ANNEX X KPC REPORT

RELIEF INTERNATIONAL NIGER

Konni District

Final Survey Report: Knowledge, Practice and Coverage

December 2011
Prepared and written by Mahaman Hallarou, MD,Child Survival Program Manager/Head of Country Office Survey Team Leader

Acknowledgements 1.1 The authors of this report, Dr. Mahaman Hallarou (Relief International) and David C.
Eastman (consultant) would like to thank various contributors who participated in this Knowledge, Practice and Coverage final survey. In particular, thanks are due to the people who supported this survey either through their involvement in its planning and implementation. These include the staff of the Konni District Ministry of Health (MOH), especially medical district coordinator Dr. Alio Tayabou and MOH supervisor Abuzeidi Chahabou; district administrator Suleymane Issaka; health supervisor Abuzeidi Chahabou; Konni Statistics Department supervisor Alio Nahantchi, MPDL Medical Officer Dr. Soumana Oumarou; and LNGO ISCV supervisor Sangar and survey interviewers (listed in Appendix 5); Meredith Chang (USAID-Child Survival and Health Grants Program); and Paulin Ntawangundi (Relief International). 1.2 Thanks are also due to USAIDCSHGP, which funded the implementation of the survey.

1.3 The following people were instrumental in bringing the KPC survey and report preparation to successful completion: 1- CORE TEAM

Num 1 2 3 4 5 6 7

Name Salissou Iliassou Abouzeidi Chouhabou Dr Mahaman Hallarou Rakia Azouma Moustapha Tcharimi Remi Sugurono Dr Soumana Oumarou

Structure

Contacts

DDP/AT/DC Konni 96879464 DS Konni RI RI RI Consultant 96878938 96292784 96876643 96883375 90612227

ONG MPDL Konni 96081133

2- SURVEY SUPERVISORS

N d'ordre 1 2 3 4 5

Nom et prnom Ali Hantchi Moussa Maman Tela Ary Issaka Ousmane Mme Garba Nana Haouaou Maman Sani Moussa Oumarou Sangar Rachide Kamay Goga Abouzeidi Chouhabou

Profil Superviseur Superviseur Superviseur Superviseur Superviseur

Structure DDP/AT/DC Konni ONG ISCV Konni DDJS Jeunesse Sport Konni ONG ISCV Konni ONG ISCV Konni ONG ISCV Konni Alphabtisation DS Konni

Contacts 96 59 07 60 96 87 89 38 98 09 19 04 90790960

91793857 96994552 96887692 96878938

6 7 8

Superviseur Superviseur Superviseur

9 10

Moustapha Tcharimi Tchari Dr Soumana Oumarou 3- INTERVIEWERS

Superviseur Superviseur

PSE/RI Konni ONG MPDL Konni

90466551 96081133

N d'ordre 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Nom et prnom Ibrahim Gado Abdoulkarim Ado Ibrahim Maman Sani Binta Ibrahim Hassane Almou Amadou

Profil Charg d'enseignement Marketeur Charg d'enseignement Enseignante Animateur

Contacts 98 74 37 40/ 94 99 02 63 96 89 75 48/90 39 32 41 96 46 66 01/90 17 19 68 96 58 72 63/90 20 52 64 90 04 12 63/94 32 35 91 96 21 88 44 96 01 43 04 91 36 34 32 90 57 95 34 96 27 78 38/91 31 00 17 96 58 04 76/90 88 20 37 96 98 08 66 96 89 89 97/90 50 11 84 96 57 44 20 94 25 45 87/97 71 45 33
96467334/90416478

Alzouma Mayaki Oumarou Etudiant Oumarou Djibo M. Salissou Dan Nana Moussa Abdou Bga Alou Enseignant Sociologue/Agent municipal Auxiliaire d'levage Sociologue

Salifou Moumouni Kadidja Sociologue Mohamed Abolbol Aichatou Abdou Garba Alzouma Mahaman Moustapha Arzika Halimatou
Dakaou Alio

Sociologue Enseignante Etudiant Biologiste

Sociologue

Abdou Andin Moussa Jean Traor Fatimatou Issaka Bilali Abdoul Razakou Habou Nagodi Souley Hamidine

Enseignant Sociologue Infirmire Assistant logistique Sociologue

91 59 95 35 91 71 50 83 96 26 75 84/90 83 43 76 96 50 40 96 96 40 20 88

22 23 24 25 26 27 28 29 30

Mato Touraki Mme Maman Fati Idi Oumarou Ibrahim Ali Abdoul Karim Salamatou Habou Garba Kano Ibro Mahamadou
Ibrahim Oumarou

Journaliste Agent du Plan Etudiant DDP/AT/DC Journaliste Radio Anfani Enseignant retrait Animateur
Etudiant

96 75 89 77 98 58 42 66 96 02 76 40 96 29 03 63 96 06 42 47 96 97 29 14 96 07 69 59/94 08 42 34
96 52 95 02/90 25 45 37

Hadiza Ibrahim

Tehnicienne de Developpement Rural

97 28 74 80

Table of Contents

Abbreviations and Acronyms

ACT BCC CCM CHA C-HIS CHN C-IMCI CMAM CSP CSTS DHS DHT DMCH DPT or DTC EDSN-MICS ENA HC HP IMCI INS IPT ITN KPC LQAS M&E MoH MUAC NCHS NMCP ORS SD TT UNICEF WHO Artemisinin Combination Therapy Behavior Change Communication Community Case Management Community Health Agent Community Health Information System Child Health and Nutrition Community-Integrated Management of Childhood Illnesses Community Management of Acute Malnutrition Child Survival Project Child Survival Technical Support project Demographic and Health Survey District Health Team Department of Maternal and Child Health Diphtheria-Pertussis-Tetanus vaccine Enqute Dmographique et de Sant du Niger- Multiple Indicator Cluster Surveys Essential Nutrition Actions Health Center Health Post Integrated Management of Childhood Illnesses Institut National de la Statistique Intermittent Preventive Treatment (Preventive Treatment for Malaria in Pregnant Women) Insecticide Treated Nets Knowledge, Practice and Coverage Lot Quality Assurance Sampling Monitoring and Evaluation Ministry of Health Mid-upper Arm Circumference National Center for Health Statistics (USA Health Statistics Agency) National Malaria Control Program Oral Rehydration Salts Standard Deviation Tetanus Toxoid United Nations Childrens Fund World Health Organization

Background

1.1 Project Location 1.2 Niger is a landlocked Sahelian country that is ranked third from the last on the 2010
Human Development Index list of 169 countries1, with 69 percent of its population living below the poverty line.2 Like the rest of the Sahel, Niger has a long history of endemic hunger characterized by seasonal fluctuations and geographic variation. 1.3 In 2005, a severe drought resulted in a famine that affected nearly 3 million people and exacerbated the already fragile health and nutritional status of the country with disproportional suffering among women and children. While the current crop harvests have ameliorated some of the immediate concerns, many areas do not have transitional support or programs to ensure adequate coping mechanisms, particularly in the areas targeted by this project. year USAID Funded Child Survival Project in Konni District.

