scissors 6 = new and boiled Scissors 7 = Scissors used 8 = Scissors used and boiled 9 = Knife 10 = Reed or tab 97 = Other, specify P18a → 98 = Do not know / Can not remember [___ | S518a 18 to Specify other ______________ [___] S519 19 Was Drying (cleaned <% S5NN%> immediately after birth, before the delivery of the placenta? 1 = Yes 2 = No 8 = Do not know [___] S520 20 Was covered <% S5NN%> in a garment or blanket (blanket or jacket), immediately after birth, before the delivery of the placenta? 1 = Yes 2 = No 8 = Do not know [___] S521 21 Where was the birth of <% S5NN%>? ONLY ONE CAN BE. READ NO OPTIONS 1 = the respondent House → P29 2 = House midwife / community facilitator / Guardian health 3 = Center Convergence 4 = Health post 5 = Health Centre 6 = Public Hospital 7 = IGSS 8 = APROFAM 9 = Private Hospital / Private Clinic 97 = Other, P21a 98 = Do not know [___ | ___] S5 21A 21 other Specify ________________ [___] S522 22 After delivery of <% S5NN%> and before you left your house, did a health worker checked how was your health and your child / a? IF YES, ASK IF ONLY check MOTHER, ONLY CHILD, OR BOTH 1 = Yes, mother and child 2 = Yes, but only the mother 3 = Yes, but only the child 4 = No, neither the mother nor the child / a → P25 [___] S523 23 How many days after delivery of <% S5NN%> was the first check? If the answer is <1 day note 1 1 = One day 2 = Two Days 3 = Three days 4 = four or more days 98 = Do not know [___] 24 Who Attended this time? NOTE ALL THE ANSWERS. Check the boxes ANSWERS READ NO OPTIONS ANSWER THIS QUESTION AFTER PASSING A SECTION BELOW When Mrs. MENTION COMPLETE ANSWERS score 2 in boxes ABOVE AND GO TO NEXT SECTION 144 response codes: 1 = Yes, 2 = not mentioned above S5 2401 1) Medical 1 = Yes 2 = No [___] S5 2402 2) Medical itinerant 1 = Yes 2 = No [___] S5 2403 3) Nurse 1 = Yes 2 = No [___] S5 2404 4) Nurse itinerant 1 = Yes 2 = No [___] S5 2405 5) trained Midwife 1 = Yes 2 = No [___] S5 2406 6) unspecified Midwife 1 = Yes 2 = No [___] S5 2407 7) Traditional Midwife 1 = Yes 2 = No [___] S5 2408 8) health promoter 1 = Yes 2 = No [___] S5 2409 9) Guardian Health 1 = Yes 2 = No [___] S5 2410 10) Healer 1 = Yes 2 = No [___] S5 2411 11) Family / friends 1 = Yes 2 = No [___] S5 2412 12) No one 1 = Yes 2 = No [___] S5 2497 13) Other, specify 1 = Yes P24a 2 = No [___] S5 2498 98) don’t know / he does not remember 1 = Yes 2 = No [___] S5 24A 24 to Specify other ________________ [___] S525 25 After that you went home, did a health worker checked how was his health and that of <% S5NN%>? IF YES, ASK IF MOTHER ONLY checkup, fishing only CHILD, OR BOTH 1 = Yes, mother and child 2 = Yes, but only the mother 3 = Yes, but only the child 4 = No, neither the mother nor the child / a → P28 [___] S526 26 How many days after delivery of <% S5NN%> was the first check? IF THE ANSWER IS <1 DAY NOTE 1 1 = A gave a 2 = Two Days 3 = Three days 4 = four or more days 98 = Do not know [___] 27 Who Attended this time? NOTE ALL THE ANSWERS. Check the boxes ANSWERS READ NO OPTIONS ANSWER THIS QUESTION AFTER PASSING A SECTION BELOW When Mrs. MENTION COMPLETE ANSWERS score 2 in boxes ABOVE AND GO TO NEXT SECTION Có response codes: 1 = Yes, 2 = not mentioned above S5 2701 1) Medical 1 = Yes 2 = No [___] S5 2702 2) Medical itinerant 1 = Yes 2 = No [___] S5 2703 3) Nurse 1 = Yes 2 = No [___] S5 2704 4) Nurse itinerant 1 = Yes 2 = No [___] S5 2705 5) trained Midwife 1 = Yes 2 = No [___] S5 2706 6) unspecified Midwife 1 = Yes 2 = No [___] S5 2707 7) Traditional Midwife 1 = Yes 2 = No [___] S5 2708 8) health promoter 1 = Yes 2 = No [___] S5 2709 9) Guardian Health 1 = Yes 2 = No [___] S52710 10) Healer 1 = Yes 2 = No [___] S5 2711 11) Family / friends 1 = Yes 2 = No [___] S5 2712 12) No one 1 = Yes 2 = No [___] S5 2797 97) Other, specify 1 = Yes P27a 2 = No [___] S5 2798 988) Do not know / cannot remember 1 = Yes 2 = No [___] S5 27A 27a Specify other ________________ [___] 145 28 Why You don’t look for assistance after delivery of <% S5NN%>? NOTE ALL THE ANSWERS. Check the boxes ANSWERS READ NO OPTIONS ANSWER THIS QUESTION AFTER PASSING A SECTION BELOW When Mrs. MENTION COMPLETE ANSWERS score 2 in boxes ABOVE AND GO TO NEXT SECTION Có response codes: 1 = Yes, 2 = not mentioned above S5 2801 1) Distance to health facility 1 = Yes 2 = No [___] S5 2802 2) Controls at home 1 = Yes 2 = No [___] S5 2803 3) Lack of confidence 1 = Yes 2 = No [___] S5 2804 4) believes that attention is bad 1 = Yes 2 = No [___] S5 2805 5) Long wait for care 1 = Yes 2 = No [___] S5 2806 6) Institution was clossed or shortly care 1 = Yes 2 = No [___] S5 2807 7) My husband would not let me 1 = Yes 2 = No [___] S5 2808 8) The family