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Primary Health Care Management Advancement Programme
ASSESSING
COMMUNITY HEALTH NEEDS
AND COVERAGE
MODULE 2
USER’S GUIDE
AGA KHAN FOUNDATION
THE AGA KHAN UNIVERSITY
Primary Health Care Management Advancement Programme
ASSESSING
COMMUNITY HEALTH NEEDS
AND COVERAGE
Jock Reynolds
University Research Corporation
MODULE 2
USER S GUIDE
Aga Khan Health Services
University Research Corporation
Center for Human Services
Monitoring the health of children, such as this child in
Portugal, helps to identify health needs.apd, later, assess
coverage of children wj
rfip’fityis^fyi'Ges.,
Photo by Jean
LIBRARY
AND
ISBN: 1-882839-01-3
Library of Congress Catalog Number: 92-
INFORMATION
Dedicated to
Dr. Duane L. Smith (1939-1992),
Dr. William B. Steeler (1948-1992)
and all other health leaders, managers and workers
who follow their example in the effort to bring quality health
care to all in need.
Assessing the awareness of women about good nutrition
and the treatment of common problems, such as
diarrhoea, is important
Photo by Jean-Luc Ray for AKF
An overview of PHC MAP
The main purpose of the Primary Health Care Management Advance
ment Programme (PHC MAP) is to help PHC management teams collect,
process and analyse useful management information.
Initiated by the Aga Khan Foundation, PHC MAP is a collaborative programme of
the Aga Khan Health Network1 and PRICOR.Z An experienced design team and equally
experienced PHC practitioner teams in several countries, including Bangladesh, Chile,
Colombia, the Dominican Republic, Guatemala, Haiti, India, Indonesia, Kenya, Pakistan,
Senegal, Thailand and Zaire, have worked together to develop, test and refine the PHC
MAP materials to make sure that they are understandable, easy to use and helpful.
PHC MAP includes nine units called modules. These modules focus on essential
information that is needed in the traditional management cycle of planning-doing
evaluating. The relationship between the modules and this cycle is illustrated below.
PHC MAP modules and the
planning-evaluation cycle
PHC MAP
MODULES
1. Information needs
2. Community needs
3. Work planning
4. Surveillance
5. Monitoring indicators
6. Service quality
7. Management quality
8. Cost analysis
9. Sustainability1
2
§
1 The Aga Khan Health Network includes the Aga Khan Foundation, the Aga Khan Health
Services, and the Aga Khan University, all of which are involved in the strengthening of
primary health care
2 Primary Health Care Operations Research is a worldwide project of the Center for Human
Services, funded by the United States Agency for International Development
ii
Managers can easily adapt these tools to fit local conditions. Both new and
experienced programmers can use them. Government and NGO managers, man
agement teams, and communities can all use the modules to gather information
that fits their needs. Each module explains how to collect, process and interpret
information that managers can use to improve planning and monitoring. The
modules include User’s guides, sample data collecting and data processing instru
ments, optional computer programs, and Facilitator’s guides, for those who want to
hold training workshops.
The health and management services included in PHC MAP are listed below.
Health and management services
HEALTH SERVICES
GENERAL
OTHER HEALTH CARE
PHC household visits
Health education
Water supply, hygiene and
sanitation
School health
Childhood disabilities
Accidents and injuries
Sexually transmitted diseases
HIV/AIDS
Malaria
Tuberculosis
Treatment of minor ailments
Chronic, non-communicable
diseases
MATERNAL CARE
Antenatal care
Safe delivery
Postnatal care
Family planning
CHILD CARE
Breastfeeding
Growth monitoring
Nutrition education
Immunization
Acute respiratory infection
Diarrhoeal disease control
Oral rehydration therapy
MANAGEMENT
SERVICES
Planning
Personnel management
Training
Supervision
Financial management
Logistics management
Information management
Community organisation
Several Manager’s guides supplement these modules. These are: Better Manage
ment: 100 Tips, a helpful hints book that describes effective ways to help managers
improve what they do; Problem-solving, a guide to help managers deal with common
problems; Computers, a guidebook providing useful hints on buying and operating
computers, printers, other hardware and software; and The computerised PRICOR
thesaurus, a compendium of PHC indicators.
IB
Women carry the burden of most family chores and of
promoting health and preventing disease within their
families and communities
Photo by Jean Luc Ray for AKF
The Primary Health Care Management Advancement
Programme has been funded by the Aga Khan Foundation
Canada, the Aga Khan Foundation USA, the Aga Khan
Foundations head office in Geneva, the Rockefeller Foun
dation, the Canadian International Development Agency,
Alberta Aid, and the United States Agency for International
Development under two matching grants to AKF USA. The
first of these grants was "Strengthening the Management,
Monitoring and Evaluation of PHC Programmes in Selected
Countries of Asia and Africa" (co-operative agreement no.
CTR-0158-A-00-8161-00,1988-1991); and the second was
"Strengthening the Effectiveness, Management and Sus
tainability of PHC/Mother and Child Survival Programmes
in Asia and Africa" (co-operative agreement no. PCD-0158A-00-1102-00,1991-1994). The development of Modules 6
and 7 was partially funded through in-kind contributions
from the Primary Health Care Operations Research project
(PRICOR) of the Centre for Human Services under its
co-operative agreement with USAID (DSPE-6920-A-001048-00).
This support is gratefully acknowledged. The views and
opinions expressed in the PHC MAP materials are those of
the authors and do not necessarily reflect those of the
donors.
All PHC MAP materia! (written and computer files) is in
the public domain and may be freely copied and distributed
to others.
Module 2: Assessing health needs
Contents
QUICK START.............................................................................................. 1
INTRODUCTION ........................................................................................ 3
What are "rapid community surveys" ................................................... 3
Some limitations of rapid surveys ........................................................ 6
How you can use this module................................................................ 10
How the module is organized ................................................................ 11
RAPID SURVEY PROCEDURES.............................................................. 15
Step 1: Specify the objectives of the rapid survey .........................15
Step 2: Decide what indicators to use............................................. 19
Step 3: Develop an outline for the survey report .......................... 21
Step 4: Design the data collection instruments.............................. 23
Step 5: Develop the sampling procedures........................................30
Step 6: Schedule the survey.............................................................. 41
Step 7: Collect the data......................................................................41
Step 8: Enter, verify, and tabulate the data...................................... 43
Step 9: Analyse, interpret, and report the findings......................... 47
Step 10: Develop an action plan........................................................ 50
APPENDICES: TEMPLATES, TOOLS, GUIDELINES, AND
COMPUTER PROGRAMS ......................................................................... 53
A. How to use Epi Info for rapid surveys ......................................... 55
B. Questionnaire design guidelines..................................................... 81
C. Rapid survey instruments .............................................................. 87
D. Cluster survey registers ................................................................ 147
E. Guidelines for training and supervising interviewers ................183
F. Cluster sampling programmes cluster identification
worksheet .........................................................................................187
G. Other sampling tools .................................................................... 191
Module 2: Assessing health needs
G.l Estimates of target group sizes................................................191
G.2 Sample size estimation for WHO two-stage cluster
survey ....................................................................................... 193
G.3 Random number table
<.......................................... 195
G.4 Random sampling procedures ............................................... 197
G.5 Estimating fertility and child mortality rates and ratios ... .199
H. Survey management forms........................................................... 203
I. Tabulation and analysis templates................................................ 207
1.1. Analysis plan...........................................................................207
1.2. Data entry and analysis templates....................................... 211
1.3. Confidence interval estimation templates ..........................221
REFERENCES AND BIBLIOGRAPHY................................................... 223
ACRONYMS AND ABBREVIATIONS ................................................... 225
GLOSSARY ................................................................................................ 226
Module 2: Assessing health needs
Acknowledgements
This module draws heavily on concepts and procedures used by the World Health
Organization in its rapid assessments of immunization coverage, the recent work
of Ralph R. Frerichs of the UCLA School of Public Health on rapid surveys, and
Anthony Bennett's work on mini-surveys. Bennett and Peerasit Kamnuansilpa
(both in Thailand) have been instrumental in early field tests of prototypes of rapid
surveys in PHC, and their experience has been incorporated into this module. Early
versions of the rapid survey instruments were reviewed by members of the Aga
Khan Health Network at a workshop in Dhaka, Bangladesh, in May 1990. Subse
quent feedback from Khatidja Husein of the Aga Khan University (Pakistan) and
Esther Sempebwa of the Kisumu Primary Health Care Project (Kenya) were
especially helpful.
Thanks are due also to Pierre Clauquin of AKF for his suggestions on computer
programs, and to Paul Richardson of URC/CHS for his advice on sampling.
The computerised version of this module is based on, Epi Info, Version 5: A Word
Processing, Database and Statistics System for Epidemiology on Microcomputers, by
A.G. Dean, J.A. Dean, A.H. Burton, and R.C. Dickers. Epi Info is a joint project of
the Centers for Disease Control (CDC) and the World Health Organization (WHO).
The Epi Info manual and computer program are in the public domain and may be
freely copied. The program is ''bundled" with this module to enable managers to
use the computer version of the module.
Reviewers:
Donald Belcher » Veterans’ Administration, Seattle, Washington USA
William Reinke • Johns Hopkins School of Hygiene and Public Health,
Johns Hopkins University, Baltimore, Maryland USA
Gilbert M. Burnham • Johns Hopkins School of Hygiene and Public Health,
Johns Hopkins University, Baltimore, Maryland, USA
David H. Peters • Johns Hopkins School of Hygiene and Public Health,
Johns Hopkins University, Baltimore, Maryland, USA
Paul Zeitz. • Johns Hopkins School of Hygiene and Public Health, Johns Hopkins
University, Baltimore, Maryland USA
Al Henn • AMREF, Nairobi, Kenya
Asif Aslam, Melvyn Lobo, Inaam-ul-Haq, Syed Meboob Ali Shah, Khatidja Husein
• Aga Khan University, Karachi
Barkat-e-Khuda • URC, Bangladesh
Field tests:
Countries, participating organisations, field test facilitators
Pakistan:
Aga Khan University, Karachi; Facilitator: Khatidja Husein, Aga
Khan University
Thailand:
Ministry of Public Health, Srisaket; Somboon Vachrotai
Foundation (SVF); ASEAN Institute for Health Development
(AIHD); Health and Population Research Company (HPRC);
Facilitators: Pearasit Kamnuansilpa, HPRC, Thongchai
Sapanuchart, SVF, Butsabar Subongkot, HPRC
Module 2: Assessing health needs
India:
Kenya:
Columbia:
Junagadh PHC Project, Jonpur; Sidhpur PHC Project,
Ahmedabad; Aga Khan Health Service, India; URMUL Trust
PHC Project
Mombasa PHC Programme; Kisumu PHC Programme;
Facilitators: Paul Richardson, URC, Esther Sempebwa, Mombasa
PHC Programme
Fundacion Santa Fe de Bogota; Facilitator: Jorge E. Medina
Module 2: Assessing health needs
1
Quick start
How to use the prototype questionnaires - rapid
surveys
Select a questionnaire
If you already know something about community surveys, you can use the questionnaires
in this manual to carry out a PHC survey. Go to Appendix C and select a questionnaire.
Modify it to fit your particular needs and situation. If you do not need to make any changes
to the questionnaire, simply print out as many copies as you need, one per interview
Draw your sample
You also need to draw your sample The User’s guide includes instructions for drawing a
cluster sample (30 clusters by seven respondents each). This is normally a large enough sample
for a rapid survey. These instructions show you how to do this manually. You do not need a
computer. However, if you have a computer, see Appendix F for instructions. It describes
how to use the enclosed computer program to draw your sample quickly.
Collect the data
We are assuming that you will interview seven eligible mothers in each of 30 clusters. It
is best to send a two-person team to each cluster - one to conduct the interviews, the other
to find the respondents and check the completed interviews. You only need to complete seven
interviews in each cluster. See Step 7 in the User’s guide if you need more information about
selecting households.
Summarise the data
Assemble all of your questionnaires. Then calculate the totals for each question and enter
them into a blank questionnaire, this will give you a summary of the entire survey on one
sheet.