1.4 In 2007, in the aftermath of the Nutritional crisis, Relief International started a four 1.5 The project Intervention Zone is located in the southwestern areat of the Tahoua region
and is 417 kilometers to the east from the capital Niamey covering 5,317 square miles. 1.6

1.7 Characteristics of the Target Population 1.8 At the Project Start up in 2007, The Konni Department has an estimated 428,623
individuals with the following repartition3: 1.9 1.10 Age Group 1.12 0-11 months 1.14 12-59 months 1.16 Pregnant woman 1.18 Woman of reproductive age 1.11 Population 1.13 24,200 1.15 59,124 1.17 20,445 1.19 91,297

1 2 http://hdrstats.undp.org/en/countries/profiles/NER.html. 3 Konni Health District Development Plan 2005-2010

1.20 It is fast growing population with 3.3% annual increase4 and in 2011, Konni total
population is estimated at 478687 , 93057 U5 children and 101960 women of reproductive age. Hausa and Peulh are the 2 main ethnic groups.

1.21 Health, Social and Economic Conditions within the Project Area
Class dans les 4 derniers Pays les plus pauvre du monde dans la classification du Program des Nations Unies pour le Development ( PNUD)5, le Niger fait rgulirement face aux contraintes des alas climatiques, et de linstabilit politiques dans un contexte de faible pouvoir dachats avec plus de la moiti de la population vivant avec moins de 1 dollar/Jour. Il rsulte une situation dinscuritaire alimentaire chronique, dans un contexte daccs insuffisant aux soins de sant de base et dhygine prcaire. Malgr ce contexte National, Le departement de Konni est nanmoins un carrefour avec sa situation gographique et la proximit avec le Nigria font de lui une plaque tournante et un carrefour important entre louest (axe Niamey-Konni), le Nord (Agadez-Tahoua), lEst (axe Diffa-Zinder-Maradi) et le Sud (axe Konni-Sokoto au Nigrian). Cette position privilgie lui confere un niveau conomique meilleur que dautres departements avec le commerce frontalier. Le Niveau danalphatisme lve denviron 83%6 de la population pose une limitation a linformation et a la communication dans toutes les interventions au niveau communitaire.

1.22 National Standards/Policies Regarding Maternal and Child health

The Niger health system has been engaged in the reduction of poverty and the promotion of development in relationship to the Millennium Development Goals and National Health Plans reflect that engagement. Niger is currently validation the 2nd Cycle of a four Year Health Plan 2011- 2015 that aims to contribute to the reduction of maternal and child mortality by building on existing capacity to improve the efficiency and quality of the health system7. Building on the national planning process, those involved in the ongoing decentralization process have also developed five-year Regional and District Health Plans. A Free Access Policy to Health care for Under five children and Pregnant women was adopted by GON since 2007 that resulted in Increase Health Services Demand for these age groups while Medical supplies and staffing still lacking. In 2008 the Ministry of Health developed a National Child Survival Strategy which includes increased access to health services through community-based management of malaria, pneumonia and diarrhea. Furthermore, this new strategy promotes the increased availability of competent personnel, an effective system of supplying essential drugs and equipment, adequate logistics, strong supervision and a viable monitoring system as critical factors in a successful Child Survival Strategy. 8 Niger Nutrition Directorate is currently reviewing for validation a New Nutrition Plan for the Years 2011-20159

4 http//www.ins.ne 5 http://hdrstats.undp.org/fr/pays/profils/NER.html 6 http://www.indexmundi.com/g/r.aspx?c=ng&v=39&l=fr 7 RN /Ministere de la SantPublique. Plan de Developpement Sanitaire du Niger adopt Janvier 2011. 8 RN/Ministre de la Sant Publique. Avant-projet de Stratgie National de Survie de lEnfant, 2008 ; page 30. 9 RN/Ministere de la Sant Publique. Plan National pour la Nutrition PNN 2011-2015

1.23 The Child Survival Project

The goal of the Healthy Start Child Survival project is to reduce morbidity and mortality rates of mothers and children under five years of age through strengthening community based health care services and information; developing mechanisms to augment food security and food availability for improved maternal and child nutrition; and, creating awareness of key behaviors for health at the community and household level through capacity building of local primary health care workers, committee members and local organizations. The technical interventions focus on the leading causes of child mortality in the project zone: Maternal and New born care (30% level of effort); Nutrition (30%); of malaria (30% level of effort) and control of diarrhea diseases (20%). The Intermediate Results (principal objectives) are: Increase the practice of selected emphasis behaviors for maternal/child survival; Ensure institutionalized sustainable MOH a0nd community support for community health workers; Strengthen the capacity of communities and local/district health teams.

The activities for achieving the Strategic Objectives are organized into five Technical Packages/Sub-Objectives: To increase access to, demand for, and use of quality maternal and child health services, including emergency care; in order to improved family behaviors related to maternal and child health. To improve case management of malaria at the community and health post levels; increase access to treatment for malaria; improve access and use of treated mosquito nets; and to improve use of chemoprophylaxis (IPT) for malaria among pregnant women. To improve prevention and treatment of diarrheal disease among rural children under five. Improve nutrition of women and children, through education and household/community food security and nutrition activities. To improve the capacity of the Ministry of Health and local partner agencies, to plan, implement, monitor and evaluate child survival interventions at the community and district levels, with an emphasis on capacity in maternal and child health, nutrition, and household food security.

The Project Targeted Initially 90 villages in 2 phased coverage approach. The project established 266 women care groups and support 50 Health posts. After the MTE, finally limited its intervention area to 61 villages. Baseline KPC and Health Facility Assessment and DIP workshop were performed in January and February 2008. The Project used an adapted version of the care group model and training for health care providers at the facility level that resulted according to the Mid Term Evaluation done in January 2010 in an increased knowledge and practice around key child survival interventions, especially malaria prevention, improved nutrition, control of diarrheal disease, and increased access to essential obstetric and neonatal care. Final KPC was implemented as part of the overall Final Evaluation Process in September.

1.1 Objectives of the KPC Survey

The general objective of the survey was to inform Project Team , Local partners on stake on Project indicators. More specifically, the objectives of the study were: 1) To collect data on the Rapid CATCH indicators by : Assessing the knowledge and practice of mothers in selected technical Packages (MNC, Nutrition , Diarrhea, malaria) Measuring nutritional status of children 0-23 months in the project Zone 1) To build the capacity of local staff of the project and partners to implement KPC surveys.