would not let me 1 = Yes 2 = No [___] S5 2809 9) Cost of care 1 = Yes 2 = No [___] S5 2810 10) Do not speak my language 1 = Yes 2 = No [___] S52811 11) Lack of time (homemaker) 1 = Yes 2 = No [___] S5 2812 12) No customary 1 = Yes 2 = No [___] S5 2897 97) Other, specify 1 = Yes Q28A 2 = No [___] S5 2898 98) Do not know 1 = Yes 2 = No [___] S5 28A 28 a Specify other ________________ [___] S529 29 After <% S5NN%> was born, did a health worker checked how was your health and the health of your child? IF YES, ASK IF MOTHER ONLY check ONLY CHILD, OR BOTH 1 = Yes, mother and child 2 = Yes, but only the mother 3 = Yes, but only the child 4 = No, neither the mother nor the child → P32 [___] S530 30 How many days after delivery of <% S5NN%> was the first check? IF THE ANSWER IS <1 1 DAY RECORD 1 = One day 2 = Two Days 3 = Three days 4 = four or more days 98 = Do not know [___] 31 Who Attended this time? NOTE ALL THE ANSWERS. Check the boxes ANSWERS READ NO OPTIONS ANSWER THIS QUESTION AFTER PASSING A SECTION BELOW When Mrs. MENTION COMPLETE ANSWERS score 2 in boxes ABOVE AND GO TO NEXT SECTION Có response codes: 1 = Yes, 2 = not mentioned above S5 3101 1) Medical 1 = Yes 2 = No [___] S5 3102 2) Medical itinerant 1 = Yes 2 = No [___] S5 3103 3) Nurse 1 = Yes 2 = No [___] S5 3104 4) Nurse itinerant S5 3105 5) trained Midwife 1 = Yes 2 = No [___] S5 3106 6) unspecified Midwife 1 = Yes 2 = No [___] 146 S5 3107 7) Traditional Midwife 1 = Yes 2 = No [___] S5 3108 8) health promoter 1 = Yes 2 = No [___] S5 3109 9) Guardian Health 1 = Yes 2 = No [___] S5 3110 10)Healer 1 = Yes 2 = No [___] S5 3111 11) Family / friends 1 = Yes 2 = No [___] S5 3112 12) No one 1 = Yes 2 = No [___] S5 3197 97) Other, specify 1 = Yes P31a 2 = No [___] S5 3198 98) Do not know / can not remember 1 = Yes 2 = No [___] S5 31A 31 a Specify other ________________ [___] 32 Why You don’t look for assistance to control your health after delivery of [NAME OF CHILD 1]? NOTE ALL THE ANSWERS. Check the boxes ANSWERS READ NO OPTIONS ANSWER THIS QUESTION AFTER PASSING A SECTION BELOW When Mrs. MENTION COMPLETE ANSWERS score 2 in boxes ABOVE AND GO TO NEXT SECTION Có response codes: 1 = Yes, 2 = not mentioned above S5 3201 1) Distance to spot 1 = Yes 2 = No [___] S5 3202 2) Controls at home 1 = Yes 2 = No [___] S5 3203 3) Lack of confidence 1 = Yes 2 = No [___] S5 3204 4) believes that attention is bad 1 = Yes 2 = No [___] S5 3205 5) Long wait for care 1 = Yes 2 = No [___] S5 3206 6) Institution was clossed or shortly care 1 = Yes 2 = No [___] S5 3207 7) My husband would not let me 1 = Yes 2 = No [___] S5 3208 8) The family would not let me 1 = Yes 2 = No [___] S5 3209 9) Cost of care 1 = Yes 2 = No [___] S5 3210 10) Do not speak my language 1 = Yes 2 = No [___] S5 3211 11) Lack of time (homemaker) 1 = Yes 2 = No [___] S5 3297 97) Other, specify 1 = Yes P32a 2 = No [___] S5 3298 98) Do not know 1 = Yes 2 = No [___] S5 32A 32a Specify other ________________ [___] 147 Household Surveys – Section 6 Infant Feeding Infant Feeding BASELINE QUESTIONNAIRE -2010 - S6CODENC SURVEY Code [__ | __ | __ | __] S6CODPER PERSONAL IDENTIFICATION CODE [__ | __ | __ | __ | __ | __] A. THESE QUESTIONS ARE ABOUT INFANT FEEDING of Children aged 0 to 24 months B. PDA FILTER: IS THERE A CHILD FROM 0 TO 24 MONTHS? 1. YES → CONTINUE, 2. NO → NEXT SECTION C. QUESTIONS TO THE MOTHER OF THE CHILD: <% S5NM%> Now I would like to ask to <% S5NM%> (Mothers name) about feeding <% S5NN%> (child name) QUESTION CODE QUESTION ANSWER CODE ANSWER S601 1 You did you breastfeed <% S5NN%> at sometime? 1 = Yes 2 = No → P3 [___] S602 2 How much time after birth <% S5NN%> you started to breastfeed? WRITE THE NUMBER OF HOURS IF THE MOTHER ANSWERS IN DAYS, WRITE THE NUMBER OF DAYS HERE SO THE PDA WILL CONVERT IT TO HOURS: (DAYS) _____  (hours) _____ AFTER ANSWERING THIS QUESTION GO TO P4 If less than 1/2 HOUR, enter "00" Between 01 and 96 hours, enter the number with two digits 97 = More than 96 hours 98 = Do not know / Cannot remember [___ | ___] S603 3 Ever <% S5NN%> or received breast milk? 1 = Yes 2 = No → P5 8 = Do not know → P5 [___] S604 4 During the day and evening yesterday, <% S5NN%> received breast milk? 1 = Yes → P6 2 = No 8 = Do not know [___] S605 5 Sometimes breastfed babies in various ways. For example, a baby can have breast milk with a spoon or cup. This may occur because the mother cannot be with the baby. Sometimes babies breastfeed from another woman's breast milk or take another woman breast milk with a spoon or cup, for example. During the day and evening yesterday, <% S5NN%> received breast milk in any of these forms mentioned? 