Analyse the data
Compute percentages for each "yes’’ answer, and summarise the results. Write out the
major findings for each question. See the analysis section in the User’s guide for analysis
instructions.
Computerised surveys
If you would like to use a computer to conduct your survey, turn to Appendix A, which
describes how to use Epi Info to design, collect, and analyse your survey data. A copy of the
Epi Info manual and the Epi Info computer program is included in this module for your use.
Module 2: Assessing health needs; Quick start
2
In Bangladesh, the empowerment of women for social
and economic development has yielded substantial
improvements in the health status of their families
Photo by Jean-Luc Ray for AKF
3
Introduction
This module introduces and shows you how to use rapid
community surveys to assess community PHC needs and
to evaluate programme effects on PHC coverage.
What are "rapid community surveys '?
PHC managers need timely and useful information about
—the health status of their target populations so that they can
do a better job of planning and monitoring PHC services.
The traditional way to collect health information is through
—, large surveys, done infrequently and generally on a national
scale. This information is of little use to local managers.
"Local programme managers often totally lack data upon ----------------------—- which to assess or evaluate the health problems in their area. The rapid survey
It is usually not possible to interpolate the results of large
ls a new tpo1
general population surveys (for) local estimates."1
"
The "rapid survey” is a new tool for getting this kind of
information quickly and inexpensively. It is especially useful
for local PHC managers who need information about their
~ local populations.
The "rapid survey" is an alternative to traditional largescale sample surveys. It was originally developed to assess
3
1
Smith, G. S. "Development of rapid epidemiological assessment methods
to evaluate health status and delivery of health services." International
journal of epidemiology 18 (4 [Supplement)) S4,1989.
Module 2: Assessing health needs; introduction
4
A typical rapid
survey
immunization coverage1 and has been adapted to other
epidemiological areas by Frerichs.*12 Recently, some explor
atory work has been undertaken to adapt the methodology
to family planning and primary health care, with special
emphasis on using rapid surveys to help managers improve
planning and monitoring of services.3
These surveys are designed to help PHC managers collect
population-based information on health status, behavi
our, and knowledge. The typical rapid survey can be
carried out in two to three weeks, from design to final report.
It involves 200-300 household interviews, drawn from 30
clusters of seven to ten respondents each. The interview
schedule is short (20-30 items), and the questions are
phrased in "yes"/"no" terms to permit statistical tests of
significance. The surveys are often pre-coded so that the
data can be entered into a local computer and immediately
analysed. The analysis is simple.
Example
When they are done well, rapid surveys are very impress
ive. The author participated in his first rapid survey in
Thailand in late 1987. Twenty two participants from three
developing countries attended a one-week workshop where
they learned the principles of rapid surveys in the first three
days and designed questionnaires and developed the samples
in the next two days for two simultaneous surveys - one on
antenatal care, and one on family planning. In the second
week they collected the data (three days), processed it (one
day), and presented a report (one day) on the findings to the
1 Henderson, R. H. and T. Sunaresan, ''Cluster sampling to assess
immunization coverage: A review of experience with a simplified
method." Bulletinofthe World Health Organization 60 (2): 253-260,1982.
2 Frerichs, R. R. and Tar Tar, K "Computer-assisted rapid surveys in
developing countries." Public health reports 104: 14-23,1989.
3 Frerichs, R.R., et al. "Family planning survey and antenatal survey,
Srisaket, Thailand," December, 1987 (unpublished paper, URC/CHS);
"Institutionalizing the use of rapid surveys for family planning
decision-making,” an Operations Research Proposal, Gadja Mada
University and University Research Corporation, November 1989; and
"Primary Health Care Management Advancement Programme
1989-1992," a proposal of the Aga Khan Health Network and PRICOR,
November, 1989.
Module 2: Assessing health needs; introduction
5
provincial management team. Excerpts from the presenta
tion are shown below.
The entire survey, including training, was conducted in
only two weeks. This was not a survey of a small population.
Six districts with an estimated combined population of
410,891 were sampled. The antenatal care (ANC) survey
Table 1: Type of attendant at last delivery, N = 206
Type attendant
Number
Percent
Government health worker
114
55.3
Traditional birth attendant
89
43.2
Unattended
3
1.5
206
100.0
Total
Table 2: Received tetanus toxoid last pregnancy; N = 209
Received TT
Number
Percent
Yes
145
69.4
No
52
24.9
DK/NR
12
5.7
Total
209
100.0
Figure 1: Received tetanus toxoid last pregnancy, N= 209
Module 2: Assessing health needs; introduction
6
targeted married women currently living in these six districts
who had had a pregnancy outcome, live birth, stillbirth,
miscarriage, or abortion, within the past 24 months. This
population was estimated to be 24,653 women.
The total number of people interviewed in a rapid survey
is typically 210, i.e., 30 clusters x 7 respondents each. Al
though this number appears small, it has been used extensively
in the Expanded Programme for Immunization (EPI) and has
been shown to produce unbiased estimates within the desired
level of precision, that is, plus or minus 10 percent.
A number of improvements can be made in this method
ology to reduce sampling error, increase the level of confi
dence, and gather more detailed information. These are
described in this guide.
Some limitations of rapid surveys
Rapid survey
samples cannot be
broken into sub
samples
Although rapid surveys are attractive alternatives to
traditional large-scale sample surveys, there are trade-offs.
The most obvious is that the number of questions must be
limited. The manager cannot expect detailed findings or
analysis. Another is that these surveys are designed to
assess levels of health or service coverage, not to identify
the determinants or causes. A rapid survey can tell you
the proportion of women who breast feed their children, but
it usually cannot tell you the differences between women
who do and do not breast feed. This is because the sample
is very small and provides a single estimate. You cannot
break the sample into sub-samples to see, for example, if
younger women breast feed longer than older women, or if
rural women are different from urban woman, or if Moslem
women are different from Christian women. If you want to
have that kind of information, you need to do a separate
rapid survey for each group.
Questions that are going to be tested for statistical
significance must be tabulated in a "yes"/"no" format, as
certain statistical rules apply to this type of sample. For this
reason, questions that are going to be analysed statistically
should not be multiple choice or open-ended. However, it
is possible to do statistical tests of multiple choice questions
by recoding the questions into a "yes"/"no" format. (This is
Module 2: Assessing health needs; introduction
$
9
'*
3
3
3
B
B
B
B
explained in the text.) There is some value in using multiple
choice and open-ended questions, even if their results can
not be analysed statistically. This is because they may
produce useful descriptive information that can give you
suggestions of possible explanations.
Rapid surveys often rely on CHW’s, health staff, or
community members to conduct the interviews rather than
on professional interviewers. Even with careful training,
non-professionals are often tempted to take shortcuts, thus
producing biased results. Typical problems include not con
tacting certain households or women because: they are too
far away; the interviewer "knows" that some women are not
eligible and therefore do not need to be contacted; and the
interviewer knows the respondents so well that he or she
answers the questions for them.
These problems are not unique to rapid surveys however,
and can usually be controlled through training, close super
vision, and spot checks, or re-interviews with a small sample
of respondents. Appendix E provides some guidelines for
dealing with this problem.
Sampling can be a problem if the WH0/EP1 cluster
sampling procedure isn’t appropriate for a given survey.
This technique seems to work better for EPl than some other
PHC interventions. Immunizations are often carried out as
campaigns where all of the children in a target village or
urban block are immunized at one time. Thus, the villages
tend to be "homogeneous," i.e., either most of the children
are immunized, or most are not. This means that it is not
overly important who is interviewed in a given cluster, since
most children have the same characteristic (they are im
munized or not). This is not so for some of the other PHC
interventions, such as antenatal care. In such cases, this
technique may produce biased results if households are
skipped because eligible respondents are not at home when
the survey is conducted.
Given the distances that might have to be travelled to get
to a cluster, the standard WHO/EPI procedure is to inter
view only those women who are at home. This can produce
significant bias, particularly during planting and harvest
periods when many able-bodied women are away in the
Module 2: Assessing health needs; introduction
Typical problems
in rapid surveys
8
You can survey
several target
groups at the
same time
fields. This problem can be largely avoided, by scheduling
the survey during seasons when respondents are likely to be
home, by visiting villages early in the morning or in the
evening, by arranging the visit to coincide with a special
event, or by making call-back visits. The trade-off is that
this can increase the costs of and the time needed to conduct
the survey.
Rapid survey results do not produce exact estimates of
values. Rather, they produce confidence intervals, usually
plus or minus 10 percent. For example, the ANC survey
described previously showed that 69.4 percent of the re
spondents received tetanus toxoid immunization during
their last pregnancy. It is more accurate to say that we are
95 percent confident that the true percentage lies some
where between 59.4 and 79.4 percent. Another way to state
this is that the estimate is 69.4 percent, plus or minus 10
percentage points.
This is a large interval and may not be of much use to
some managers, especially if they want to plot trends over
time. All surveys have a potential sampling error, but it is
usually much lower, around three to five percentage points.
This problem can be dealt with, at least partially, in several
ways: by increasing the sample size; by accepting a lower
confidence interval (e.g., 90 percent, 80 percent); and by
conducting a post-enumeration survey to validate and adjust
the results, if necessary.
You can survey several target groups at the same time,
such as children under two years of age (for immunization),
pregnant women (for antenatal care), and children under age
five (for ORT). However, the overall sample for this type of
study will usually be larger than 210 because you need 210
respondents from each target group. But many respondents
fall into two or more categories. A typical example is a
pregnant woman with a child under age five. She can
respond to questions on antenatal care, ORT, immunization,
growth monitoring, nutrition, ARI, water and sanitation, and
other topics.
Module 2: Assessing health needs; introduction
9
Figure 2: Proportion of married women who received TT
90%
95%
99%
High
0.774
0.79
0.821
Mean
0.694
0.694
0.694
Low
0.613
0.597
0.567
c
o
o
a
o
0.774
0.79
0.613
0.597
0.821
0.8
0.694
0.6
90%
93%
0.567
99%
Confidence intervals
Surveys of mortality and morbidity require much larger
samples because the events are so rare. For example, if you
want to assess infant mortality, you may need a sample of
2,000 mothers to identify enough infant deaths. For child
and maternal mortality rates you may need 7,000 interviews.
If the maternal mortality rate (MMR) is 250/100,000 live
births, you would normally need to identify 1,000 women
who had been pregnant just to find two to three maternal
deaths.
Some indirect estimation techniques have been devel
oped to get estimates with smaller samples. These are
described in Appendix G.5. However, the samples are still
relatively large and the analytical techniques are complex.
You should probably get expert advice before trying to
measure mortality rates.
Identifying broad disease patterns and health problems
is probably more useful to PHC managers. This can be done
Module 2: Assessing health needs; introduction
10
through the Vital Events questionnaire provided in this
module. It may also be important to determine the causes
of some of the more serious events, such as a maternal death
or a case of polio. Module 4 (Surveillance) describes how to
do that.
Finally, these surveys are completed most rapidly if
computers (laptops or PCs) are used. The survey programs,
including those provided in this module, can help you to
calculate your sample in a matter of minutes. Data entry and
analysis can also be done very quickly. Surveys for which
computers are not used will take longer. But they can be
done, and this User’s guide describes how.
How you can use this module
Common informa
tion gaps
This module is designed to provide PHC managers,
consultants, and researchers with simple and inexpensive
tools that they can readily adapt to assess quickly commu
nity health needs and/or PHC programme effects on
health knowledge, behaviour, and status.
The most common information gaps that managers have
fall into these two areas. First, many managers have no way
of determining what the real PHC needs of their target
population are. What do people know about immunizable
diseases? What do they do about diarrhoea? What is the
health condition of their infants? And, second, they have
no way of assessing the effects that their PHC programme
activities are having on those needs: What have mothers
learned about nutrition? What are they doing about
sanitation? What improvements have been made in im
munization coverage?
Module 2 is designed to help managers collect and
analyse this kind of information and to do it quickly, simply,
and inexpensively. It can be used by established and new
PHC programmes. Public and private programmes can use
it, as well as single (categorical) and comprehensive (inte
grated) programmes.