Indicators Selected by Technical Intervention Area (2006 Rapid Catch)

Maternal and Newborn Care: Percentage of mothers with children age 0-23 months who received at least two Tetanus toxoid before the birth of the youngest child Percentage of children age 0-23 months whose births were attended by skilled personnel Percentage of children age 0-23 months who received a post-natal visit from an appropriately trained health worker within three days after birth Breastfeeding and Infant and Young Child Feeding Percentage of child age 0-5 months who were exclusively given breatmilk the day prior to the interview Percent of children age 6-23 months fed according to minimum of appropriately feeding practices Vitamin A Supplementation Percent of children age 6-23 months who received a dose of Vitamin A in the last 6 months: card verfied or mothers recall Immunization Percent of children aged 12-23 months who received measles vaccine according to the vaccination card or mothers recall by the time of the survey Percent of children aged 12-23 months who received DTP1 according to the vaccination card or mothers recall by the time of the survey Percent of children aged 12-23 months who received DTP3 according to the vaccination card or mothers recall by the time of the survey Malaria Percentage of children age 0-23 months with a febrile episode during the last two weeks who were treated with an effective anti-malarial drug within 24 hours after the fever began Percentage of children age 0-23 months who slept under an insecticide-treated bed net the previous night Control of Diarrhea

 Percentage of children age 0-23 months with diarrhea in the last two weeks who received oral rehydration solution (ORS) and/or recommended home fluids. Acute Respiratory Infections Percentage of children age 0-23 months with chest-related cough and fast and/or difficult breathing in the last two weeks who were taken to an appropriate health provider Water and Sanitation Percentage of households of children age 0-23 months that treat water effectively Percentage of mothers of children age 0-23 months who lived in a household with soap at the place for hand washing Anthropometrics Percentage of children age 0-23 months who are underweight (-2SD for the median weight for age, according to WHO/NCHS reference population)

1 Methods
1.1 Partnership Building in the Survey preparation :
Dans le mois de Aout 2011 et en prparation a lenqute KPC de Septembre ,lEquipe du projet a envoy des lettres de participation a la prparation et a la mise en uvre de lEnqute KPC. Ces structures sont : La Mission USAID a Niamey La Direction Rgional8 de la sant publique de Tahoua Le District Sanitaire La Direction dpartemental de lAgriculture La Direction dpartement du Plan Les ONGS Mouviento Por La PAZ et Initiatives pour la scurisation des Mnages (ISCV) de Konni La Direction National de linformation sanitaire (DSSRE)

La Runion du Comit de Pilotage de lEnqute KPC sest tenue le 16-17 septembre en vue de passer en revue le niveau de prparation de lEnqute sur : Revue des Termes de Rfrences de la formation des enquteurs, Revue des drafts doutils de collecte des donnes adapts par lEquipe du projet Aspects logistiques de lorganisation de lEnqute : Matriels et quipement ( toise et Balance, Mdicaments, Moustiquaires), identification des enquteurs etc. Ainsi les contributions des partenaires dans la collecte des ressources ncessaire a la ralisation de cette enqute sont les suivants : CONCERN Tahoua : Toise et Balance District Sanitaire de konni : Echantillon de Medicaments ( Paracetamol, Fer acid folique, Vitamine A, Zince , Sulfadoxine-Pyrimethamine, balance, Moustiquaires impregnes, etc) et un superviseur ISCV : Local et chaises pour la formation des enqueteurs Datashow Superviseur et Enqueteurs Direction Departementale du Plan : Base des donnes demographiques Superviseurs En annexe les lettres dinvitations de ces structures ( USAID, DRSP, DS, MPDL)

1.1 Training and Capacity Building

Core Team Training The core Team is composed of 6 persons: the Project Manager, Project Training Coordinator, Project M&E, the District Communition Officer, the Representative of the Local Government Agricultural Office, the Representant of the Local GON Community Development Office. The Core and the Child Survival Program staff worked on reviewing the Survey plan. The agenda of the review included refresher session on KPC purpose and

Methodology, review and adaptation of questionnaires and Training agenda and logistic and budget arrangement to conduct the Training of Supervisors. The planning intervenes during an ultimate Budget Revision process that significantly reduces provision of funds for the Final Evaluation. The Budget Revision process delayed availability of project funds wire in country to start implementation of the KPC that finally come to Mid Sept 2011. To accommodate the short time implementation of the Survey, the project management Team decided to recall Survey Trainers and Enumerators who participated in the Initial KPC survey. This could improve the quality of the Training and save time. Questionnaire: The scope of the survey and the development of the survey questions were focused on the four intervention area of the project: Maternal and newborn healthcare Control & treatment of malaria Control & treatment of diarrheal disease Nutrition/Food Security The survey questionnaire was 87 questions in length excluding the anthropometrics. The anthropometrics consisted of three measurements: height, weight, and MUAC (where appropriate). The questionnaire was translated into French from the final English version. During the survey the French questionnaire was used as a guide for the verbalization of the survey into Hausa (the local language). Hausa translations of key words are included in annexe6 Training of Suveryors Trainer (TOST) From Sept 1617 2011, the Project Senior staff, Konni Health District and Local Government Technical Services Chief Officer trained five supervisors. 3 supervisors participated in the initial KPC and all have some professional survey experience according to the Learning Need assessment. Agenda and content of TOST are in annexe2. It includes review of KPC general purpose and sampling, review of questionnaire and logistics for conducting Surveyors training. An Adaptation of Key local language items of Initial KPC was done. Supervisors contributed insight into traditions and cultural issues that could impact survey results, and brainstormed solutions to overcome bias. Training of Surveyors RIs survey supervisors conducted a two-day training of 30 interviewers to prepare them for the use of the questionnaire, anthropometric measurement equipment, and presentation samples. Since 50% of the Surveyors participated in the 2008 initial KPC, the supervisors involved them to participate to the rest of the interviewers. The teams of interviewers practiced completing the questionnaire in Konni town on the second training day. A list of highly experienced interviewers in anthropometrics was established to set up 5 Teams for the Field data collection. The supervisors met with the program manager and the coordination Team at the end of each day for feedback and to finalize plans for the survey implementation. The KPC survey was collaborative effort of RI staff and local partners/stakeholders. Some of the constraints in making this Final KPC included the following: Delay in start up and Limited funds to recruit more enumerators Limited timeline ( 2 days TOST, 2 days TOT and 5 days data collection)

1.1 Study Population 2.4.1 Sample Size Calculation

The Organization Team adopted the 30 Cluster sampling of 10 units for this Final KPC, same method as initial survey. However given that the project initial KPC sampling was done on the basis of the 453 villages of the whole district area, and that the project was finally able to develop later its intervention only in 61 as results of MTE recommendation to limit intervention villages. There was a discussion on which sampling to use for the final KPC. Consultation and discussion with the Final Evaluation Consultant and the MCHIP Team and given the limited resources and time for the survey implementation, the basis of 61 villages is used to choose the 30 clusters.

2.4.2 Sampling Design

Steps Followed for Choosing 30 Clusters Step 1: A list of the 61 villages was used as the sampling frame for selection of cluster. The population of the villages was provided by the Niger Bureau of Statistics. A master list with cumulative population totals was constructed including all villages. Step 2: The total estimated population of the Project Zone (61 villages) is 83286 divided by 30, giving a sampling interval of 2776. A start number of 3839 was randomly identified among the last 4 Numbers of the serial Number of Niger 10000 CFA currency Lot. Step 3: After the selection of the first cluster, the remaining 29 clusters were identified using the sampling interval.

1.1 Data Collection and Analysis

The survey team was divided in six teams. Each team was composed of 4 Interviewers, one measurer and one supervisor each team covered one cluster per day, filling out 12 questionnaires. At the end of the data collection, a total of 360 questionnaires were filled out by the interviewers. The supervisors were responsible for the selection of the starting household and survey direction. Each questionnaire was reviewed by a supervisor in the field. Each questionnaire was further reviewed each evening. This process was efficient to detect and report recurrent errors to interviewers. Each team was supervised at least twice by a member of the Core team engaged occasionally in the supervision of supervisor.