1 = Yes 2 = No 8 = Do not know [___] S606 6 Now I want to ask you about some of the medicines and vitamins that children sometimes take. During the day and evening yesterday, did you give <% S5NN%> vitamin drops or other medicines in drops? 1 = Yes 2 = No 8 = Do not know [___] S607 7 During the day and evening yesterday, did <% S5NN%> received oral rehydration solution? SHOWN ORS envelope 1 = Yes 2 = No 8 = Do not know [___] 8 Now I’d like to talk about liquids that <% S5NN%> may have taken or received during the day and evening yesterday. READ THE LIST FROM 8a TO 8i, starting with the next row S608A 8a During the day and evening yesterday, <% 1 = Yes [___] 148 S5NN%> took or received pure water? 2 = No 8 = Do not know S608B 8b During the day and evening yesterday, <% S5NN%> took or received special formula for infants such as: NAN, Prosobee or Enfamil? 1 = Yes → P9b 2 = No → P8C 8 = Do not know → P8C [___] S609B 9b How many times <% S5NN%> took special formula for babies, such as: NAN, or Enfamil Prosobee during the day and evening yesterday? 98 = Do not know [___ | ___] S608C 8c During the day and evening yesterday, <% S5NN%> took or received bottled cow milk or fresh cow's or goat milk? 1 = Yes → P9c 2 = No → P8d 8 = Do not know → P8d [___] S609C 9 c How many times took <% S5NN%> bottled cow milk or fresh cow's or goat milk? 98 = Do not know [___ | ___] S608D 8d During the day and evening yesterday, <% S5NN%> took or received natural or artificial juices or sugar water? 1 = Yes 2 = No 8 = Do not know [___] S608E 8e During the day and evening yesterday, <% S5NN%> took or received broth? Without vegetables, without meat, without rice, ETC. Only water or liquid. 1 = Yes 2 = No 8 = Do not know [___] S608F 8f During the day and evening yesterday, <% S5NN%> took or received yogurt? 1 = Yes → P9f 2 = No → P8g 8 = Do not know → P8g [___] S609F 9f How many times <% S5NN%> ate yogurt? 98 = Do not know [___ | ___] S608G 8g During the day and evening yesterday, <% S5NN%> took or received liquid porridge? PORRIDGE WITH WATER ADDED TO MAKE IT MORE LIQUID. 1 = Yes 2 = No 8 = Do not know [___] S608H 8h During the day and evening yesterday, <% S5NN%> took or received other water-based liquid such as tea, coffee, herbal tea, or other liquids such as these? 1 = Yes 2 = No 8 = Do not know [___] S608I 8i During the day and evening yesterday, <% S5NN%> took or received other liquids other than those mentioned above? 1 = Yes 2 = No 8 = Do not know [___] 10 24 hour recall of food consumption for <% S5NN%> YESTERDAY DURING THE DAY AND NIGHT Please list everything that <% S5NN%> ate in the house or outside the house during the day and evening yesterday. A) Please remember since <% S5NN%> woke up yesterday and what did (s)he ate first. <% S5NN%> ate something? i) IF THE ANSWER IS "YES"  ASK: Please tell me everything that the child has eaten. Ask  Did the child eat anything else? (REPEAT THIS QUESTION UNTIL THE MOTHER SAY child did not eat more  go to Part "C") ii) IF THE ANSWER IS "NO"  go to Part "B". B) What did <% S5NN%> do after waking up? ? <% S5NN%> ate something at that time? i) IF THE ANSWER IS "YES"  ASK: Please tell me everything <% S5NN%> ate. PROBE Did the child eat anything else? (REPEAT THIS QUESTION UNTIL THE MOTHER SAY ate nothing more and went  sleep go to Part "C") 149 ii) IF THE ANSWER IS "NO" pass PART "C" FOR EACH FOOD THE MOTHER MENTIONS enter "1" in RESPONSE COLUMN. If food is NOT on the list, write it down on QUESTION 10R AND SPECIFY THE FOOD. If the food is USED as a condiment, include them in QUESTION 10o. IF MIXED DISHES OR COMPOUNDS OF several ingredients or foods are mentioned, like soup, broth, stewed, braised, etc. ASK  What ingredients or foods were in [THIS DISH MIX]? WHEN SHE FINISHED, ask  Anything else? C) When the mother finished REMEMBERING what THE CHILD ate, read every food she did not mention asking the question: During the day and night yesterday <% S5NN%> ate [FOOD]? EVERY FOOD must have an answer. When questions are answered GO TO QUESTION 11. S610A 10a Bread, Rice, tortillas, noodles or other foods made from grain? 1 = Yes 2 = No 8 = Do not know [___] S610 B 10b Pumpkin, carrots, squash, sweet potatoes or other vegetables in orange? 1 = Yes 2 = No 8 = Do not know [___] S610 C 10c Potatoes, taro, cassava or any other food from roots or tubers? 1 = Yes 2 = No 8 = Do not know [___] S610 D 10d Dark green leafy vegetable - such as spinach, amaranth, macuy, tzoloj, chipilín, roqtix, güisquil tip, squash tip, or other dark green leafy foods? 1 = Yes 2 = No 8 = Do not know [___] S610 E 10e Fruits that are yellow or orange inside, like ripe mangoes, ripe papayas, melon, sapota? NOT BE INCLUDED pineapple. 