Although this module is part of a series, it can be used
independently. You do not need to use any other module
before or after this one. We hope that you will, however.
That’s the purpose of having a series, after all.
Module 2: Assessing health needs; introduction
11
Module 2 is linked to Modules 3 (Work Planning), 4
(Surveillance), and 6 (Service Quality) in particular. Module
2 can provide broad findings which the other modules can
be used to examine in more detail. In addition, the instru
ments in Module 2 can be used in Module 4 for surveillance
of morbidity and mortality.
How the module is organised
This User’s guide includes:
• Basic instructions: how to design and conduct a rapid
survey by hand (without a computer); ten easy steps
described in pages 15-50.
• Epi Info to design and carry out a rapid survey (with a
computer): See Appendix A, 26 pages of instructions,
and use the complete computer files.
• Sample questionnaires and "cluster registers" that you
can adapt to fit your own needs. There is one for each
PHC topic, pre-coded and ready to use or adapt to fit local
needs in Appendices C and D.
• A simple computer program for drawing cluster sam
ples quickly and accurately (Appendix F), and other tools
for estimating sample sizes and drawing random samples
(Appendix G).
• Other guidelines and tools that you may find useful:
suggestions for constructing questionnaires (Appen
dix B); guidelines for training and supervising inter
viewers (Appendix E); survey management forms (Ap
pendix H); and tabulation and analysis templates
(Appendix I).
Sample rapid survey questionnaires have been included
for each of the principal PHC services:
• Health education
• Antenatal care, safe delivery and postnatal care
• Family planning
• Breast feeding, growth monitoring, nutrition education
• Acute respiratory infections
• Breast feeding
Module 2: Assessing health needs; introduction
12
• Diarrhoeal disease control/oral rehydration therapy
• Childhood disabilities
• Child immunization
• Growth monitoring/nutrition education
• Water supply, environmental hygiene and sanitation
• Accidents and injuries
• Chronic, non-communicable diseases
• Malaria
• Tuberculosis
• Sexually-transmitted diseases, HIV/AIDS
In addition, one questionnaire has been prepared for
assessing multiple health needs/services and three others
for morbidity and mortality.
• Community assessment of PHC services
• Vital events and health status
• Child morbidity and mortality
° Adult morbidity and mortality
There is also a Facilitator’s guide that you can use if you
wish to conduct a workshop or seminar on rapid surveys.
Computer programs are also included on the disks that are
included. One disk contains the complete Epi Info manual
and program files.
Where to begin
If you already know something about surveys and com
puters, you may want to skip to Appendix A: How to use
Epi Info to conduct rapid surveys. If not, you should start
with the basic guidelines in the next section: Rapid survey
procedures. These include worksheets that you can fill out
as you follow the steps.
You may also want to have a facilitator help you, espe
cially if a group is going to learn how to do rapid surveys.
The facilitator should have experience in surveys and
computers. He or she need not be an expert trainer. The
Facilitator’s guide includes session plans and provides charts
that can be photocopied for handouts or transparencies.
Module 2: Assessing health needs; introduction
13
Adaptations
All of the tools, checklists, guidelines, computer pro
3 grammes,
and other material included in this module are
3
3
3
3
3
illustrative. It is expected that they will need to be revised
to fit local conditions, and you are encouraged to do so.
You may want to change the wording of questions in the
prototype questionnaires; you may want to eliminate certain
questions and add others; you may want to redesign the
format, design your own instrument, use another computer
programme (SPSS or dBase), draw your sample from your
computerised household registration database, create other
kinds of graphs, and so on. We want to make it very clear
that this is encouraged. These tools are not presented as
"standards" that should be used in all PHC programmes.
Rather, they are designed to encourage and help managers
to carry out community surveys by providing them with a
starting point, general tools, and guidelines that they can
adapt to fit their own situations.
Don’t forget to include the target communities and your
CHWs in the design, execution and analysis of the survey.
There are several advantages to this:
It increases awareness and knowledge about PHC in
3 • general;
3
3
• It increases awareness in the communities of their own
health problems and needs; and
• It increases "ownership" of the survey, its results and
recommendations.
Community representatives can also help you to phrase
questions in local terms so that they are better understood.
They can help you to identify common health problems to
be included in your survey, help you to find eligible respon
dents, and help you to understand responses and hidden
meanings.
Module 2: Assessing health needs; introduction
—Adaptations
encouraged
”
14
The elderly need to be targeted with health messages so
that their authority in the family helps support good
health practices
Photo by Jean-Luc Ray for AKF
15
Rapid survey procedures
The steps in the design and conduct of rapid surveys are
no different from those of larger, more traditional sample
surveys. If a team is going to design the survey, field
experience has shown that it may be faster to divide the
tasks and have one group develop the data collection instru
ment (Steps 1-4) and another the sampling (Steps 5-6).
Step 1: Specify the objectives of the rapid survey
Step 2: Decide what indicators to use
Step 3: Develop an outline for the survey report
Step 4: Design the data collection instruments
Step 5: Develop the sampling procedures
Step 6: Schedule the survey
Step 7: Collect the data
Step 8: Enter, verify and tabulate the data
Step 9: Analyse, interpret and report the findings
Step 10: Develop an action plan
Step 1: Specify the objectives of the rapid
survey
If you have gone through Module 1, you may already have
determined the information you want about the health needs
and PHC coverage of your target groups.
Module 2: Assessing health needs; procedures
16
Module 1 asked you to summarise your programme’s
major health goals, target groups, the PHC services offered
to each target group, and indicators of coverage for each
PHC service. It also suggested that you include additional
target groups or health services if you think your programme
should be expanded. The point of going through these steps
was to determine if you have enough information about
coverage, and if not, the information that you need to collect.
A summary worksheet from Module 1 is reproduced
below.
If you haven’t already filled out a worksheet like this, it
would be helpful to do so now. This should give you a
summary of the coverage information you need to collect.
Target group (yrs) Health services
Children < 2, < 5
Married women
15-49
Child immunization
Growth monitoring
Oral rehydration
Nutrition education
Antenatal care & TT
Family planning
Summary work
sheet from
Module 1
Coverage indicators
% < 24 mos. fully immunized
% < 5 yrs. weighed
% using ORT last episode diarrhoea
% < 2 yrs low weight-for-age
% pregnant women enrolled in
ANC
No. new acceptors
Now you can be specific and state the objectives of your
rapid survey. The following worksheet can help you to
summarise them.
First, you need to identify the user or users of the
information. This is critical, since each could have different
interests. If there are multiple users (yourself, a donor, an
evaluation team), you should find out exactly what each one
wants.
You also need to clarify precisely why this information is
needed. The two most common purposes are to assess
health needs and to evaluate programme performance.
These are quite different, and although Module 2 can address
both, the design and analysis of your rapid survey will be
slightly different depending on which purpose you have. For
one thing, if you are interested in assessing performance,
you would limit the survey to current PHC services. But if
you want to assess needs, you would not.
Module 2: Assessing health needs; procedures
17
9
3
WORKSHEET FOR SPECIFYING RAPID SURVEY
OBJECTIVES
User
-3
3
Manager
Board
Donor
Community
Other:
Purpose
3
3
3
3
3
3
'3
3
•3
:3
Target groups
Children
Women
Other:
PHC service(s)
Planning
____
Health status/needs
Service status/needs
Evaluation
Service coverage/effects
Health status/impact
Geographic area:
Start Date:
End Date:
Next, you should decide which target population and
which PHC component the user(s) wants to study. The
summary worksheet from Module 1 is a place to start. But
you may have listed several target groups and services. Do
you want to study all of them or just one? You can study as
many as you want, but keep in mind that you will have to
draw a separate sample for each target group that you
include. So if you decide to study ANC, immunization, and
sanitation, you will have to do three rapid surveys: one of
pregnant women, one of children 12-23 months, and one of
households. These can all be done at one time, but each will
require 30 clusters of seven respondents. In many cases,
the clusters and respondents can be the same for each
survey. So if you plan to do several rapid surveys, it would
be economical to combine them.
This module describes how to do this in a relatively simple
way, so do not be intimidated. If you need information on
several target groups and services, then note who and what
they are in the worksheet.
You also need to specify the geographic scope of the
survey. Will it cover the entire catchment area or a part of
it? Keep in mind that the survey results will only represent
-3 Module 2: Assessing health needs; procedures
18
the area covered. If you decide to limit the survey to five
districts because they are close by, then the outlying areas
will not be represented in the study. That means you cannot
apply the results to the entire project, only to the five
districts.
Lastly, it is helpful to determine immediately when the
study will start and especially when the results will be
needed. It does no good to provide rapid survey results after
the deadline for making key decisions.
Measuring effects and impact
Module 2 can be used to measure:
Programme effects on target groups
1
Knowledge
Attitudes/motivation
Behaviour/coverage
Programme impact on target groups
Morbidity
Mortality
Disability
Fertility
!
You can use Module 2 to attribute changes in knowledge,
attitude, and practice (KAP) to your programme. To do this
you should: conduct a baseline survey of the current KAP
of your target groups; carry out your programme for a
specified period, e.g., 1-2 years; and conduct a follow-up
survey sometime later.
Use the computer program in Appendix G.2 (Hypothesis
testing - two samples of equal size) to determine the sample
sizes needed for a "before-after" comparison. Estimate the
current level of your principal effect or impact measure, such
as coverage. Enter this in the line that reads "Est. proportion
with the attribute FIRST (or BEFORE) population." Decide
the amount of change you wish to detect and enter that in
the next line "Est. the proportion with the attribute in the
SECOND (or AFTER) population." For example, if you want
to measure changes in infant mortality, you would enter the
Module 2: Assessing health needs; procedures
19
current figure (say .08) as the BEFORE proportion and .06
as the AFTER proportion. Thus you will be able to detect
a drop in the IMR from 80/1,000 to 60/1,000. Enter the
other information requested, and the programme will com
pute the sample sizes you will need for the baseline survey
and the follow-up survey.
Your evaluation will be even better if you include a control
area which is similar to your project area but which does not
get PHC services. Conduct baseline and follow-up surveys
there at the same time. The design of this kind of study is
summarised below, in which O indicates an observation
(baseline and follow-up surveys) and X indicates the PHC
programme intervention.
Study design
Programme area
Control area
Baseline
Oi
Oi
Intervention
X
Follow-up
O2
O2
Note: Impact evaluations are easy to conceptualise, but
difficult to carry out. Seek professional advice before you start.
Step 2: Decide what indicators to use1
This module focuses on outcome indicators, especially
coverage.
These are the best indicators for assessing health needs
and the effects of the PHC programme on health.
Other modules deal with input and process indicators:
the performance of health workers (Module 3), short-term
assessment of PHC activities (Module 5), the quality of PHC
services (Module 6), and the effectiveness and efficiency of
PHC management (Module 7). You can include any of these
indicators in a rapid survey, of course, as long as they are
community-based. Rapid surveys gather information about
populations, not about health centres or staff.
Thus, the manager (or team) needs to decide which
outcome indicators to examine. In most cases these will
deal with coverage. In general, coverage indicators tell you
the proportion of the target population that is protected by
1 See Module 1 for a discussion of types of indicators and Module 5 for
lists of indicators.
Module 2: Assessing health needs; procedures
20
your programme. Examples of coverage indicators
from Module 1) are shown below.
Examples of PHC coverage indicators
Service
Coverage indicator
Antenatal care
Tetanus toxoid immunization
Safe delivery
Family planning
Breast feeding
Growth monitoring
Child immunization
Acute respiratory infection
Diarrhoea disease control
Oral rehydration therapy
Water, sanitation, hygiene
Vitamin A
Tuberculosis
Malaria
Sexually transmitted diseases/HIV
Disability
Health education at home
% made 3 or more ANC visits
% received TT immunization
% delivered by trained attendant
% current users of FP services
% breast feeding to 18 months
% 2 yrs weighed last quarter
% 12-23 mos. fully immunized
% ARI cases treated
No. children < 5 yrs with diarrhoea/1,000
% used ORT last episode diarrhoea
% households with safe water/latrine
% 6-12 mo. received Vit. A
% cases followed to cure
% cases treated
% target group infected/treated
% 5 yrs disabled
% schools receiving or participating in health
education activities
% communities with adequate supplies
No. accidents + injuries/1,000 population
% target group with hypertension, chronic heart
disease, anaemia, diabetes
% episodes treated
% low weight-for-age
Drug supply
Accidents and injuries
Chronic, non-communicable diseases
Treatment of minor ailments
Nutrition education
You may also be interested in finding out what people
know about a service or health problem, the skills they
have in diagnosing and treating health problems, or people’s
opinions about your health workers and programme. You
may also want to assess health status and the impact of
the programme on health. These are all legitimate interests
and can be included in a rapid survey.