The survey data was entered into Epi Info and checked for analysis. The data management is composed of one staff from the MOH HIS , one project M&E Staff and the Project Manager. Due to the tight timeline to submit an Outline of the Interim by the Consultant and questionnaire check remained incomplete and continued through the analysis phase. Several back and forth on the questionnaires lead to a preliminary analysis of the Priority Rapid Cath Indicator. Analysis of one indicator revealed to be difficult to calculate to the Team: complementary feeding composite indicator. Disease data tables locked and were not accessible temporary for analysis. A special assistance from Niger WHO Statistician was requested. As results, by September 30, the End of the Child Survival Official contracting period for Project Staff and therefore the core team of the Survey, IYCF indicators were missing. 2 months later in Dec 15, the Former child Survival Project was recalled by Relief International-HQ to complete the analysis and the Report. Challenges and Issues during the Survey Implementation: Throughout the whole Survey Process, the Team worked under pressure of finalizing the whole KPC survey and to assist the Consultant to do the qualitative assessment within 9 days before the official End of the Project Contracting period. Despite the commitment of the Survey Team, this working atmosphere has resulted in some biases worthy to mention here: Data Collection phase: Some Mothers Prenatal consultation cards were not filled even though child vaccination confirmed by the Village worker register and the Mother saying. Weight for height Measurement was all done by a team of Six measurers, therefore multiplying the risk of same measurer errors. For children under 30 days (One month) too small to be weighed or sick, Weight was replaced by Birth weight in the Child Cards or replaced by same age children who was known either by recall or in the Child Health Card. The total replacement done was about. Thus could inflate Num of children less than one month age and too small to be measured some surveyor have reported either 0 Month or 1 month for Children less that under 1 month or 1 month

Analysis: 2 missing questionnaires in a remote cluster that was identified only at the analysis phase without any practical option to go back to the village to complete the missing questionnaire, An insufficient verification of the data that resulted in missing data in some questionnaires

Result
Sommaire
1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Introduction..................................................................................................................1 Demographic Characteristics.......................................................................................1 Maternal and newborn care:.........................................................................................2 Breastfeeding................................................................................................................4 Vitamin A Supplementation.........................................................................................5 Vaccination:.................................................................................................................5 Malaria:........................................................................................................................7 Discussions and Recommendations............................................................................8

Table 9: Post Natal Check within 3 days for New born.........................................................4

Discussions and Recommendations

1.1 Introduction
This section presents the findings of the Final knowledge, attitude and coverage survey that was conducted in the Konni District, Niger. Findings are presented under the following categories; Demographics characteristics ,Maternal and newborn health, child spacing, breast feeding, vitamin A supplementation, child immunization, malaria, control of diarrhea, Acute Respiratory Infections, water and sanitation and Anthropometrics. This section also compares baseline with endline findings.

1.2 Demographic Characteristics

Table 1: Age of Children under 2 (n=358) Age of children (n=300) 0 to 5 months 6 to 11 months 12 to 23 months Total Freq 107 95 156 358 % 30 27 43 100.0

Table 2: Sex of Children under 2 (n=358) Sex of children (n=358) Female Male Total Freq 137 163 358 % 45.7 54.3 100.0

1.3 Maternal and newborn care:

Table 5: Health Center/Home Delivery Freq Health Center Home Total 213 144 357 % 59,7 40,3 100,0

60% of deliveries take place in the Health centers. It is twice the baseline line (29%). While there has been modest increase in the extension of Health facility coverage between 2007 (52 Health post) and 2011 (60 Health post) in the Konni District in general. In the surveyed 60 villages, the number of HP and Primary Health Care ( CSI) Centers has even remained unchanged. Improved Health care delivery and Community Mobilization in project area may have contributed . Table 6: Assistance during the Delivery (n=358)

Person who assisted Doctor/ Nurse/Midwife HP worker Traditional birth attendant Other Not assisted Total

Freq 161 28 140 25* 2 358

% 45 8 40

100.0

*within this group, 4 responses were categorized as auxiliaire and the cross check on where this staff exist shows that they are in Health Centers. This could be related to Health post workers ( HPw) who temporarily work in Integrated Health Centers ( CSI) during the Frequent absence of the Chief CSI nurse in the majority of Health centers staffed by only one or 2 nurses. The Catch indicator includes Health post worker as qualified Personnel since they were trained by Project in Clean Delivery. Some of this HPW are nurses but may not be known as such by respondents. There almost 40% of delivery still attended by TBA (Matrons) even though they are not considered as skilled personnel. The project has devoted considerable time in the sensitization to teach to TBA in their new role of companion to delivery . Table 6: Home delivery By TBA HomedeliveryTBA Yes No Total Frequency 67 75 142 Percent 47,2% 52,8% 100,0%

95% Conf Limits Yes 38,8% 55,7% No 44,3% 61,2% Comments: when we cross where do the Birth assisted by matrons took, we find that only half of them were at Home, 50% of these Births assisted by TBA( 75/142) occurred in Health Centers. This is well know practices particularly in CSI and District Hospital where matrons are still used for night shift under Midwife supervision. Officially matrons are expected even in those centers to only accompany Parturient to Maternity and help the women in post partum wards. But the reality is that matrons continue to assist delivery when the Midwife actually went to rest during night guards.

Table 7: Use of Clean delivery Kits (n=358)

Was a Clean Delivery Kit used during delivery? Yes No Do Not Know Total

Freq 272 84 2 358

% 76 23 1 100.0

76% of the deliveries benefited clean delivery kit. Project has provided a single use delivery Kit in health centers. The Kit comprises a 2 Yards Cloth to wrap the baby, a razor blade for Cordon Section, a gloves and soap. While 60% of the delivery occurred in health centers, approximately 16% of Kit used were either at home or elsewhere. This is a significant increase compared to 21% of Kit delivery use at baseline KPC Table 8: Post Natal check for Mother within first week When did the Check take place ? Hour 1 Day 1 Week1 Do not Know Total Frequency 159 19 3 20 201 Percent 79,1% 9,5% 1,5% 10,0% 100,0%

95% Conf Limits 72,8 Hours % Day1 5,8% Do not Know 6,2% Week 1 0,3%

84,5% 14,4% 14,9% 4,3%

88% (178/201) of mothers who delivered in Health Centers had a post natal check within the first week and 80% of them had the check within the day after delivery. The total number of the respondents matches with 213 who delivered in Health Center. Only 29 mothers were able to identify the Health personnel who performed the Check. Half of them (51%) were done by Health post Worker. 4 checks done by midwifes and 2 by Doctors. It appears clearly that Doctor and Midwife are most recognizable or may be more communicative (?) Than Nurses and Health Post worker, since the number of deliveries assisted by Midwife and Doctors are the same for the post natal checks.

Table 9: Post Natal Check within 3 days for New born Freq 34 29 63 Percent 54,0% 46,0% 100,0%

Yes No Total

36% (63/216) of mothers said that their baby was checked by the health personnel of the facility where they delivered but only half of the Newborn (38) were checked within the week after birth.