1 = Yes 2 = No 8 = Do not know [___] S610 F 10f Any other fruit or vegetable? 1 = Yes 2 = No 8 = Do not know [___] S610 G 10g Liver, kidney, heart or other giblets? 1 = Yes 2 = No 8 = Do not know [___] S610 H 10h Beef, turkey, pig, chicken, lamb, duck, goat, or other meat? 1 = Yes 2 = No 8 = Do not know [___] S610 I 10i Eggs? 1 = Yes 2 = No 8 = Do not know [___] S610 J 10j Fish or seafood? Fried or dry? 1 = Yes 2 = No 8 = Do not know [___] S610 K 10k Beans, peas, lentils, habas or nuts? 1 = Yes 2 = No 8 = Do not know [___] S610 L 10l Cheese, cream, yogurt or other foods made from milk? 1 = Yes 2 = No 8 = Do not know [___] S610 M 10m Did you use and / or gave oil, margarine, shortening, butter or foods with these things? 1 = Yes 2 = No 8 = Do not know [___] S610 N 10n Sweet foods like chocolates, icecream, cakes, or cookies or other food with sugar? 1 = Yes 2 = No 8 = Do not know [___] S610 O 10o Flavored condiments, such as chilly, pepper, salt, broth, or other species that are dry or powder? 1 = Yes 2 = No 8 = Do not know [___] S610 P 10p Ants, snails, or other insects? 1 = Yes 2 = No 8 = Do not know [___] S610 Q 10q Food prepared with palm oil, palm kernel or palm sauce? 1 = Yes 2 = No 8 = Do not know [___] S610 R 10r Any type of food that is not in the list? 1 = Yes 2 = No  P11 [___] S610 S 10s Specify other food: ___________ (If it does not mention other  P11) [___] 150 S610 T 10t Specify other food: ___________ (If it does not mention other  P11) [___] S610 U 10u Specify other food: ___________ (If it does not mention other P11) [___] S610 V 10v Specify other food: ___________ (If it does not mention other  P11) [___] S610 W 10w Specify other food: ___________ (If it does not mention other  P11) [___] S610 X 10x Specify other food: ___________ (If it does not mention other  P11) [___] S611 11 PDA: Check Q10a to P10q 1 = Yes, at least once "yes" → P13 2 = No, not once "yes" → P12 3 = All "do not know" → P13 [___] S612 12 ? <% S5NN%> ate food whole or crushed during the day and evening yesterday? 1 = Yes → Return to P10 and ask for food you ate, when finished move on  P13 2 = No → P14 8 = Do not know → Q14 [___] S613 13 How many times <% S5NN%> ate food whole or crushed during the day and evening yesterday? 98 = Do not know [___ | ___] S614 14 ? <% S5NN%> drank something from a bottle during the day and evening yesterday? 1 = Yes 2 = No 8 = Do not know [___] I would like to ask you about some foods that <% S5NN%> may have eaten. I wonder if (s)he consumed them, including when combined with other foods. S615 15 During day and evening yesterday <% S5NN%> consumed or crushed whole foods that were prepared with CSB (like polenta or yellow porridge)? 1 = Yes 2 = No 8 = Do not know [___] S616 16 During the day and evening yesterday, <% S5NN%> consumed any foods that were mixed with micro-nutrient powders (MNP)? SHOW AN ENVELOPE OF Mercy Corps MNP. 1 = Yes 2 = No 8 = Do not know [___] S617 17 During day and evening yesterday, <% S5NN%> supplements consumed lipid-based micro-nutrients such as Nutri Nim? SHOW AN ENVELOPE of LNS OF Mercy Corps 1 = Yes 2 = No 8 = Do not know [___] S618 18 During the day and evening yesterday, <% S5NN%> took porridge or foods made with fortified cereals such as Cerelac, Vitacereal Incaparina or Bienestarina? 1 = Yes 2 = No 8 = Do not know [___] S619 19 During the day and evening yesterday, <% S5NN%> took porridge or beverages made 1 = Yes 2 = No [___] 151 with unfortified cereals? 8 = Do not know 152 Household Surveys – Section 7 Vaccinations and Preventive Health SECTION 7: Vaccinations and preventive health BASELINE QUESTIONNAIRE - 2010 - S7CODENC SURVEY CODE [__ | __ | __ | __] S7CODPER PERSONAL IDENTIFICATION CODE [__ | __ | __ | __ | __ | __] A. THESE QUESTIONS ARE ABOUT VACCINES THAT HAS HAD THE PREVENTIVE HEALTH CHILD (If CHILD are aged 0 to 24 months) B. PDA FILTER: IS THERE A CHILD FROM 0 TO 24 MONTHS? 1. YES → CONTINUE, 2. NO → NEXT SECTION C. QUESTIONS TO THE MOTHER OF THE CHILD <% S5NM%> QUESTION CODE QUESTION ANSWER CODES ANSWER Now I would to ask you about vaccines <% S5NN%> S701 1 Do you have a card on which are recorded vaccines <% S5NN%>? 