Module 5 includes lists of recommended indicators for
each PHC and management service. It also includes sepa
rate lists of morbidity and mortality indicators. These lists
can be helpful guides in designing a questionnaire.
Make a list of the key indicators you want to measure. It
shouldn’t be a long list. Start with the desired outcome.
Select one or two indicators for that. Then work backwards
Module 2: Assessing health needs; procedures
21
(as described in the "If-then" sequence and Worksheet A in
Module 1) to determine what needs to happen for this
outcome to be achieved. Select one or more key indicators
for that outcome, and so on.
This is a good time to involve the staff, community
representatives, and others who are part of the programme.
They can articulate the perspectives of the community, and
they often have valuable insights as to what is important,
and feasible, to measure.
In addition to performance indicators, three other types
of data are usually needed in a rapid survey:
• Descriptors: respondent name, village name, address of
household, etc;
• Characteristics of respondent: age, sex, parity, edu
cation, literacy, income, caste, race, ethnic group, etc; and
• Survey management data: interviewer name, supervi
sor, date of interview, etc.
The descriptors and management data are needed to
identify the respondent and, in particular, to make a call
back visit and to correct possible errors.
The characteristics are used to describe the surveyed
group. If several surveys are done, then the characteristics
can be useful for making comparisons between one kind of
respondent and another. The manager may want, for ex
ample, to know if there is any difference between the health
behaviour of people in one district and another, or between
one ethnic group and another. Separate surveys would be
required to do this, of course. Remember that each rapid
survey is designed only to provide information about a
single population.
Step 3: Develop an outline for the survey
report
Most researchers don’t do this, but it will be very helpful
at this point to outline a report so that you and your
colleagues know what information will be produced. That
will make construction of the questionnaire, data analysis,
and especially interpretation much easier. If this is not done,
you may get a lot of information that you don’t want, such
Module 2: Assessing health needs; procedures
Characteristics of
group surveyed
22
Managers want
results
as 10 pages of tables describing the characteristics of the
survey population. Step 10 includes a generic outline for
getting started.
This is also a good time to check with outside users to
make sure that the report will meet their expectations.
Most managers aren’t interested in background, method
ology, qualifications, descriptions of the survey process,
descriptions of the survey population, etc. They want re
sults. So write your report outline to suit the user’s needs.
The other information should be presented, but not neces
sarily first. Many managers want the ''bottom line" first and
will ask about the sample, data collection procedures, and
other methodological issues later.
Construct a list of "dummy tables" (blank tables — without
data) and identify the kinds of frequency distributions and
cross-tabulations the user(s) wants. Don’t forget to include
graphs (pie charts, histograms). Appendix 1 includes an
illustrative list of frequency distributions and cross-tabula
tions. This type of list will be needed so that the analyst
knows which tables and graphs to produce. Obviously, it
can be modified later, but it can help your planning to start
it now.
List questions and issues that you think should be ad
dressed in the report. Typical questions are:
What percentage of the target group is covered?
What are the major reasons some people aren’t covered?
Where do people go for services?
What are the major reasons they don’t utilise available
services?
Finally, make an outline, and set a page limit. Put more
emphasis on visual presentation through handouts, trans
parencies, slides, etc. These attract managers’ attention more
than written text. Remember KISS - "Keep It Straightfor
ward and Simple".
•
•
•
•
Module 2: Assessing health needs; procedures
23
Step 4: Design the data collection
instruments
The following checklist summarises your main options
and the substeps that you will need to follow.
Checklist for designing questionnaires
Type survey instrument:
Types of questions/fields:
Yes/No
Multiple choice
Open-ended
Dates
Ranges (e.g., 1-4 years)
Questionnaire
Register
.Other
Target group(s):
Coding:
Children
Women
Other
Uncoded
_ .Pre-coded
Numerical
Alphabetical
NA: Not applicable
DK Don't know
NR: No response
Questionnaire or register
First you need to decide if you want to use a question
naire or a "cluster register."
Questionnaires usually provide more information, includ
ing instructions for the interviewer, the exact phrasing of
each question, and pre-coded responses. But you have to
have one questionnaire for each of the 210 respondents.
That is, a minimum of 210 pages, 420 if its a two-page
questionnaire.
Cluster registers allow the interviewer to record the
responses of all seven or eight respondents from one cluster
on the same page. This means you will need only 30 pages,
one for each cluster.
But the number of items ("questions") is limited by the
size of the paper. Instructions and question phrasing have
to be provided elsewhere, or learned beforehand. Excerpts
of both are shown on the next pages.
Module 2: Assessing health needs; procedures
24
Exhibit 1: Excerpt from rapid survey questionnaire on antenatal
care, safe delivery, and postnatal care
Complete for all women currently living in the household who have had a pregnancy
outcome during the past 24 months. The outcome may be a live birth, stillbirth, or
abortion. If the woman has had more than one pregnancy, ask about the most recent
pregnancy outcome.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no.
5. Respondent no.
8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
9.
10.
11.
12.
13.
14.
15.
16.
How many live births have you had so far? Number of live births:
(99) DK/NR
Did you receive antenatal care during your last pregnancy?
(1) Yes
(0) No, go to Q14
(9) DK/NR, go to Q14
How many times did you get antenatal care?times
(If DK/NR, enter 99)
How many months had you been pregnant before you got antenatal care?
(1) 3 mo. (first trimester)
(2) 4-6 mo. (second trimester)
(3) 7-9 mo. (third trimester)
(9) DK/NR
Which is the principal place you received antenatal care?
(1) Hospital
(2) Health centre/clinic
(3) Private hospital/clinic
(4) Local TBA/healer
(5) Other site of care specify:
(9) DK/NR
Did anyone advise you to get antenatal care?
(0) No
Yes:
(1) Physician, nurse
(5) Mother, relative
(2) Community nurse/midwife
(6) Friend, neighbour
(3) CHW/volunteer
J7) Other:
(4) Traditional birth attendant
(9) DK/NR
Did you receive a tetanus vaccination during your last pregnancy?
(1) Yes
__(0) No, go to Q17
. _(9) DK/NR, go to Q17
How many vaccinations did you receive?
(1) One
(2) Two
(3) Three or more
(9JDK/NR, go to Q17
Questionnaire continues for four months
Module 2: Assessing health needs; procedures
25
Exhibit 2: Excerpt from cluster form on antenatal care, safe
delivery and postnatal care
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
(6) Date
/
N
A
M
E
1
2
3
4
5
/
(7) Age
(8) Sex
(9) How many live births have you had
so far?
(10) Did you receive antenatal care during
your last pregnancy?
(11) How many times did you get
antenatal care?
(12) How many months had you been
pregnant before you got antenatal
care?
(13) Which is the principal place you
received antenatal care?
(14) Did anyone advise you to get
antenatal care?
(15) Did you receive a tetanus vaccination
during your last pregnancy?
(16) How many vaccinations did you
receive?
(17) During your pregnancy, did you take
iron pills to keep you strong?
(18) What was the outcome of your most
recent pregnancy?
(19) Where did the delivery take place?
(20) Who was the main person
attending the delivery?
(21) What is the name of the local CHW?
(22) Has the CHW visited/contacted you
during the last three months?
Key (12)
1) three mo. (first trimester)
2) 4-6 mo. (second trimester)
3) 7-9 mo. (third trimester)
9) DK/NR
(18)
1) live birth
2) stillbirth
3) abortion/miscarriage
4) DK/NR
Module 2: Assessing health needs; procedures
6
7
8
9
10
26
For larger clusters, 15 or more respondents, you may want
to switch the rows and columns. That is, put the questions
in the top row and the respondents in the left column. Here’s
a partial example. See Appendix I for an example of how
to set up a register like this on a spreadsheet so that all 210
respondents can be recorded and analysed on one (long)
page or spreadsheet.
Respondent
no. name
house
Age
Rec’d No.
ANC visits
Source of service Rec’d No.
Pregnancy
TT doses outcome
Hosp Hlth.
Cntr.
TBA
Live
Still
1
2
3
4
5
6
7
8
One target group or several
Many managers will want to include several topics and
target groups in the same survey. This will not be a problem
as far as instrument design is concerned. Generally, you
have three choices. First, you could use the sample Commu
nity assessment of PHC questionnaire in Appendix C. This
instrument includes 4-5 key questions on each of several
PHC topics:
Availability of health care
Antenatal care and childbirth
Family planning/child spacing
Breast feeding and growth monitoring
Immunization
Diarrhoea and ORT
Water and environmental sanitation
Malaria
Child disabilities
Tuberculosis
Sexually-transmitted diseases
Module 2: Assessing health needs; procedures
27
Second, you could combine several questionnaires from
Appendix C into a single instrument. Third, you could pick
out questions you are interested in from other questionnaires
and construct your own instrument.
However, be aware that combined questionnaires usually
require information about different target groups. If that is
the case, you will have to draw separate samples for each
target group. This will be explained more fully in the
discussion of the sampling step.
When doing a multi-target group survey, it is best to----------------------prepare the questionnaire in modular form. Combine all of Multi-target group
the questions for one target group and put them in one
surveys
section. Develop a separate section for each target group.
Be sure to include descriptor information in each module so
you can identify the respondent.
Design the data collection instrument(s)
The sample instruments in Appendices C (questionnaires)
and D (cluster registers) can be photocopied and used as is.
They can also be revised, new ones can be compiled, etc.
The questions should be designed to collect the indicators
you identified in Step 2.
The sample instruments show how most questions can
be structured in a "Yes/No," precoded format. This is im
portant for those questions that you want to analyse statis
tically. When multiple choice and continuous variable ques
tions are needed, make sure they can be recoded later to be
analysed as "yes"/"no" (dichotomous) questions. Some ex
amples:
Multiple choice
--------- ->
Recoded as dichotomous
(Yes/No)
Received care from :
Received care from:
1 Provincial hospital
-------- ->
2 District hospital
\
3 Health centre
\
5 Traditional birth att.
/
6 Private clinic
/
7 Other (name:
) /
1 Provincial hospital
2 Other
9 Don’t know/No response —
9 Don’t know/No response
Module 2: Assessing health needs; procedures
28
You can repeat this procedure for each response. That
is, you can recode the question as District vs. Other; Health
centre vs. Other, and so forth. You can recode the question
for a different age group: under 25 years vs. 25 years and
over.
Continuous variables can be recoded as shown in the
following example.
Continuous
--------------- ►
Age of respondent
yrs.
(Enter completed years
or 99 if DK/NR)
Recoded as dichotomous (Yes/No)
Age of respondent
1
Under 30 years
2
30 years and over
9
Don’t know/no response
Most rapid survey questions allow only one response per
question. If you include questions that allow multiple re
sponses, you can do one of two things. First, you can ask
the respondent for the most important (principal, major,
etc.) single response, and code only this response. For
example:
Q.8. Where did you first hear about ORT? (Check the
first source mentioned)
(1)
Friend or relative
(2)
CHW
(3)
Doctor/nurse
(4)
Television
(5)
Radio
Or, you can record each response as a separate question.
Where did you hear about ORT? (List all mentioned)
Q-8
Friend or relative (Y/N)
Q.9
CHW (Y/N)
Q-10
Doctor/nurse (Y/N)
Q.ll
Television (Y/N)
Q.12
Radio (Y/N)
Appendix B includes some other suggestions for
designing questionnaires.
Module 2: Assessing health needs; procedures
29
Pre-test the instrument
If the questionnaire has to be translated into a local
language, this should be done after it is drafted, but before
it is pre-tested. Do not leave it to each interviewer to do his
or her own translation. This can cause confusion and
misinterpretation. It is best to translate the instrument into
the local language and then have someone else translate it
back to make sure the questions are clear.