1.4 Breastfeeding
Time Within 1 hour (Initiation ) After 1 hour Did not Know Total Freq 339 13 6 358 % 94% 62.0 2.7 100.0

Table10: Time of Breastfeeding after Birth (n=358) 94% of the newborn were breastfed Immediately ( with 1 hour) and same proportion were given colostrums during the first 3 days after birth and 84% of the newborn were not given any other feed during the same period. This is twice (42% at baseline) higher than baseline rate.

Type of feeding EBF Breastmilk and water

Freq 77 9*

% 72 8.4

Table11: Exclusive Breafeeding (EBF)/ breastmilk and simple water (n= 107) Exclusive Breastfeeding is one of the most cost effective interventions in child survival project especially in developing countries. The Guidelines recommend that a child is not given any other feeds than breast milk until 6 month except medicine. The findings showed a 72% of children under 6 month exclusively Breast feed. This is a significant increase compared to baseline value of 36%.

1.5 Vitamin A Supplementation

Table 12: Children who received Vit A (n=251)

Received Vit A (at least once) Yes No Did not know Blank Total

Freq 184 62 4 1 251

% 74 25 1 0 100.0

The survey noted that among children aged 6-23 months 74% were reported to have received a dose of vitamin A in the last six months while baseline weighed 72% of the children aged 6-23 months received a dose of vitamin A in the last six months.

1.6 Vaccination:
Table 13: Health Card/vaccination possession
Do you have a card where your childs vaccinations are written down? Freq 273 1 68 16 358 % 76,3 ,3 19,0 4,5 100,0

Yes,seen by the Surveyor Do not Know Not availalbe Never had a Card Total

73% of mothers possess Health or vaccination cards. Baseline line value is 61%. The major issue with Health/vaccination card is that they are not filled mostly by Health personnel.

72% (258/358) of mother mentioned to have received vaccination that is not written in the book. Freq 94 49 % 78 41

Penta 1 Penta3

Table 14: Children who received Penta 1 / Penta3 (n=120, children 12-23mth who possess vaccination card)

Table 15: Children who received Vit A (Most Recent Dose, children 6-23, card seen by enumerator)

Yes No NA Total

Freq 140 46 65* 251

% 56 19 25 100.0

This result is obtained from a cross table of Q44 (did the child receive a single dose of Vitamin A with the last 6 month) and Q45 ( do the mother possess a vaccination card?) as indicated in the KPC 2000Tabulation guide .The 65 responses categorized as NA includes children 8-23 month who either have the card and not available (n=50) or never possess a vaccination card (n= 11) or 1 mother was not clear whether she possessed a card or not and therefore classified as No. If the we calculate the percentage of children whose mother said to have received a single dose of Vitamin A whether or not they have a vaccination card, then the percentage increase to 74%. In contrary when we calculate the proportion of children who possessed a vaccination card in which is mentioned that the child has received a Vitamin A dose either the date is or not found; the percentage will drop to 11% only.

Table 16: children with BCG Receive BCG?

Valide Yes NON NS Total

Freq
236 32 90* 358

%
66 8,9 24.1 100,0

66% of children were reported to have received BCG. In infant less than 12 month 70% ( 137/202) had the BCG. Pending the incertainty of the 26% of Non specified responses in either baseline and endline survey, this proportion is lower than the 71% (166/234) weighed at baseline.

63% (99/156) in children 12-23month had the BCG.when compared to 2010 National Child Survival Survey who found 72% for Tahoua Region, Konni district declines in BCG coverage. In fact, Konni District has one the lowest vaccination coverage with recurrent outbreaks of

Table 17: Children who received Measles vaccine (children 9-23, card seen by enumerator):

Received VAR? Yes No Do not Know Total

Freq 94 48 40* 189

% 51% 23% 26% 100.0

The percentage of children who had measles vaccination is calculated among children 9-23. 51% of them had the vaccination. The percentage remains the same when it is calculated among children 12-23mth ( 52%= 78/151)

1.1 Malaria:

Yes No Do not Know Total

Freq 144 72 212

% 68% 32% 100.0

Table 18: Children who had Malaria and received appropriate Treatment 59% (212/358) of the children had fever in the last 2 weeks prior the survey and 68% of them were treated with appropriate anti malarial ( ACT, Fansidar, Chloro and amodiaquine) within 24h of the onset of the fever. This is a moderate decrease in the prevalence of malaria from 2008 KPC (64%) but access to the treatment has been significantly improved from 17.5% in 2008. Coexistence of reported high prevalence of malaria cases and ITNS alleged used in survey in a National pattern known in Niger by Both small scale project and the National Malaria Program. Possible reason to look at in further investigation are the time people start using the ITN at night time and issues pertaining to drug resistance because even though the National policy has adopted since 2008 use of combined Artemisin drugs, Choloroquine, amodiaquine are still be used as first line therapy mostly by Ambulant Pharmacist.

1.2 Discussions and Recommendations

In general, findings of the endline survey in Konni District have shown 2 major Trends: improvements in most of the indicators in Maternal and newborn care, Prevention and Treatment of infant disease, Immunization and Watsan and rather deterioration of Nutritional status of children in the project area that will be discussed more extensively.

1.2.1 Maternal and Newborn

On Mother Child Protection against Tetanos indicator, the endline findings has shown that a higher proportion (81% vs 28.8% at baseline) of mothers with children 0-23 who received at least 2 doses of Tetanus Toxoid vaccine before the birth of their youngest child. This is higher than the 62.1% found by the 2010 Child Survival National Survey[1] for the Region of Tahoua.(Statistique, Juin 2010). Increase in TT is generally related in improved attendance of Antenatal Consultation by women. Despite several stock out of vaccines recorded during the four year implementation of the child survival project, the Policy of Free care access to Mother and child care decreed by the GON in 2008 and community sensitization done by project could be contributing factor. The increase in TT vaccine has also been correlated with proportionate increase in access to maternal Health service as shown by 73% of mother possessing a Health/vaccination cards and 60% of pregnant women that give birth in Health Center. The project area showed a better correlation of completion of ANC/TT visits and birth in health facility than the National Child Survey of 2010 who showed that despite a significant increase of Antenatal visits (55% in Tahoua Region where the project is located), deliveries in Health facility remained low (31%). Among the 60% of pregnant women who gave birth in Health Centers, 52% of the deliveries were attended by skilled personnel against 26.4% at the project start up. MOH indicator do not account though among skilled personnel Health post Worker who are not Nurse. This accounts for almost 60% of all the Health workers in the 60 HP of Konni. 76% of the deliveries performed in these facilities used a clean Birth Kit compared to 20% reported in the Initial KPC. The rate of post-partum check has not changed and have even slightly decreased both for mothers ( 88% vs. 92% at baseline) and children (11% vs. 13% ). While this results may translate a real stagnation of the post natal check-up, it should be noted that the responses rate in the Final KPC is low. Even though 60% (201/358) of mothers said yes that they were checked of their child birth ,Only 29 mothers were able to identify clearly who assisted her during the delivery.