1 = Yes 2 = No card → P4 [___] S70 2 2 Please could I see the vaccination card? 1 = Yes, view 2 = No → P5 view [___] 3 VERIFY IF THE CARD <% S5NN%> RECEIVED: 3A S70 3a BCG 1 = Yes 2 = No [___] 3B S70 3b Polio1 1 = Yes 2 = No [___] S70 3C 3c Polio2 1 = Yes 2 = No [___] S70 3D 3d Polio3 1 = Yes 2 = No [___] S70 3E 3e Penta1 (hepatitis, influenza, diphtheria, tetanus and pertussis tea) 1 = Yes 2 = No [___] S70 3F 3f Penta2 (hepatitis, influenza, diphtheria, tetanus and pertussis) 1 = Yes 2 = No [___] S70 3G 3g Penta3 (hepatitis, influenza, diphtheria, tetanus and pertussis) 1 = Yes 2 = No [___] 3H S70 3h MMR (Measles, Mumps and Rubella) 1 = Yes 2 = No [___] 3I S70 3i Polio R1 (first booster of diphtheria, pertussis and tetanus tea) 1 = Yes 2 = No [___] 3J S70 3j Polio R2 (second booster of diphtheria, pertussis and tetanus) 1 = Yes 2 = No [___] S70 K 3k DPT R1 (first booster of diphtheria, pertussis and tetanus tea) 1 = Yes 2 = No [___] 3L S70 3l DPT R2 (Second reinforcing diphtheria, pertussis and tetanus) 1 = Yes 2 = No [___] 3M S70 3m Vitamin A. IF NOT SHOWN VITAMIN A RECORD 3 or 4 and ask Mrs. 1 = Yes 2 = No → P3O 3 = not available in the card and had 4 = not available in the card and had no P3O → [___] S70 3N 3n RECORD THE LAST DOSE OF VITAMIN received. RECORD day, month, and year [__ | __] day [__ | __] Month [__ | __ | __ | __] Year 3O S70 3o Iron (ferrous sulphate syrup) APPEARS 1 = Yes 2 = No → P3q [___] 153 IRON OR WRITE 3 or 4 and ask Mrs. 3 = do not exist in the card and had 4 = not exist in the card and had no P3q → S70 3P 3p RECORD THE LAST iron dose received. RECORD dayl, month, and year [__ | __] day [__ | __] Month [__ | __ | __ | __] Year S70 3Q 3q Acid folic acid (tablets). FOLIC ACID OR APPEARS score 3 or 4 and ask Mrs. 1 = Yes 2 = No → P3s 3 = do not exist in the card and had 4 = not exist in the card and had no P3s → [___] 3R S70 3r RECORD THE LAST doses of folic acid have received. WRITE day, month, and year [__ | __] day [__ | __] Month [__ | __ | __ | __] Year 3S S70 3s Dewormer. WRITE OR APPEARS dewormer 3 or 4 and ask Mrs. 1 = Yes 2 = No → P3U 3 = do not exist in the card and had 4 = not exist in the card and had no P3U → [___] S70 3T 3t RECORD THE LAST DOSE RECEIVED dewormer. WRITE day, month, and year [__ | __] day [__ | __] Month [__ | __ | __ | __] Year 3U S70 3u “Chispitas”. WRITE OR APPEARS Sparky 3 or 4 and ask Mrs. 1 = Yes 2 = No → P3W 3 = do not exist in the card and had 4 = not exist in the card and had no P3W → [___] S70 3V 3v RECROD THE LAST DOSE RECEIVED SPARKLER. WRITE day, month, and year [__ | __] day [__ | __] Month [__ | __ | __ | __] Year S70 3W 3w In the past 12 months, did you take <% S5NN%> to weight control? 1 = Yes 2 = No → Next section 8 = Do not know → Next section [___] S70 3X 3x In the past 12 months, how many times was taked <% S5NN%> to weight control? 98 = Do not know [___ | ___] S70 3Y 3y RECORD THE LAST VISIT YOUR WEIGHT. WRITE RESPONSE AND GO TO NEXT SECTION RECORD day, month, and year Enter "98" if there is no day or month. Enter "9998" MISSING YEAR. WRITE RESPONSE AND GO TO NEXT SECTION [__ | __] day [__ | __] Month [__ | __ | __ | __] Year S704 4 Have you ever had a card or vaccination card (or health) of <% S5NN%>? 1 = Yes → P6 2 = No 8 = Do not know [___] S70 5 5 Have you received <% S5NN%> a 1 = Yes 2 = No → P7 8 = Do [___] 154 vaccine to prevent disease? Have you ever vaccinated your child ? not know → Q7 6 Tell me please if <% S5NN%> has received any of the following vaccines: S706 A 6a BCG against tuberculosis, this is a shot in the right arm (or shoulder) that leaves a scar and is usually given at birth. 1 = Yes 2 = No 8 = Do not know [___] S706 B 6b Did <% S5NN%> receive Polio vaccine, given as drops in the mouth? 1 = Yes 2 = No → P6e 8 = Do not know → P6e [___] S706 C 6c How many times? 8 = Do not know [___] S706 D 6d Does the first polio vaccine was given at 2 months of age? 1 = Yes 2 = No 8 = Do not know [___] S706 E 6e Did <% S5NN%> receive MMR or DPT or Pentavalent vaccine, which is usually applied while Polio vaccine and applied to the muscle (the buttock or leg)? 1 = Yes 2 = No → P6G 8 = Do not know → P6G [___] S706 F 6f How many times? 8 = Do not know [___] S706 G 6g Did <% S5NN%> receive MMR (Measles, Mumps and Rubella) or Three viral vaccine that is applied on the left arm? 1 = Yes 2 = No 8 = Do not know [___] S706 H 6h Did <% S5NN%> receive the first reinforcement of Polio? 1 = Yes 2 = No 8 = Do not know [___] S706 I 6i Did <% S5NN%> receive the first reinforcement of DPT? 1 = Yes 2 = No 8 = Do not know [___] 7 Now let me ask you about some medicines and vitamins that your bab may have received or taken. S707A 7a ? <% S5NN%> ever received a dose of vitamin A as this? CAPSULE SHOW 1 = Yes 2 = No → P7C 8 = Do not know → P7C [___] S707 B 7b When received it last? WRITE day, month, and year Enter "98" if there is no day or month. Enter "9998" MISSING YEAR. [__ | __] day [__ | __] Month [__ | __ | __ | __] Year S707 C 7c Does <% S5NN%> ever received a dose of iron or ferrous sulfate, like this? SHOW CAPSULE 1 = Yes 2 = No → P7E 8 = Do not know → P7E [___] S707 D 7d When received it last? WRITE Tell, month, and year Enter "98" if there