When the instrument has been drafted, it should be
pre-tested with a small sample (five to ten women) to make
sure that the questions are understandable, the pre-coded
responses are realistic, and the sequence of questions is
logical. Then the instrument should be revised as appropri
ate.
Ideally, the interviewers should be involved in the pre
testing, perhaps as part of their training. Their feedback can
be very helpful in making revisions. It is also important that
they follow the sampling procedures for selecting house
holds and respondents. They may have questions and
suggestions about those procedures, as well.
Pre-testing is very important and should be done care
fully with the intended target group as respondents.
Pre-tests with office colleagues or PHC staff are of very
limited value, since they do not represent the target groups.
A worksheet should be devised for summarising feedback.
Or notes could be written on the instruments to identify
problems with comprehension (interviewer and respondent),
coding, and logical sequence.
Estimate the data collection requirements
The pre-tests should give you an idea of the amount of
time it will take to find a respondent, and complete an
interview. With this information you can estimate the
number of interviewers you will need and the number of
days it will take to complete data collection.
Usually you will want a two-person team to complete at
least one cluster per day, seven or eight interviews. You will
also need several supervisors, the number of which will
depend on the number of interviewer teams you have and
Module 2: Assessing health needs; procedures
Involve
interviewers in
pre-testing
30
the distance the supervisors will need to travel between
clusters.
If the questionnaire is short, the respondents are easy to
find, and distances between clusters are short,- then a team
should be able to complete two or three clusters each day.
Use the following formula to make a quick estimate:
------- 30 clusters
= 15 „team d
complete 2 clusters/day
If you have five teams (ten persons) the data collection
could be completed in three days. Or three teams would
require five days. Fifteen teams could finish in one day!
Develop a code book
This can be very useful, especially when the questionnaire
is long or in modular form. Code books can be important
during analysis, especially if tables are produced with codes
instead of labels.
Code books generally include the following: variable
number, name, label, value codes, and value labels. An exam
ple is included in Appendix B.
Step 5: Develop the sampling procedures
Target groups, attributes and sample sizes
These instructions are for manually drawing a cluster
sample of 30 clusters with seven respondents each?
You may skip this step if:
• You have a complete household listing of pour survey area
so that you can draw a random sample. See Appendix G
• You plan to use a computer to draw your sample. See
Appendix F which describes how to use a spreadsheet
1 This module emphasizes cluster samples. If you can draw a simple
random sample, you are encouraged to do so. See Appendix G for
instructions. Stratified samples can be even more effective, but they are
also more complex. You should seek expert advice for this kind of
sample. Stratified samples are not described in this module.
Module 2: Assessing health needs; procedures
31
program (Cluster Identification Worksheet) to draw a
cluster sample
First we will describe the basic procedures for drawing a
sample of 30 clusters. Then we will discuss some varia
tions of those procedures that you may have to apply. The
selection of the seven respondents from each cluster is
described in Step 7.
Determine the size of the clusters
Although most people think of clusters as natural group
ings of people (villages, census tracts, urban blocks), clusters
have a different meaning in sampling. In cluster sampling
you will divide your total survey population into 30 equal
groups. Each of those groups will be a "cluster." Then you
will identify seven respondents in each of those clusters.
This second step will be discussed in Step 7: Collect the
data.
You need to know the total population of your survey
population to determine the size of each cluster. Simply
divide the total population by 30. For example, if your
catchment area has 45,000 people, each cluster will include
1,500 people (45,000/30 = 1,500).
It doesn’t matter if there are fewer or more than 30
villages or districts, since you will define the clusters by
dividing the total population into 30 groups of equal size.
It also doesn’t matter if the population is scattered over
a large area. People can even be on islands or in remote
areas and still be included in the sample. If you want your
sample to represent all of your target population, then do
not leave any "natural clusters" out. However, if it is not
feasible to include some areas, then leave them out. BUT,
remember, your sample will not represent those who are left
out. If you limit your sample to people within one kilometre
of a health centre, for example, then that is all it represents.
You must have population size estimates of the sub-units
of your sample. List these sub-units, villages, census tracts,
voting precincts, towns, in Columns A and B of a Cluster
identification worksheet(see Exhibit 3).
Record the population of each sub-unit in Column C. This
figure does not have to be exact. The relative size of each
Module 2: Assessing health needs; procedures
Population size
estimates
32
Exhibit 3: Cluster Identification Worksheet
30
29,481
983
491
Enter
A
Community
Name
Pagai
Santai
Serina
Mu! rose
Fanta
Bagia
Rostan
Mt. Sil
Livton
Farry
Tunis
Pulau
Sasarota
Pingra
Kanata
Sirvish
Balding
Rescuut
Krista
Manalopa
Garafa
Spiltar
Masraf
Abrama
Junagadh
Singri
Kalarata
Ichitoma
Chaplar
St. Kitt
Nevis
Mt Carans
Betul
Charga
Rio Negra
Fostervill
Maryoak
Slipfern
Tinggi
Punjak
Capital
Comouter
D
Cumulative
Population
548
1,278
1,964
2,244
3,500
4,184
5,103
6,477
7,610
8,154
8,347
8,722
9,055
12,559
12,895
15,010
15,268
15,946
16,153
17,315
17,723
18,178
19,156
19,491
20,032
20,757
21,112
21,610
21,957
22,143
23,484
24,154
24,475
25,147
25,852
26,296
27,077
28,036
28,341
28,104
29,481
Preset
Enter
B
c
Community Estimated
Number
Population
1
548
2
730
3
686
4
280
5
1,256
6
684
7
919
8
1,374
9
1,133
10
544
11
193
12
375
13
333
14
3,504
15
336
16
2,115
17
258
18
678
19
207
20
1,162
21
408
22
455
23
978
24
335
25
541
26
725
27
355
28
498
29
347
30
186
31
1,341
32
670
33
321
34
672
35
705
36
444
37
781
38
959
39
305
40
763
41
377
Cluster.WQl
(Enter Number Desired)
(Enter total from Column C)
Number of Clusters
Sample Population Size
Cluster Size (sampling interval)
Random Start Number
INPUT DATA
OUTPUT DATA
Preset
E
Selected
Cluster
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
TOTAL
29.481
To add more rows see Appendix 1.2, "Adjusting the Spreadsheet."
Sample
Sites
Computer
F
Start
Number
491
1,474
2,457
3,440
4,423
5,406
6,389
7,372
8,355
9,338
10,321
11,304
12,287
13,270
14,253
15,236
16,219
17,202
18,185
19,168
20,151
21,134
22,117
23,100
24,083
25,066
26,049
27,032
28,015
28,998
G
Community
Name
Pagai
Serina
Fanta
Fanta
Rostan
Mt. Sil
Mt. Sil
Livton
Pulau
Pingra
Pingra
Pingra
Pingra
Srivish
Srivish
Balding
Manalopa
Manalooa
Masraf
Abrama
Singri
Chitoma
St. Kitt
Nevis
Mt. Carans
Charga
Fosterville
Maryoak
Slipfern
Punjak
28.998
Press <CTRL + W> to widen columns.
Module 2: Assessing health needs; procedures
33
sub-units is what is important. Thus, you can even use data
which are a few years old. In Column D, add the cumulative
population. For example, add the population of the second
district (730) to that of the first (548) to get the cumulative
population of the first two districts (1,278). Add the popula
tion of the third district (686) to that total (1,278) to get the
next cumulative figure (1,964).
The total size of this population is 29,481. If your
addition is correct, this should be the figure you end up with
at the bottom of Columns C and D. Divide that total by the
number of clusters (30) to get the cluster size (both numbers
are entered at the top of the form).
29,481/30 = 982.7, rounded off to 983
This figure is also called the sampling interval, which
means the interval between one cluster and the next.
You are now going to select randomly a number in the
first cluster. That will be a number between 1 and 983.
Theoretically this number represents the first person in the
cluster that you will interview.
Use the random number table in Appendix G or take a
three-digit number from any currency note. In our example,
the random number turned out to be 491. Enter this at the
top of the form. This is the "start number" for your first
cluster. Now add 983 to that number to get the start number
of the second cluster (491+983 = 1,474). Add 983 to that
total to get the third start number (2,456), and so on. Repeat
this process until you have 30 start numbers. These are
listed in the table in Column F.
The last step is to identify the communities where those
start numbers are located. Compare the first number (491)
with the cumulative figures. Find the first number in Col
umn D that is greater than 491. This is 548 (Pagai). Thus,
the first start number is in Pagai. Put a 1 in Column A to
identify Pagai as the location of the start number for the first
cluster or list the names of the selected sites in Column G.
Do the same thing with the second start number in Column
E (1,474). The first number in Column D that is greater than
1,474 is 1,964 (Serina). Put a 2 in Column E to identify
Serina or write the name in Column G. Continue until you
Module 2: Assessing health needs; procedures
The last step
ill
34
Look at the data
collection
estimate
have identified all 30 communities where your start numbers
are located.
Communities that have large populations (such as #14
and #16, Pingra and Srivish) are likely to have more than
one start number. This is because their populations are two
or three times larger than the cluster size (983). Therefore,
two or three of your clusters may be in one community.
Now that you know where you have to go, you should
look at the data collection estimate that you made at the
end of Step 4. Will travel time to the clusters increase or
decrease the amount of time it will take to collect the data?
Do you need to revise your estimates? Do not draw another
sample to make data collection easier!
This procedure may seem complicated at first, but try it
a few times and you will quickly get the hang of it. You can
also run the computerized version of this worksheet, which
is even easier. See Appendix F.
Variations
• If your sample population is very large, say 300,000,
you can still follow this procedure by doing it twice. First,
list the large sub-units, districts for example. Follow this
same procedure to identify the districts where the 30
clusters are located. Then list the smaller sub-units in
each of those districts. Make the computations again to
find the village where each start number occurs. As you
will learn, it is better to start with a large number of
sub-units. If you only have 30-35 sub-units, almost all will
be selected and you will have to do a lot of listing for the
next selection. It would be better to start with 100-200
sub-units.
• If your population is very small, say 15,000 or less,
you should make sure that there will be enough respon
dents in each cluster to interview. For example, WHO
estimates that the target group for EPI surveys of children
12-23 months of age, averages three percent of the
population in developing countries. Thus, you would
need clusters of at least 250 people to find seven children
in this age group. To take account of those who are away,
ineligible, etc., WHO suggests doubling that number to
Module 2: Assessing health needs; procedures
35
500. For 30 clusters, therefore, you would need a mini
mum of 15,000 people to do a survey of that target group.
• If there are fewer than 30 "natural clusters,” then
what? For example, what should you do if there are only
24 villages, or 13 districts. Remember that these admin
istrative units are not the sampling clusters. Follow the
same procedures described above to fill in the Cluster
identification worksheet (Exhibit 3). You will simply select
more clusters per administrative unit. Try this with Ex
hibit 3. Take the first 20 communities listed and follow
the same procedures. The total population will be 17,315
and the cluster size (sampling interval) will be 577. After
you draw a random start number you will add 577 to it to
select the first cluster; then add 577 again to select the
second, and so on. You will still get 30 clusters and 30
start numbers, but there will be several communities that
will have more than one cluster. If you can, it would be
best to divide your communities into smaller administra
tive units first, say into sub-communities. In this way you
can avoid having several sampling clusters in the same
community.
0 If you are looking for a rare event, say an infant death
or a pregnant woman who received two TT shots, then
you may have to have much larger clusters in order to find
them. To estimate the cluster size for rare events, you need
to know: the percentage of the target group in the sample
population (e.g., women who were pregnant last year);
and the percentage of that target group that has the
attribute you are looking for (e.g., two TT shots).
» An attribute is similar to an outcome indicator.
For each PHC component there are usually one to three
important attributes that a manager is likely to want to
measure. These would have been identified in Step 2 and
would be included in the data collection instrument.