1.2.2 Infant and Yang Child Feeding

The survey has noted a significant increase (72% vs. 36%) in the proportion of children age 05 months who were exclusively breastfed during the last 24 hours from the baseline to end line survey. This is more than twice the proportion found by the National Child Survival Survey of June 2010 (26.9%). However we find similar scale of increase when we compare the increase between 2008baseline/end line (36/72) and National Survey (13/26.9) during the same period.

National survey cluster representatively is limited of the Tahoua Region where Konni is one of the 7 Health Districts. The Survey supported semi -quantitative observations done by the MTE Evaluation that Breastfeeding has significantly increased in the project area. Complementary Feeding: ( to be completed after indicator calculation) On Brezs 74% of children aged 6-23 month received a dose of Vitamin A in the last 6 month according to mother recall and whiles it is only 10% in the baseline KPC. If we exclude responses from Mothers whose card do not mention a precise date Vitamin is received, then the proportion drops to 8% (20/251). DHS calculate this indicator for children 0-5yrs and 2006 DHS found 70% of children fewer than 5 yrs who have received a supplement of mega dose Vitamin. Biannual campaign of National vaccination days are organized in Niger. Since the dose are renewed every six month to moving cohort of under 5 children, the stagnation of the proportion over 4 years This indicate almost the limitation of the distribution strategy rather.

1.3 Child Immunization:

The proportion of mothers with children aged 12-23 months who were vaccinated 3 has improved from baseline to endline in Penta3 from 28% to 41 %, in measles ( 38% vs 51%) but rather decline for BCG ( 72% vs 66%). These all antigens vaccination were still low . as consequences the project has reported annual outbreaks(International, Oct 31 2008) . District has repeatedly reported stocks out in vaccine ()during the annual Health plan evaluation. It is important to note however the rates were higher that the Endline projected targets for these antigens ( 40%)(International, March 2010) Use of vitamin A supplementation among children aged 6-23 months has improved from baseline (10%) and endline survey (73%). This improvement is good for the children as vitamin A is essential for their growth. Vit A is integrated in the 2 semiannual Vaccination campaign. National surveys has continuously shown high coverage of vitamin supplementation in Niger to the point to be removed among priority child Survival indicators tracked by annual Child Survival Survival Surveys.

1.4 . Prevention and treatment of childhood illness:

The Survey found a significant improvement in the prevention and treatment of malaria. Use of Mosquito by mother and child and appropriate treatment of malaria have respectively doubled ( 76% vs 40%) and more for effective treatment of fever ( 17.5 % vs 68%). Dispite several stock outs noted during the project course ((International, March 2010), the project BCC effort and increased availability of ITN in the communities may have contributed to this results.. Furthermore The MTE Evaluation showed that the project has been to educate communities in the use of ITN beyond the rainy season. Diarrhea has been one of the major causes of morbidity and mortality among children and the use of ORS is one treatment used to manage the disease. The end line survey noted an improvement in the use of ORS among children aged 0-23 months to control diarrhea ( 50% vs. 17.5%) . this result would have been better if the project has been able to distribute ORS through the care group volunteers. Access to ORS was only limited to consulting mothers at the Health post.

The endline survey identified an improvement in health seeking behavior among mothers with children aged 0-23 months as evidenced by increased use of appropriate health provider to manage cough and fast and/or difficult breathing of children aged 0-23 months from baseline findings (44% vs 18.2%). Even though ARI treatment is not a priority intervention of the Konni. Improvement of case management has been promoted through capacity building of Health post worker in C-IMCI and better linkages for referral through care group mobilization.

1.5 . Point of use

Use of clean water and good sanitation prevents children from having waterborne diseases. The study noted improvements in households with children aged 0-23 months which treat water effectively ( 75% vs 15.2%) and use soap for hand washing compared to baseline findings ( 24% vs 11.5%).while the improvement is beyond Dip targets for the POU, handwashing has been one of the most challenging intervention during the project implementation for several reasons: the project has adopted a gradual introduction of BCC packages and hand washing was introduced at Year 2 and did not benefit as much sensitization time as MNC or Breastfeeding. Second, placement of soap at POU is highly cultural dependant. soap is mostly in the bathing area and prayer ablution Kettle used mostly for handwashing in the project is not culturally associated with using soap. also, soap is costly and cannot be exposed outside because of birds, hens or domestic animal that tend to displace it or be in a container where it could easily dilute. The project has trained at the last quarter of implementation period ( april-May-june) for few women volunteers to produce locally soap. there is however a need to create a mechanism of expanding the production in the project area but this is a an outcome that could be seen within the current phase of this project.

1.6 .Nutritional status of children

The study found that 44 The national nutrition policy for Malawi indicates that 21% of children under five years old are underweight. The baseline findings noted that 28% were underweight while the endline survey noted that 16% were underweight. This shows that the nutrition status for children has improved in the district.

Annexe:

Q15:Did you ever breastfeed your child? Effectifs Valide NON OUI Total Pourcentage 4 1,1 354 358 98,9 100,0 Pourcentag Pourcentag e valide e cumul 1,1 1,1 98,9 100,0 100,0

Q16:How long after birth did you first put your child to the breast? Effectifs Valide HEURE IMMEDIATEMENT JOURS NSP Total Pourcentage 80 22,3 259 13 6 358 72,3 3,6 1,7 100,0 Pourcentag e valide 22,3 72,3 3,6 1,7 100,0 Pourcentag e cumul 22,3 94,7 98,3 100,0

Q17:During the first three or four days after delivery, before your regular milk began flowing, did you give your child the liquid (colostrum) that came from your breast? Effectifs Valide NON OUI Pourcentage 18 5,0 340 95,0 Pourcentag Pourcentag e valide e cumul 5,0 5,0 95,0 100,0

Total

358

100,0

100,0

Q18: In the first three days after delivery, was your child given anything to drink other than breast milk? Effectifs Valide NON OUI Total Pourcentage 302 84,4 56 358 15,6 100,0 Pourcentag e valide 84,4 15,6 100,0 Pourcentag e cumul 84,4 100,0

Q16:How long after birth did you first put your child to the breast? Effectifs 80 259 13 6 358 Pourcentag e 22,3 72,3 3,6 1,7 100,0 Pourcentag Pourcentag e valide e cumul 22,3 22,3 72,3 3,6 1,7 100,0 94,7 98,3 100,0

Valid e

HEURE IMMEDIATEMEN T JOURS NSP Total

Q44: tr_age 1 Valide NON OUI Total NON NSP OUI Total

Effec Pource tifs ntage 25 82 107 63 4 184 251 23,4 76,6 100,0 25,1 1,6 73,3 100,0

Valide

Pourcen tage valide 23,4 76,6 100,0 25,1 1,6 73,3 100,0

Pourcen tage cumul 23,4 100,0 25,1 26,7 100,0

Forward VITAMINEA Frequency Percent Cum Percent 40241 1 3,6% 3,6% 40387 1 3,6% 7,1% 40494 1 3,6% 10,7% 40538 1 3,6% 14,3% 40559 1 3,6% 17,9% 40570 1 3,6% 21,4% 40596 1 3,6% 25,0% 40608 1 3,6% 28,6% 40617 1 3,6% 32,1% 40624 1 3,6% 35,7%