is no day or month. Enter "9998" MISSING YEAR. [__ | __] day [__ | __] Month [__ | __ | __ | __] Year S707 E 7e Does <% S5NN%> ever received a dose of folic acid, like this? CAPSULE SHOW 1 = Yes 2 = No → P7G 8 = Do not know → P7G [___] S707 F 7f When received it last? WRITE day, month, and year [__ | __] day [__ | __] Month 155 Enter "98" if there is no day or month. Enter "9998" MISSING YEAR. [__ | __ | __ | __] Year S707 G 7g Does <% S5NN%> have received a dose of sparks like these? CAPSULE SHOW 1 = Yes 2 = No → P7i 8 = Do not know → P7i [___] S707 H 7h When received it last? WRITE day, month, and year Enter "98" if there is no day or month. Enter "9998" MISSING YEAR. [__ | __] day [__ | __] Month [__ | __ | __ | __] Year S707 I 7i Does <% S5NN%> have ever been treated like this with dewormer? SHOW CAPSULE 1 = Yes 2 = No → P8 8 = Do not know → P8 [___] S707 J 7j When received it last? WRITE day, month, and year Enter "98" if there is no day or month. Enter "9998" MISSING YEAR. [__ | __] day [__ | __] Month [__ | __ | __ | __] Year S70 8 8 In the past 12 months, did you take <% S5NN%> to weight control? 1 = Yes 2 = No → Next section 8 = Do not know → Next section [___] S70 9 9 In the past 12 months, how many times was <% S5NN%> taken to weight control? 98 = Do not know [___ | ___] S707M S07p10 10 When was the last time you took <% S5NN%>to weight control? WRITE RESPONSE AND GO TO NEXT SECTION WRITE day, month, and year Enter "98" if there is no day or month. Enter "9998" MISSING YEAR. [__ | __] Day [__ | __] Months [__ | __ | __ | __] Year 156 Household Surveys – Section 9 Home Action Plan SECTION 9: Home Action plan BASELINE QUESTIONNAIRE - 2010 S7CODENC SURVEY CODE [__ | __ | __ | __] A. THESE QUESTIONS ARE ABOUT HOME AND PLOT (LAND) MANAGE B. FILL IN EVERY FAMILY SAMPLE C. QUESTIONS TO THE MOTHER OF THE SAMPLE QUESTIO N CODE QUESTION ANSWER CODES ANSWE R S900 Who is the Mother of sample? [NAME OF MOTHER] Now I would like to ask some questions to [NAME OF MOTHER] S901 1 Does your family have a manageme nt plan for housing and plot? READ NO OPTIONS 1 = Yes 3 = P3 is in progress → 2 = No → P3 8 = Do not know → P3 [___] S902 2 Can I have it be displayed? READ NO OPTIONS 1 = Yes is shown and MC 2 = If it shows, but it is by MC 3 = not shown 8 = Do not know [___] S903 3 What material is the most of the floor of this house? 1 = Ground 2 = Cement firm 3 = mosaic, wood or other coatings 7 = Other, esp. [___] S904 4 What material is most of the walls and walls of this house? 1 carton 2 = Carrizo, palm or bamboo 3 = mud or daub 4 = Wood 5 = asbestos sheet, galvanized metal or 6 = Adobe 7 = Partition or brick partition wall, block, stone, masonry or concrete 8 = Other Materials [___] S905 5 What material is the most of the roof of this house? 1 = Duralita 2 = Palma, shingle or wood 3 = asbestos sheet, galvanized metal or 4 = Tile 5 = Concrete slab, brick vault or roof, brickwork beams 7 = Other Materials [___] S906 6 Is there a separate 1 = Yes 2 = No [___] 157 room for cooking, whether in the home or apart? S907 7 Does the room to cook ALSO is used for sleeping? 1 = Yes 2 = No [___] S908 8 In total how many rooms have this property without corridors or bathrooms ? # Of Rooms [___] S909 9 And of [TOTAL quarter-P8] how many rooms are used for sleeping? # Of bedrooms [___] S910 1 0 L What is your main source of water? READ OPTIONS. Check only one answer. 1 = Piped water inside the kitchen or Bath 2 = Piped water outside the house but within the field 3 = Water piped public key or hydrant 4 = Well water or pump 5 = Spring water, river or lake 6 = Water Pipe 7 = Natural spring 8 = catchment tank 9 = Rainwater 97 = Other 98 = Do not know [___] S911 1 1 This property has: READ 1 = toilet or sanitary 2 = latrine or toilet 3 = do not use toilet (do on the floor, corral, barn, beach, etc..) 7 = Other [___] 158 OPTIONS. Choosing the option that used primarily. There can only be ONE S912 1 2 Does this household have electricity? 1 = Yes 2 = No [___] S913 1 3 Do you have a vegetable patch? 1 = Yes 2 = No → next section [___] S914 1 4 Please can I see the vegetable patch 1 = Yes, the family has 2 = No, no vegetable patch 3 = not allowed to observe [___] 159 Household Surveys – Section 13 Participation in Other Projects or Programs SECTION 13: Participation in other projects or programs MIDTERM EVALUATION QUESTIONNAIRE S13CODENC SURVEY CODE [__ | __ | __ | __] A. These questions are about participation BENEFICIARY PROCOMIDA in projects or programs of other institutions. B. FILL IN FAMILIES answer affirmatively be beneficiaries of a project or PROCOMIDA separate program. C. QUESTIONS TO THE MOTHER OF THE SAMPLE QUESTION CODE QUESTION ANSWER CODE ANSWER S 1300 Who? Mother n is the sample? [NAME OF MOTHER] Now I would like to ask some questions to [NAME OF MOTHER] S1301 1 How many projects of other institutions involved? [___] I would like to answer some questions of the projects involved, starting with the one is more important for the family s In the [PROJECT No.1] S1302 2 What type of institution is implemented? 