Some examples are listed below as well as included in the
next worksheet:
Example: Let us assume that the survey is of antenatal
care (ANC) and that the target group consists of women who
Module 2: Assessing health needs; procedures
36
had a pregnancy outcome within the past 12 months. Local
figures may show that approximately 4 percent of the total
population is pregnant in a year. The survey wants to
determine how many of those women: 1) received at least
one tetanus toxoid immunization during their pregnancy;
and, 2) were delivered by a trained attendant. The rough
estimates, which might be based on service records or prior
experience, show that 33 percent probably received TT, and
15 percent were delivered by a trained attendant.
For the first indicator the survey needs to be able to find
seven women in each cluster who were pregnant in the last
12 months. That is estimated as 4 percent of the population.
Thus, the minimal cluster and sample size would be:
7 resP°^ent:s- = 175 cluster size * 30 clusters
= 5,250 population
However, this is a minimum size. You would probably
want to double it to make sure that there would be at least
15 people in each cluster from which to draw. Thus, the
clusters should be at least 350 population each.
The second indicator requires finding seven women in
each cluster who were pregnant and were delivered by a
trained attendant. Only 15 percent of the women who were
pregnant were delivered by a trained attendant. Thus, the
minimal cluster size would be
-7-ZOntdrtS = W67 cluster size ‘ 30 clusters
.U4- * .ID
= 35,000 population
If doubled to be safe, that would require clusters of 2,334
and a total sample population of 70,000.
See Appendix G for a computer program (Target.WKl)
that will help you make the estimates of various target
groups.
Increasing the number of clusters and the number
of respondents per cluster may help you get more
accurate results. Of course, that will also increase the cost.
Module 2: Assessing health needs; procedures
37
WORKSHEET FOR IDENTIFYING ATTRIBUTES AND
ESTIMATES
PHC
component
Target
population
Percent
of total
pop.
7
15
7'30
15'30
Antenatal
Pregnant last
12 months
Delivered by
trained attend.
4%
175
375
5,250
11,250
15%
1,167
2,334
35,000
70,000
Family plan.
Married
women 15-44
Child < 2
20%
35
75
1,050
2,250
8%
88
188
2,640
5,640
ORT
Child < 5
14%
50
107
1,050
3,210
Immunisation
Child 12-23
mo.
3%
233
500
6,990
15,000
Growth mon.
Minimum
cluster size
No. eligible
in cluster
Size of sample population
(# respondents * # clusters)
Whether it is worth doing depends partly on how homoge
neous the clusters are. Homogeneous means that all of
the respondents in a cluster are the same with respect to the
attribute you are studying. As mentioned previously, this is
often the case in immunization programmes. In any given
cluster either most of the children have been immunized or
most have not been. Heterogeneous is the opposite. It
means that the respondents are different. For example, some
children would be fully immunized, some would have had one
shot, others two, others three, and some none at all.
The rule of thumb is: if the clusters are homogeneous,
reduce sampling error by increasing the number of clusters
(since all of the respondents are similar, increasing the
number of respondents will not help); and if the clusters are
heterogeneous, reduce sampling error by increasing the
number of respondents per cluster.
The number of clusters should not be reduced below 30.
This is the minimum number that is required to produce
relatively valid results. Do not succumb to the temptation
to double the number of respondents in order to cut the
Module 2: Assessing health needs; procedures
38
clusters in half. You can increase the number of clusters, but
there must be at least 30.
Generally, it is easier and less costly to increase the
number of respondents in a cluster, since the interviewers
are already there, than to add more clusters, which means
travelling to another site. If you can reduce the sampling
error from plus or minus 10 percent to plus or minus 6
percent by increasing the number of respondents in a cluster,
it may be well worth the extra cost.
See Appendix G for a computer program that can help
you estimate the required sizes for clusters and respondents.
Multiple target groups
In Step 4 we noted that many managers will want to
include several PHC topics and target groups in the rapid
survey. If the target groups for all of the topics are the same,
then there will be no effect on the sample. For example, if
the survey covers growth monitoring, immunization, and use
of ORT, and the target group for all three services is children
under two years old, then only one sample needs to be
drawn.
However, if the target group for immunization is children
12-23 months of age, then you will not be able to get
information on those under 12 months of age for the
immunization portion of your survey. Thus, you will need
to contact an additional number of people to find seven
eligible respondents.
The previous worksheet can help you to determine the
cluster sizes you will need for each target group. From this
you can also estimate the number of households you will
probably have to visit to find your quotas for each part of
the survey.
"For the same overall total sample size, however, a survey
in which a large number of clusters is selected and a few
households visited in each, will give more precise results than
a survey in which a larger number of households is visited in
each of a smaller number of clusters."1
A rough rule of thumb is: find the target group in your
survey with the lowest percentage of the target population,
Module 2: Assessing health needs; procedures
39
and calculate the minimal cluster size for that group. Use
that as the minimal size for your survey. Then examine the
ratios between the size of that cluster and the size of the
clusters needed for your other target groups. That ratio will
tell you roughly how many more households you must
contact to complete the survey. For example
PHC service
Target group
Minimum cluster
size
ORT
Children < 5 years
107
Immunization
Children 12-23 months
500
Ratio 500:107 = 4.7
You will have to contact about five times as many
households to complete your immunization questions as
your ORT questions. If you get all your ORT data from the
first 10 households contacted, you will probably have to
contact 40 more to complete the immunization questions.1
Again, if you want to find only 20-30 people with the
attribute, you will only have to find one or two per cluster,
not all seven. Again, see the TARGET program in Appendix
G for help in making these estimates.
The last step (selecting the households) will be described
in Step 7.
Sampling for mortality estimates
If you want to measure infant, child, or maternal mortality
rates or ratios, you will have to modify these procedures.
As mentioned earlier, you will probably need samples of
2,000 eligible respondents for an infant mortality survey and
7,000 for child and maternal mortality surveys. You can
conduct a mortality survey at the same time as a conven
tional cluster survey, but you will have to interview all
eligible women in each household, and you will have to visit
7 Bennett, et al. op cit.
1 This assumes that you follow the EPI "next nearest front door" approach.
If you have a complete household listing, you will be able to identify
seven eligible respondents for each part of your survey from this listing.
Module 2: Assessing health needs; procedures
40
an additional number of households to find the 2,000 to
7,000 eligible women. Use the SIZE.WK1 worksheet in
Appendix G to estimate the size of the sample you will need.
Use the Vital Events questionnaire in Appendix C to collect
your mortality data.
A recent UNICEF publication describes how to conduct
childhood mortality surveys.1 This handbook contains
complete information for formulating questionnaires, draw
ing samples, collecting and analysing data, and preparing
reports. One of the questionnaires from this handbook is
included in Appendix C, Childhood Mortality. The instruc
tions for drawing a sample for this questionnaire are in
Appendix G. The calculation and analysis procedures for
direct estimations are straightforward, but the indirect
estimation techniques described in the handbook are com
plicated. You should call on a trained demographer if you
wish to make indirect estimates.
To measure maternal mortality you will need to find
even more eligible respondents. One approach, called the
sisterhood method,12 involves interviewing all adults in the
household — or even in the village or block — to identify
everyone who had an adult sister who had been pregnant.
This method produces indirect estimates of the probability
of dying. It is relatively simple, and since all adults are
interviewed, you may find enough eligible respondents in
1,000 to 2,000 households. But, this is still a large number
of households to contact. In addition, the method is contro
versial.3
Again, we recommend that you get expert advice before
designing a mortality survey.
1 David, P. H., et al. Measuring childhood mortality: A guide for simple
surveys. Unicef, Regional Office of the Middle East and North Africa,
Amman, Jordan, 1990.
2 Graham, W. et. al. Estimating maternal mortality; The sisterhood
method. Studies in Family Planning, Vol. 20, No. 3, May/June, 1989, pp.
125-135.
3 Trussell, J. & Rodriguez, G. A note on the sisterhood estimator of
maternal mortality. Studies in Family Planning, Volume 21, Number 6,
November/December, 1990, pp 344-346
Module 2: Assessing health needs; procedures
41
Step 6: Schedule the survey
The three most important things to do at this point are:
finalise the data collection schedule; prepare the survey
management forms; and recruit and train the interviewers.
At the end of Step 5 you made some estimates of the
"data collection requirements," meaning the number of in
terviewers and supervisors you would need and the number
of days required to collect the data. You should finalise the
data collection schedule now and prepare an overall sched
ule for all other aspects of the study. This includes the
recruitment and training of data collection staff; the produc
tion of the questionnaires; logistical arrangements to get the
interviewers to the clusters; procedures for checking and
verifying the completed questionnaires, data entry, and
analysis; and report preparation.
Survey management forms are important for keeping
track of the numbers of households contacted, the number
of call-back visits made, interviews completed, and so forth.
Appendix H includes illustrative sample survey manage
ment forms for single and multiple target groups.
Appendix E includes some guidelines for training and
supervising field interviewers. You should prepare written
instructions for the interviewers that describe exactly how
they should select households, how to identify eligible re
spondents, which respondents to interview, when and how
often to make call-back visits, how to check the completed
form before leaving the household, and what to do if a
mistake is made.
Step 7: Collect the data
Selecting households
The selection of the starting household must be made
from within the cluster. The first house must be selected at
random. It would be best to select all seven households at
random.
This may be possible if there is an up-to-date house
hold listing of the community. The listing must be up to
date, otherwise the sample will be biased toward old-timers.
Use currency notes or the random number table in Appen
Module 2: Assessing health needs; procedures
42
dix G to select your seven households. To be safe, select ten,
just in case there are refusals, ineligible respondents, or
people have recently moved away.
If there is no list but the community is small, it would be
best to do a quick enumeration of all households and then
select the sample at random.
If that is not possible, the next best approach is the EPI
method. The typical approach that WHO uses is to select
the first household at random in each cluster, interview an
eligible woman, if there is one at home, and then go to the
next nearest household to find the next respondent. Re
spondents who are not home are skipped, even if they are
eligible. This search continues until the required number of
interviews, usually seven, has been completed.
The starting household is usually selected by choosing
some central point in the community, such as a market;
spinning a bottle to select a direction at random; walking in
that direction, counting, mapping, and numbering the
households you pass as you walk from the central point to
the edge of the community; and finally selecting one of these
houses at random. This house is the starting point.
There are several improvements on this approach that
have been suggested:
"It would be better to choose, say, the fifth nearest
household..."
"In large communities it would be a good idea to spread
the sample around by having more than one starting point
in different parts of the community."
"Any method which achieves a random or near-random
selection of households, preferably spread wide apart over
the community, would be acceptable as long as it is clear
and unambiguous, and does not give the field worker the
opportunity to make personal choices which may introduce
bias."1
1
Bennett, et al. op cit.
Module 2: Assessing health needs; procedures
43
Multiple target groups
If you draw a random sample, remember to draw a
separate one for each target group. If a household that you
draw includes respondents for two or more of your target
groups, it is quite alright to collect data from that household
for as many of your survey modules as possible.
If you follow the EPI approach, or the variations sug
gested above, you would just keep going from house to house
until you completed all parts of your questionnaire.
Call-backs
The EPI method replaces respondents who aren’t at home
with the next available respondent. It is much better to try at
least two revisits to collect data from the household originally
selected. This maintains the integrity of the sample, whereas
replacement introduces bias. People who stay at home may
be very different from those who are away at work.
Step 8: Enter, verify, and tabulate the
data
You may skip this step if:
• You are going to use the Epi Info computer program
Appendix A contains complete instructions for entering,
tabulating, and producing tables and graphs
° You plan to use another computer program for data entry,
verification, and tabulation
This step describes manual procedures for: 1) summaris
ing the data that have been collected; and 2) producing some
simple tables. Suggestions for using standard spreadsheet
programs are described in Appendix I.
Manual data entry
If you have been collecting data in cluster registers, you
only need to take the summary tabulations from each of the
30 registers and compile them on a summary form. In the
following example, the sample cluster register shown in Step
4 is reproduced with some illustrative data. The interviewer
(or supervisor) will tally the totals in the right column, as
shown. For simple "yes"/"no" questions count the number
Module 2: Assessing health needs; procedures
44
of "yes" responses. For example, five of the seven women
received ANC during their last pregnancy. One received care
from a hospital, two from a health centre, and two from TBAs.