40628 40647 40659 40663 40681 40697 40717 40718 40721 40756 40768 40779 40783 47484 146099 Total 95% Conf Limits 40241 0,1% 18,3% 40387 0,1% 18,3% 40494 0,1% 18,3% 40538 0,1% 18,3% 40559 0,1% 18,3% 40570 0,1% 18,3% 40596 0,1% 18,3% 40608 0,1% 18,3% 40617 0,1% 18,3% 40624 0,1% 18,3% 40628 0,1% 18,3% 40647 0,1% 18,3% 40659 0,1% 18,3% 40663 0,9% 23,5% 40681 0,1% 18,3% 40697 0,1% 18,3% 40717 0,1% 18,3% 40718 0,1% 18,3% 40721 0,1% 18,3% 40756 0,1% 18,3% 40768 0,1% 18,3% 40779 0,1% 18,3% 40783 0,1% 18,3% 47484 2,3% 28,2% 146099 0,1% 18,3%

1 3,6% 1 3,6% 1 3,6% 2 7,1% 1 3,6% 1 3,6% 1 3,6% 1 3,6% 1 3,6% 1 3,6% 1 3,6% 1 3,6% 1 3,6% 3 10,7% 1 3,6% 28 100,0%

39,3% 42,9% 46,4% 53,6% 57,1% 60,7% 64,3% 67,9% 71,4% 75,0% 78,6% 82,1% 85,7% 96,4% 100,0% 100,0%

Previous Dataset Results Library

1.6.1.1 FREQ Q44

Next Procedure Forward Q44 Frequency Percent Cum Percent NON 62 24,8% 24,8% NSP 4 1,6% 26,4% OUI 184 73,6% 100,0% Total 250 100,0% 100,0% 95% Conf Limits NON 19,6% 30,6% NSP 0,4% 4,0% OUI 67,7% 79,0% Previous Dataset Results Library

1.6.1.2 TABLES VITAMINEA Q44

Next Procedure Forward

Q44 VITAMINEA NON OUI TOTAL 40241 0 1 1 1.6.1.3 Single Table Row % 0,0 100,0 100,0 Analysis Col % 0,0 3,8 3,6 40387 0 1 1 ChiProbability df Row % 0,0 100,0 100,0 square Col % 0,0 3,8 3,6 28,0000 24 0,2600 40494 0 1 1 Row % 0,0 100,0 100,0 An expected value is < 5. Col % 0,0 3,8 3,6 Chi-square not valid. 40538 0 1 1 Row % 0,0 100,0 100,0 Col % 0,0 3,8 3,6 Tab: Exclusive 40559 0 1 1 Breastfeeding Row % 0,0 100,0 100,0 Col % 0,0 3,8 3,6 40570 0 1 1 bf Row % 0,0 100,0 100,0 Exclusive Breasfeeding % 0,0 3,84 3,6 1 Col 2 3 5 Total 0 9 1 6 1 0 tr_age 1 Effectif 9240596 0 107 Row % 0,0 100,05,6% 100,0 % compris 86,0% ,0% 8,4% ,0% 100,0% Col % 0,0 3,8 3,6 dans tr_age % compris 29,5%40608 ,0% 34,6% 40,0% ,0% 29,9% 1 0 1 dans bf Row % 100,0 0,0 100,0 % du total 25,7% ,0% 2,5% ,0% 29,9% Col % 50,0 0,01,7% 3,6 2 Effectif 220 251 40617 3 0 17 1 9 1 2 % compris 87,6% 1,2% 6,8% ,8% 100,0% Row % 0,0 100,03,6% 100,0 dans tr_age Col % 0,0 3,8 3,6 % compris 70,5% 100,0% 65,4% 60,0% 100,0% 70,1% 40624 0 1 1 dans bf % du total 61,5% ,8% 4,7% ,6% 70,1% Row % 0,0 100,02,5% 100,0 Col % 0,0 3,8 3,6 40628 0 1 1 Row % 0,0 100,0 100,0 Col % 0,0 3,8 3,6 40647 0 1 1 Row % 0,0 100,0 100,0 Col % 0,0 3,8 3,6 40659 0 1 1 :\Users\Relief2\Desktop\KPC report ne\Ali Results Dec 100,0 Row % 0,0 100,0 26\ClasseurfullrecombinedHMdec27.xls:Feuil1$ 3,8 Col % 0,0 3,6 Select: (Q45 = "Oui, vu par l'enqueteur" ) AND (Age > 40663 0 2 2 11 Row % ) 0,0 100,0 100,0 Record Count:% 0,0 7,7 Col 120 7,1 Date: 31/12/2011 18:02:44 40681 0 1 1 Row % 0,0 100,0 100,0 Col % 0,0 3,8 3,6 40697 0 1 1 Row % 0,0 100,0 100,0 Col % 0,0 3,8 3,6

1.6.1.4 FREQ DTC1Penta1 DTC3Penta3

Next Procedure DTC1Penta1 DTC3Penta3

1.6.1.5 DTC1Penta1
Forward DTC1Penta1 Frequency Percent Cum Percent 22/05/2001 1 1,1% 1,1% 28/12/2009 1 1,1% 2,1% 24/02/2010 2 2,1% 4,3% 15/03/2010 1 1,1% 5,3% 26/03/2010 1 1,1% 6,4% 09/04/2010 1 1,1% 7,4% 21/04/2010 1 1,1% 8,5% 23/04/2010 1 1,1% 9,6% 24/04/2010 1 1,1% 10,6% 27/04/2010 1 1,1% 11,7% 05/06/2010 1 1,1% 12,8% 21/06/2010 1 1,1% 13,8% 27/06/2010 1 1,1% 14,9% 16/07/2010 1 1,1% 16,0% 29/07/2010 3 3,2% 19,1% 26/08/2010 1 1,1% 20,2% 03/09/2010 1 1,1% 21,3% 05/09/2010 1 1,1% 22,3% 08/09/2010 1 1,1% 23,4% 22/09/2010 1 1,1% 24,5% 23/09/2010 1 1,1% 25,5% 24/09/2010 1 1,1% 26,6% 11/10/2010 1 1,1% 27,7% 23/10/2010 1 1,1% 28,7% 23/11/2010 1 1,1% 29,8% 25/11/2010 1 1,1% 30,9% 06/12/2010 1 1,1% 31,9% 08/12/2010 1 1,1% 33,0% 22/12/2010 1 1,1% 34,0% 05/01/2011 1 1,1% 35,1% 07/01/2011 1 1,1% 36,2% 15/01/2011 1 1,1% 37,2% 20/01/2011 1 1,1% 38,3% 22/01/2011 1 1,1% 39,4% 24/01/2011 1 1,1% 40,4% 25/01/2011 1 1,1% 41,5%