1 = Government. 2 = Non-governmental organization. 3 = Do not know. [___] S1303 3 When became involved? WRITE THE MONTH, AND YEAR [__ | __] Months [__ | __ | __ | __] Year S1304 4 What kind of support do you receive on that project? NOTE ALL THE ANSWERS. Check the boxes ANSWERS READ NO OPTIONS response codes: 1 = Yes, 2 = not mentioned above S130401 1) Food 1 = Yes 2 = No [___] S130402 2) Money. 1 = Yes 2 = No [___] S130403 3) agricultural inputs queues. (Fertilizer, tools, seeds) 1 = Yes 2 = No [___] S130404 4) Other production inputs. 1 = Yes 2 = No [___] S130405 5) Health training 1 = Yes 2 = No [___] S130406 6) production training 1 = Yes 2 = No [___] S13040 7 7) Other, specify 1 = Yes P7a 2 = No [___] S130407a Other, specify ________________ [___] S1305 5 Are you involved in another project / program? 1 = Yes → RETURN TO P2 2 = No End the interview | ___] 160 Household Surveys – Section 14 Resilience S14CODENC SURVEY CODE [__ | __ | __ | __] A. These questions are about the ability to obtain food B. FILL IN FOR EVERY FAMILY SAMPLE C. QUESTIONS TO THE MOTHER OF THE SAMPLE QUESTION CODE QUESTION Code ANSWER S 1400 Who is the Mother in the sample? [NAME OF MOTHER] Now I would like to ask some questions to [NAME OF MOTHER] Do not read answers, investigate. S14 01 During the past 30 days, how many times has your family stopped eating their favorite food and replaced with food they like less or of lower quality because they ran out of preferred food and do not have enough money to buy? Note the num ber of days (0-30) If you say once a week, mark 4 If he says occasionally mark 90 If you say hardly ever, mark 91 If you say never, mark 0 Do not know: 98 [___][___] S14 02 During the past 30 days, how many times have you borrowed food from family, friend or neighbor, or bought on credit, because he had no money to buy? Note the num ber of days (0-30) If you say once a week, mark 4 If he says occasionally mark 90 If you say hardly ever, mark 91 If you say never, mark 0 Do not know: 98 [___] [___] S14 03 During the past 30 days, how many times have you relied on wild food, hunt or harvest immature crops to eat, because you had no money to buy? Note the num ber of days (0-30) If you say once a week, mark 4 If he says occasionally mark 90 If you say hardly ever, mark 91 If you say never, mark 0 Do not know: 98 [___] [___] S14 04 During the past 30 days, how many times have you consumed grains that were saved for use as seed? Note the num ber of days (0-30) If you say once a week, mark 4 If he says occasionally mark 90 [___] [___] 161 If you say hardly ever, mark 91 If you say never, mark 0 Do not know: 98 S14 05 During the past 30 days, how many times have you had to send someone in your family to beg for food? Note the num ber of days (0-30) If you say once a week, mark 4 If he says occasionally mark 90 If you say hardly ever, mark 91 If you say never, mark 0 Do not know: 98 [___] [___] S14 06 During the past 30 days, how many times have you reduced the portion sizes of meals? Note the num ber of days (0-30) If you say once a week, mark 4 If he says occasionally mark 90 If you say hardly ever, mark 91 If you say never, mark 0 Do not know: 98 [___] [___] S14 07 During the past 30 days, how many times have you reduced the portion sizes s of adults so children could be fed, because you didn’t have enough food or money to buy more? Note the num ber of days (0-30) If you say once a week, mark 4 If he says occasionally mark 90 If you say hardly ever, mark 91 If you say never, mark 0 Do not know: 98 [___] [___] S14 08 During the past 30 days, how many times family members who work were fed at the expenses of those who do not work? (reduction of ration of those family members that don’t work) Note the num ber of days (0-30) If you say once a week, mark 4 If he says occasionally mark 90 If you say hardly ever, mark 91 If you say never, mark 0 Do not know: 98 [___] [___] S14 09 During the past 30 days, how many times have you reduced the number of daily meals? Note the num ber of days (0-30) [___] [___] 162 If you say once a week, mark 4 If he says occasionally mark 90 If you say hardly ever, mark 91 If you say never, mark 0 Do not know: 98 S14 10 During the past 30 days, how many times didn’t you eat all