For continuous variables, age, number of visits, add the
numbers and also show the number of respondents. For
example, the ages of all seven respondents totals 190 years.
The total column shows 190/7. Later, when the data from
all of the clusters are summarised, these figures can be used
to compute average age. Averages should not be calculated
for each cluster. The number of ANC visits made by the five
women who received ANC is shown as 10/5.
The summaries from each cluster can then be transferred
to a master sheet, such as that shown below. This form would
have 30 columns, one (1) for the data from each cluster, and
a column to summarise the totals.
The data from the above form for cluster No. 1 are shown
in the second column from the left marked "1.” For example,
age is shown as 190/7, Rec’d ANC is 5, and so forth. The
data from each cluster register would be entered this way
and then the totals produced at the end.
Data collected on questionnaires can be summarised in a
similar manner. This can be done in two steps or one. The
two-step process would be the same as that shown above. Each
interviewer or supervisor would summarise the data from a
cluster on a form similar to the cluster register. That would then
be summarised on a cluster summary form and tabulated.
The one-step alternative is to develop a large summary form
with 210 columns, or as many as there are interviews.
This is especially easy to do on a spreadsheet. Appendix 1
includes two computerised forms that are designed for this
purpose.
Verifying and cleaning the data
The data need to be "verified" to make sure that no
mistakes were made in summarising the totals and transfer
ring them to the summary sheets.
This can be done by having two separate teams indepen
dently summarise and transfer all of the data to summary
tables. The results are then compared. Discrepancies can be
checked and corrected fairly easily this way.
Module 2: Assessing health needs; procedures
Z1
■«r"
* •- '
45
Cleaning the data involves correcting mistakes in the
original interview forms and summary sheets. Although the
supervisors probably checked each questionnaire and cluster
register, mistakes can still happen. Typical mistakes include
using the wrong code, leaving a question blank, misinterpreting
a written code (e.g., 0 for 8), skipping to the wrong question,
and entering an answer in the wrong space.
Some of these mistakes will be caught by the supervisor,
others by the verification process, and some won’t be noticed
until the preliminary analysis is done. To find the source of the
error, you will usually have to go step-by-step back through
the data entry process: first to the summary sheets, then the
cluster forms, then the original questionnaires or registers.
Tabulation
Manual tabulation will usually be limited to summarising
counts, computing a few averages, and preparing some
frequency distributions. If you are using a computer, you can
do much more. See Appendix I for examples of simple
computerised tabulation procedures that use a spreadsheet
program.
For manual tabulation, you will already have totals
summarised in the Summary Form. Use these and the report
outline that you prepared in Step 3 to decide what to prepare.
1
JB
13
23
Y
2
KH
25
25
Y
Date:
03/04/92
Area: So.
Bajju
3
4
TD
MJ
38
37
22
34
Y
N
2
2
1
Y
Y
Interviewer name: B Rangka
Cluster: 1
Respondent no.
Name
House no.
Age
Rec’d ANC last
pregnancy
No. ANC visits
Source of service:
Hospital
Health centre
Local TBA
Other:
Book no. 1
Supervisor: Sonia Barang
5
NKT
42
42
Y
3
6
TR
54
18
N
7
JN
65
26
Y
Module 2: Assessing health needs; procedures
Total
190/7
5
2
10/5
Y
1
2
2
Y
Y
8
46
Summary cluster form
Date of last interview: 03/21/92
Date of first interviewer: 03/04/92
Prepared by . Sonia Baranq
Checked by: Marcus Stefensen
Area: Baiiu
4
5
29
30
Cluster No.
1
2
3
Total
Age
180/8 180/7 5715/214
190/7 185/7 210/8 175/7 197/7
Received ANC
4
5
5
5
4
6
3
156
last preqnancv
No. ANC visits
12/5 10/5
10/5 10/4 13/6
9/3 10/4
314/156
Source of service:
Hospital
1
1
1
15
Health Centre
1
2
1
1
2
2
47
Local TBA
2
3
2
4
3
3
94
3
Other:
At that time you also prepared some dummy tables. Prepare
the data needed to fill them in. Appendix 1 includes an
illustrative list of frequency distributions and cross-tabula
tions.
Averages: Let’s start with computing averages. All of
the data that are continuous variables were entered in the
summary table as two numbers: the total years, visits, and
events divided by the total number of those who responded
to that item. Examples are age and number of ANC visits.
Just perform this division to compute the average (mean):
5715/214 = 26.7 years (the average age
of your sample)
No. ANC Visits 314/156 = 2.01 visits
(the average number of visits made by
women who received ANC during their
last pregnancy)
Please note that the denominators (the number of re
spondents) is different in these examples. A common mis
take is to use the wrong denominator, for example, dividing
the total number of ANC visits by 214, the total sample. Be
careful to use the correct denominator.
Coverage percentages: Your most important data will
probably be coverage data. This is computed by counting
the number of people covered and dividing it by the number
of eligible respondents. Examples from the Summary Form
Module 2: Assessing health needs; procedures
47
are the number who received ANC. The sheet shows that
156 women out of 214 received ANC. To compute the
coverage percentage, divide 156/214 and multiply by 100.
Received ANC last pregnancy: 156/214 = .72897 * 100 =
72.9% (the percent of eligible women covered)
Frequency distributions: This information will also
be important for determining the numbers and percentages
of people who use different services, use different providers,
have different reasons for accepting a service, and so forth.
The Summary Form shows that there were three sources of
service for the 156 women who received ANC. To compute
the frequency distribution, divide the counts of each of these
by 156 and multiply by 100.
You should go through your Summary Form and com
pute these three types of statistics for your report. It is
possible to do more sophisticated tables by hand, such as
cross-tabulations of ANC use by age and computation of
tests of significance, but these are tedious when done man
ually. If you need this information, it would be best to use
a computer programme or find someone who has a com
puter and can do it for you. They may want to use the
programmes included in Appendix I for tabulation and
statistical analysis. Appendix 1.3 also includes examples of
a programme developed by Ralph Frerichs for computing
confidence intervals for selected indicators (ANC.WK1).
Step 9: Analyse, interpret and report the
findings
Consult your report outline again to make sure that you know
the users most important indicators, questions, and issues. Yin
have already produced some of these in Step 8: coverage data
and frequency distributions of key variables, for example.
Analysis and interpretation
When you have your tables completed, examine them to
make sure that you understand what they mean. Think in
terms of different kinds of interpretations:
Module 2: Assessing health needs; procedures
48
• Descriptions: This is the most basic level of analysis.
Simply present the facts: X number of women were
served; Y percent covered.
• Performance: This requires comparing the descriptive
data with performance expectations or standards. Is 73
percent coverage adequate, excellent, below expectations?
Where is the programme performing well? Where is it not?
• Explanations: Some of your frequency distributions can
provide explanations. Where did women go for service?
What reasons did they give for not coming back? Rapid
surveys usually do not get into much detail in this category,
but the results can stimulate staff discussion and result in
insightful explanations. For example, why don’t women
come to the hospital? Why are so many going to TBAs?
Modules 6 and 7 can help you get some explanatory data.
• Implications: This involves going beyond the data to
think of implications for the future. If coverage is low,
what does that mean for the future? Can it be increased?
Is it feasible? How could it be done? Should the pro
gramme try to get more women to come to hospitals and
health centres for ANC? Or should we train TBAs to
provide better services?
° Issues needing further study: Most studies raise ques
tions, as well as answer them. Rapid surveys are no
different. Identify questions that cannot be answered with
the available data. Some of those might be investigated
with a second survey or through one of the other modules
that look at the quality of services (Module 6), short-term
monitoring of an activity (Module 5), identifying high-risk
women (Module 3), etc.
Remember that you can only do an analysis of the entire sample
You cannot divide the sample into sub-samples to compare
groups. This requires separate rapid surveys for each group.
Source of service
Hospital
Health centre
TBA
Total
Number served
15
47
94
156
Percentage
(15/156)’100 = 9.6%
(47/156)* 100 = 30.1%
(94/156)*100 = 60.3%
100.0%
Module 2: Assessing health needs; procedures
49
Reporting
The easiest way to prepare a report is to present the
findings from each question in the sequence followed in the
questionnaire. Another is to present the major findings first,
since this is what most managers want to know. Most rapid
survey reports are presented orally at first and include a few
tables and graphs of key findings. The final written report
may include additional tables at the manager’s request.
A typical formal outline of a research report is shown below:
• Title, authors, date, acknowledgements, table of
contents
• Executive summary (key findings, implications, brief
description of the study design)
• Statement of the research problem (the background
and problems to be investigated)
• Study objectives (purpose of the study, expected out
comes)
• Methodology (brief description of the key indicators,
sample, instruments used, analysis procedures, timetable)
0 Findings (summary of findings, divided into sections,
formatted to address questions and issues the user wants
answered — should include tables and graphs of key
points)
0 Discussion (interpretation of the findings, discussion of
implications for the future, identification of other issues
needing study or analysis)
° Recommendations (suggested courses of action to take
for policy, planning, services, management, further research)
° Appendices (detailed data tables, questionnaire or reg
ister used, reference materials)
The formal report does not have to be long. Some of the
sections listed above can be covered in a paragraph, others
in a page. The longest sections are likely to be the findings.
Keep the audience in mind when preparing the report.
Managers, in particular, are not likely to read long reports.
That’s why the executive summary is so important. That
may be all that they read.
Module 2: Assessing health needs; procedures
50
Step 10: Develop an action plan
The Implications and Recommendations sections of the
formal report may not necessarily lead to action. That is why
it is important to make development of an action plan a
separate step and to introduce it as part of the study objectives.
The managers and other users should be expecting to take
action on the study results. Make that a stated expectation
from the beginning and reinforce it throughout the study.
The best time to begin preparing an action plan is during
the oral presentation of the study results. The plan does not
have to be detailed, but it should include:
• WHAT: the action(s) to be taken should be specified (e.g.,
provide ANC training to TBAs, or brainstorm what can
be done to enrol high-risk women in ANC).
• WHO: the specific people who will be responsible for each
action should be identified (by name or position).
• WHEN: the dates for starting and/or completing the actions.
In some cases it may be important to include WHERE,
to specify the sites or locations where the actions will take
place, HOW, to outline the procedures that will be followed,
and the RESOURCES that will be made available to carry
out the actions.
Specific details may need to be worked out later, and even
some of the above elements may have to wait until the
formal report is ready and can be studied more carefully. If
so, then they should be incorporated into the preliminary
action plan.
Worksheet for developing action plans
ACTION TO TAKE
RESPONSIBLE
DATES
OTHER
(What)
(Who)
(When)
(Where)
Module 2: Assessing health needs; procedures
53
Appendices: Templates, tools, guidelines,
and computer programs
A.
How to use Epi Info to conduct rapid surveys
B.
Questionnaire design guidelines
C.
Rapid survey instruments
D.
Community assessment of PHC (overall)
Health education
Antenatal care, safe delivery and postnatal care
Family planning
Acute respiratory infection
Breast feeding
Diarrhoeal disease control/oral rehydration therapy
Childhood disabilities
Child immunization
Growth monitoring/nutrition education
Water supply, hygiene and sanitation
Accidents and injuries
Chronic, non-communicable diseases
Tuberculosis
Malaria
Sexually-transmitted diseases, HIV/AIDS
Vital events and health status
Child morbidity and mortality assessment
Adult morbidity and mortality assessment
Cluster survey registers
Health education
Antenatal care, safe delivery and postnatal care
Family planning
Acute respiratory infection
Breast feeding
Diarrhoeal disease control/oral rehydration therapy
Childhood disabilities
Child immunization
Growth monitoring/nutrition education
Water supply, environmental hygiene and sanitation
Accidents and injuries
Sexually-transmitted diseases, HIV/AIDS
Module 2: Assessing health needs; appendices; contents
54
Malaria
Tuberculosis
Chronic, non-communicable diseases
Vital events and health status
Child morbidity and mortality assessment
Adult morbidity and mortality assessment
E.
F.
G.
H.