15/02/2011 21/02/2011 26/02/2011 14/03/2011 29/03/2011 13/04/2011 21/04/2011 25/04/2011 30/04/2011 02/05/2011 11/05/2011 12/05/2011 18/05/2011 26/05/2011 27/05/2011 28/05/2011 30/05/2011 31/05/2011 03/06/2011 05/06/2011 21/06/2011 22/06/2011 23/06/2011 24/06/2011 25/06/2011 26/06/2011 28/06/2011 30/06/2011 04/07/2011 17/07/2011 22/07/2011 29/07/2011 10/08/2011 17/08/2011 28/08/2011 12/09/2011 13/09/2011 20/09/2011 28/10/2011 26/11/2011 03/09/2019 01/01/2030 Total 95% Conf Limits

1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 5 5,3% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 4 4,3% 2 2,1% 1 1,1% 1 1,1% 1 1,1% 3 3,2% 2 2,1% 1 1,1% 2 2,1% 1 1,1% 1 1,1% 2 2,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 1 1,1% 94 100,0%

42,6% 43,6% 44,7% 45,7% 46,8% 47,9% 48,9% 50,0% 55,3% 56,4% 57,4% 58,5% 59,6% 60,6% 61,7% 62,8% 63,8% 64,9% 69,1% 71,3% 72,3% 73,4% 74,5% 77,7% 79,8% 80,9% 83,0% 84,0% 85,1% 87,2% 88,3% 89,4% 90,4% 91,5% 92,6% 93,6% 94,7% 95,7% 96,8% 97,9% 98,9% 100,0% 100,0%

22/05/2001 28/12/2009 24/02/2010 15/03/2010 26/03/2010 09/04/2010 21/04/2010 23/04/2010 24/04/2010 27/04/2010 05/06/2010 21/06/2010 27/06/2010 16/07/2010 29/07/2010 26/08/2010 03/09/2010 05/09/2010 08/09/2010 22/09/2010 23/09/2010 24/09/2010 11/10/2010 23/10/2010 23/11/2010 25/11/2010 06/12/2010 08/12/2010 22/12/2010 05/01/2011 07/01/2011 15/01/2011 20/01/2011 22/01/2011 24/01/2011 25/01/2011 15/02/2011 21/02/2011 26/02/2011 14/03/2011 29/03/2011 13/04/2011 21/04/2011 25/04/2011 30/04/2011 02/05/2011 11/05/2011

0,0% 5,8% 0,0% 5,8% 0,3% 7,5% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,7% 9,0% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 1,7% 12,0% 0,0% 5,8% 0,0% 5,8%

12/05/2011 18/05/2011 26/05/2011 27/05/2011 28/05/2011 30/05/2011 31/05/2011 03/06/2011 05/06/2011 21/06/2011 22/06/2011 23/06/2011 24/06/2011 25/06/2011 26/06/2011 28/06/2011 30/06/2011 04/07/2011 17/07/2011 22/07/2011 29/07/2011 10/08/2011 17/08/2011 28/08/2011 12/09/2011 13/09/2011 20/09/2011 28/10/2011 26/11/2011 03/09/2019 01/01/2030

0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 1,2% 10,5% 0,3% 7,5% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,7% 9,0% 0,3% 7,5% 0,0% 5,8% 0,3% 7,5% 0,0% 5,8% 0,0% 5,8% 0,3% 7,5% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8% 0,0% 5,8%

1.6.1.6 DTC3Penta3
Back Forward Current Procedure DTC3Penta3 Frequency Percent Cum Percent 24/04/2010 1 2,0% 2,0% 10/05/2010 1 2,0% 4,1% 22/06/2010 1 2,0% 6,1% 24/06/2010 1 2,0% 8,2% 21/08/2010 1 2,0% 10,2% 27/08/2010 1 2,0% 12,2% 09/09/2010 1 2,0% 14,3% 19/10/2010 1 2,0% 16,3% 10/11/2010 1 2,0% 18,4%

11/11/2010 07/12/2010 20/12/2010 14/01/2011 15/02/2011 21/02/2011 23/02/2011 09/03/2011 15/03/2011 22/03/2011 25/03/2011 18/04/2011 15/05/2011 18/05/2011 03/06/2011 04/06/2011 20/06/2011 29/06/2011 05/07/2011 12/07/2011 15/07/2011 20/07/2011 25/07/2011 26/07/2011 29/07/2011 31/07/2011 13/08/2011 27/08/2011 28/08/2011 09/09/2011 18/09/2011 11/10/2011 02/11/2011 14/11/2011 22/11/2011 Total

1 2,0% 1 2,0% 1 2,0% 2 4,1% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 2 4,1% 2 4,1% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 2 4,1% 1 2,0% 1 2,0% 1 2,0% 2 4,1% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 1 2,0% 49 100,0%

20,4% 22,4% 24,5% 28,6% 30,6% 32,7% 34,7% 36,7% 38,8% 40,8% 42,9% 44,9% 46,9% 49,0% 53,1% 57,1% 59,2% 61,2% 63,3% 65,3% 67,3% 69,4% 71,4% 73,5% 77,6% 79,6% 81,6% 83,7% 87,8% 89,8% 91,8% 93,9% 95,9% 98,0% 100,0% 100,0%

95% Conf Limits 24/04/2010 0,1% 10,9% 10/05/2010 0,1% 10,9% 22/06/2010 0,1% 10,9% 24/06/2010 0,1% 10,9% 21/08/2010 0,1% 10,9% 27/08/2010 0,1% 10,9% 09/09/2010 0,1% 10,9%

19/10/2010 10/11/2010 11/11/2010 07/12/2010 20/12/2010 14/01/2011 15/02/2011 21/02/2011 23/02/2011 09/03/2011 15/03/2011 22/03/2011 25/03/2011 18/04/2011 15/05/2011 18/05/2011 03/06/2011 04/06/2011 20/06/2011 29/06/2011 05/07/2011 12/07/2011 15/07/2011 20/07/2011 25/07/2011 26/07/2011 29/07/2011 31/07/2011 13/08/2011 27/08/2011 28/08/2011 09/09/2011 18/09/2011 11/10/2011 02/11/2011 14/11/2011 22/11/2011

0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,5% 14,0% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,5% 14,0% 0,5% 14,0% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,5% 14,0% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,5% 14,0% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9% 0,1% 10,9%

Select age>11, freq Recevoir_VAR Frequency Percent Cum Percent NON 37 32,2% 32,2% OUI 78 67,8% 100,0%

Total

115 100,0%

100,0%

Next Procedure Forward Recevoir_VAR Frequency Percent Cum Percent NON 43 31,4% 31,4% OUI 94 68,6% 100,0% Total 137 100,0% 100,0% 95% Conf Limits NON 23,7% 39,9% OUI 60,1% 76,3%

Next Procedure Forward Recevoir_VAR Frequency Percent Cum Percent NON 37 32,2% 32,2% OUI 78 67,8% 100,0% Total 115 100,0% 100,0% 95% Conf Limits NON 23,8% 41,5% OUI 58,5% 76,2% Bibliograhy : 1. 2. 3. 4.
5. 6. 7. 8. 9.

RN/Institut National de la Statistique :Equete Survie de lEnfant Juin 2010 RN/ District Sanitaire konni : Plan de Developpeemnt Sanitaire 2012-2016 RN/ Institut National de la statistique : Enquete Nutrition Juin 2011 Population Niger 2011: http//www.ins.ne
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