day? Note the num ber of days (0-30) If you say once a week, mark 4 If he says occasionally mark 90 If you say hardly ever, mark 91 If you say never, mark 0 Do not know: 98 [___] [___] S14 11 What was the last month that you received PROCOMIDA ration? Note the number. month(1- 12) Do not know: 98 [___] [___] 163 Appendix E: Evaluation Dates Dates / Periods Evaluated Clusters Completed surveys Expected surveys % of interviews June 15 to June 22 16 310 320 96.88 June 25 to June 29 10 197 200 98.50 July 2 to July 13 24 477 480 99.38 Totals 50 984 1000 98.40 164 Appendix F: Information Sources Insert List of all information sources including documents reviewed (list of references – have asked Marcel to provide), key informants (# mothers, # children, # CHVs). KARINA – can you extract from data? Level Respondent # of Respondents (n) Community CHV (local staff or related with MSPAS) CC CHV (local staff or related with MSPAS Household Mother Child under 5 years of age 165 Appendix G: Questionnaire Modules (Topics) Topics Included in Community Level Questionnaires Section Topic Description Addressed to Heading General information of the survey Coding of the interviewers, geographic location. CHV (local staff or related with MSPAS) I General information of the interview Date and time of the survey, reporting data. II Health infrastructure in the locality Presence of health personnel and official buildings and traditional. Distances between home and health infrastructure. III Available staff in the communities Local health personnel (midwives, traditional healers, health monitors). IV Community participation Local Health Organization (Committee or Health Committee and its functions). Topics Included in CC Level Questionnaires Section Topic Description Addressed to Headings EC1, EC2 General information Geographic location of the Convergence Center. Local staff or related with Initial MSPAS (CHV) information EC1, EC2 General information Date, time, name and position of the respondent. I (EC1) Education and basic knowledge of the informant Schooling, working time in relation to health, training received on the care and feeding of the pregnant mother, nursing mother, sick children, overall health. Basic knowledge of AIEPI-AINME-C, use of nutritional supplements for mothers and children. II (EC2) Danger Signs in Pregnancy Knowledge of health in relation to the danger signs during pregnancy, delivery and postpartum. Warning signs related to child health. Knowledge in immunization, growth monitoring, de-worming, use of nutritional supplements. Topics Included in Household Level Questionnaires Section Topic Description Addressed to Initial Household General information Household identification and geographical location. Information of the interview. Mothers I Members of the household Listing and coding of household members. Basic information about the family (integration, leadership, language. No. of children under 24 and 60 months). 166 II Dietary Diversity Houehold Diet composition of the household. III Food Safety Frequency of the household feeding, availability of financial resources to purchase food. IV Knowledge of the mother Knowledge of danger signs in pregnancy, childbirth, newborn care (diseases, nutrition, breastfeeding, hygiene practices). V Pre and post natal health Attendance and frequency of prenatal care. Institutions that have visited. Causes of attendance / non-attendance at health centers. Attention from MSPAS staff. Vaccination. Supplements for mother and child. Care during and after delivery. Evaluation of maternal care. VI Baby food Breastfeeding, child feeding. VII Vaccinations and preventive health Verification of vaccination, supplementation, de￾worming, and growth control. VIII Morbidity and attention seeking Child health problems associated with breathing and digestion among others. Treatments applied from home to health services. IX Home Action Plan Tenure of the Plan. Characterization of housing (floor, ceiling, walls). Access to water and sanitation. X Anthropometry. Children < 5 XI Using food from PROCOMIDA Reception or non-reception of rations and their motives. Consumption and duration of rations. Mothers XII Participation in other projects Other projects which involved the target population, help they provide. XIII resilience Questions about resilience strategies in homes during the 30 days prior to the interview. Last date for reception of food PROCOMIDA. Conclusion Final survey Metadata End time, language used, the result of the interview, other observations. Interviewer Revision Review editor, date, results, and recommendations. Editor 167 Appendix H: Implementation Area Map