Guidelines for training and supervising interviewers
Cluster sampling programmes
Cluster identification worksheet
Other sampling tools
G.l Estimates of target group sizes (TARGET.WK1)
G.2 Sample size estimation for WHO two-stage cluster survey
(SIZE.WK1)
G.3 Random number table
(RAND0M.WK1)
G.4 Random sampling procedures
Survey management forms
Form 1: Household enumeration
Form 2: Respondent disposition
Form 3: Multiple-target group management form
I.
Tabulation and analysis templates
1.1
Data analysis plan
1.2 Rapid survey analysis template (RAPID ANC.WK1)
1.3 Cluster summary template (MINI GM.WK1)
1.4 Confidence interval estimation templates (TT.WK1; ANC.WK1)
Module 2: Assessing health needs; appendices; contents
56
Sample files that you can use to illustrate the
instructions:
RAPIDFPQES (a family planning questionnaire)
RAPIDFPREC (a data entry file)
RAPIDFPCHK (a file for including range checks and other instructions
for data entry)
RAPIDFRPGM (a file of analysis instructions to produce tables and
graphs)
FPTEST.WK1 (a Lotus 1-2-3 spreadsheet file with sample data)
FPTEST1.REC (a data entry file constructed from FPTEST.WK1)
Use the sample files that come with these instructions in conjunction
with the Epi Info computer program to learn how to use Epi Info in
conducting rapid surveys in family planning and primary health care. You
can also read and print out sections or all of the Epi Info User’s guide from
the enclosed diskette.
Installing EPI info and using the tutorials
Installation: Epi Info is very easy to install. Follow the instructions in
the README file on the first PHC MAP diskette. It will tell you how to
extract Epi Info and other files. When you have extracted the Epi Info files
and put them on separate diskettes you can install Epi Info onto your
computer. Place Disk 1 of the Epi Info System in one of your floppy drives,
say drive A. At the A prompt type INSTALL. Then just follow the
directions on the screen. See Chapter 4 of the Epi Info User’s guide for more
details.
Notations: These instructions use the same notations as the Epi Info
User’s guide (see p. 7 of the guide). Keys on the computer’s keyboard are
indicated by < >. Examples : < Fl > (means press the Fl key), < Ctrl + S
> (means hold down the Control key and press the S key). The material
that you should type is shown in boldface. Example: type EPI and press
<Enter>.
Tutorials: Epi Info includes a tutorial program in a file called EPIAID.
First get into the EPI5 directory. Then type EPI to load EPI5. The main
menu should appear. Move the cursor to EPED and press <Enter> to load
it. Then press <F3>. Next move the cursor to EPIAID and press <Enter>.
Choose one of the tutorial programs —Word processing, Make Epi Info
Questionnaire — and press <Enter>.
There are also two analysis tutorials. Load EPI5 as before. Move the
cursor to ANALYSIS on the menu and press <Enter>. Then type RUN
Module 2: Assessing health needs; appendix A
57
TUTOR1 and <Enter> for basic analysis procedures or RUN TUTOR2
for developing an analysis program.
The User’s guide also includes Tutorial Instructions at the beginning of
Chapters 4 (Installation), 5 (Starting Epi Info), 8 (Entering Data), and 10 (the
CHECK program). It also includes a number of tutorials for advanced work
with Epi Info.
The following summarises the basic tutorial programs included
in Epi Info:
Tutorials
1. Installation
2. Starting
3. Word processing
4. Designing questionnaires
5. Data entry
6. Data entry instructions
7. Analysis
8. Analysis programs
Source
Chapter 4 (page 1)
Epi Info Chapter 5
EPIAID: Word processing
EPIAID: Make EPI info questionnaire
Chapter 8
Chapter 10
ANALYSIS: RUN TUTOR1
ANALYSIS: RUN TUTOR2
These instructions are based on Epi Info, Version 5: A wordprocessing,
database, and statistics system for epidemiology on microcomputers, by A.G.
Dean, J.A. Dean, A.H. Burton, and R.C. Dickers. Epi Info is a joint project
of the Centers for Disease Control (CDC) and the World Health Organiza
tion (WHO).
The User’s guide and the computer programs are in the public domain
and may be freely copied, as can these instructions. The program and User’s
guide can be purchased for $35 from USD Incorporated, 2075A West Park
Place, Stone Mountain, GA 30087. The User’s guide is also available from
several countries, often through Departments of Epidemiology in local
schools of public health.
How to develop a questionnaire in Epi Info
You may construct a questionnaire directly in Epi Info or import one that
you developed on a word processor. We recommend that you develop (or
revise/edit) your questionnaire on your word processor first. It will be easier
for you to work on a word processor with which you are already familiar.
Epi Info uses a simple word processor based on WordStar. It may take some
time to get used to Epi Info’s wordprocessing commands. We strongly
recommend that you read Chapters 6 and 7 of the Epi Info User’s guide for
Module 2: Assessing health needs; appendix A
58
instructions. Also, run the EPIAID tutorials on Word processing and make
the Epi Info Questionnaire.
The following instructions first tell you how to prepare a questionnaire
on your word processor (A). This is followed by instructions for preparing
one within Epi Info (B).
How to prepare a questionnaire that will be imported to Epi Info
1.
Prepare your questionnaire on your word processor.
Use one of the draft questionnaires in Appendix C as a guide. Also see
the sample Family Planning questionnaire that follows. You may load these
questionnaires into your word processor and revise them by adding,
deleting, or editing the questions. List the most likely responses and give
each a code number. Make sure to include 9 or 99 for "Don’t Know/No"
response (DK/NR). Example:
8.
Are you using a method now? Yes (1), No (0), DK/NR (9)
When you are finished, save the questionnaire twice. Save it first as a
regular document, for example RAPIDFPDOC. You will use this version
for your interviewers.
Save it a second time as an unformatted file (ASCII). You will use this
version to set up a data entry programme in Epi Info. When you save it,
add QES as the extension. Example: RAPIDFPQES
Enter the Fields.
Now you will enter "fields" in the *.QES version of the questionnaire. You
should still be working in your word processor.
Types of fields. A "field" is an area in the questionnaire where you will
enter data. After each question you will insert symbols for an appropriate
field. These are examples of questionnaire items followed by different kinds
of fields:
Today’s date: </mm/yy> Interviewer name
2. How old are you? ## 3. Are you married? <Y>
The first is a "date" field. You would enter two numerals each for the day,
month, and year. The second, to the right, is called a "string" field. You can
enter up to 80 characters in a string field. The third, following, "How old
are you/," is a "numeric" field. The # symbol represents a numeral, in this
case, a two-digit number. The last is a field for entering "yes"/"no"
responses.
Symbols. The following list summarises the major symbols you can
used for your .fields. Usually, each question will have one field for the
2.
Module 2: Assessing health needs; appendix A
59
response, and you will decide which type of field is appropriate and where
to place it. The numeric and string fields require a symbol for each digit or
character in the response. For example, if you record the respondent’s age,
you need to allow space for two digits, so enter ##. If you want to record
the person’s name, you might allow space for 20 or 30 characters. Type
one underline character for each space :. (This is
a 20-space string.)
#
<dd/mm/yy>
<IDNUM>
For numbers: ## (26)
###.#(26.4)
.###(264)
For Yes/No responses: Y = Yes, N = No,
(Accepts Y, N, and space (missing value. Does not allow
DK/NR codes.)
For dates: 23/04/92
For written responses (especially for open-ended
questions) maximum length is 80 characters.
For the case number; 0231
Instructions. Type in the appropriate symbols in the second (*.QES)
version of your questionnaire. Put them where you want the data to be
entered. Later you will use this questionnaire to construct a file for entering
data into the computer. The computer program will display this question
naire, and the cursor will skip from one field to the next to allow you to
enter data. Thus, it is important where you place the symbols. In the
sample questionnaire, we have placed all of the symbols in the right margin.
You may also place them at the end of the questions, below them, inside
them, wherever you wish. For example:
Are you using a method now? # Yes (1), No (0) DK/NR (9)
Yes (1), No (0) DK/NR (9)#
Are you using a method now?
# Are you using a method now? Yes (1), No (0) DK/NR (9)
Remove any symbols that you don’t want to be read as fields by the
computer. Underlines
, chevrons <2>, pound signs #3, will all be read
as fields. In the following examples you would remove all of these symbols
except the one # sign at the end, which is the field you want.
(9) #
Are you using a method now? Yes
CD, No
(0), DK/NR
DK/NR <9>#
Are you using a method now? Yes <1>, No <0>,
DK/NR (#9) #
Are you using a method now? Yes (#1), No (#0),
Module 2: Assessing health needs; appendix A
60
Rapid survey questionnaire: Family planning
Complete for all married women aged 15-44 years who are currently
living in the household.
Office Use
CASE NO: IDENTIFICATION
1.
2.
3.
4.
{Study} No
{Province) No
{Interviewer)
{Date) of Interview
5. ID Number (4 digits): {Cluster No). {Woman No), in Cluster
{NAME) OF RESPONDENT.
6. How {old) are you? (Probe) years (if DK/NR, enter 99)
7. How many living {children) do you have? (if DK/NR, enter
99)
8. Are you or your husband currently using any family planning
(method)?
Yes (1) No (0) Go to Q 13 DK/NR (9) Go to Q13
9. Which method are you/your husband using now (select
principal {method only))?
Tubectomy
(1) NORPLANT
(6)
Vasectomy
(2) Condom
(7)
IUD
Oral pill
Injection
(3) Foam, emco, jelly, cream,
diaphragm
(4) Safe period, withdrawal,
abstain
(5) Other:
DK/NR
(99)
{How long) have you been continually using this method?
0-3 months
(1) 1-2 years
4-6 months
(2) 3-4 years
7-12 months
(3) 5 years or more
DK/NR
(9)
11. For how long have you been practising family planning,
i.e., continuously using one method or another without
(interruption)?
0-3 months
(1) 1-2 years
4-6 months
(2) 3-4 years
\ 7-12 months
(3) 5 years or more
\ DK/NR
(9)
<ID number>
1.##
2.##
3.##
4.
<dd/mm/yy>
5.##
6.##
7.##
8#
9.##
<dd/mm/yy>
(8)
(9)
(10)
10.
10.#
(4)
(5)
(6)
11.#
(4)
(5)
(6)
Module 2: Assessing health needs; appendix A
61
12.
What is the main source of your family planning service or (supplies)?
12.##
Govt, hospital/clinic
(1) Private hospital/clinic
(6)
Govt, field worker
(2) NGO clinic
(7)
Social marketing prog.
(3) NGO field worker
(8)
Private physician
(4) Other: __
(9)
Pharmacy
(5) DK/NR
(99)
Go to Q17
13. If you are not using family planning now, have you or
13#
your (husband ever) used any method in the past?
Yes(l)
(1) No
(0) Goto
Q15
DK/NR
(9)
14 Which method did you/your husband use most recently
(select (latest method) only)?
14.##
Tubectomy
(1) NORPLANT
(6)
Vasectomy
(2) Condom
(7)
IUD
(3) Foam, emco, jelly, cream,
(8)
diaphragm
Oral pill
(4) Safe period, withdrawal,
(9)
abstain
Injection
(5) Other
(10)
DK/NR
(99)
15.#
15. Do you/your husband intend to practice family planning in the
(future)?
Yes
(1) No
(0)
DK/NR
(9)
16.##
16. What is the most important reason you are not using
family (planning now)?
Want more children
(1) Method/service unavailable
(6)
Husband objects
(2) Sterilily
(7)
Health reasons
(3) Breast feeding
(8)
Religious reasons
(4) Pregnant
(9)
Fear side effects
(5) Other
(10)
DK/NR
(99)
17.#
17. What is the name of the local {Community} Health
Worker?
Knows (said name)
(1) Does not know
(0)
No response
(9)
18.#
18. Has the Community Health Worker visited or contacted
you during the (last three months)?
Yes
(1) No
(0)
DK/NR
(9)
This concludes the interview. Thank you for taking the time to participate in this survey.
Module 2: Assessing health needs; appendix A
62
!n this version the data are entered in a column on the right; many
researchers prefer this format. However, it is important for-only the data
entry version of the questionnaire. The interviewers can enter responses
anywhere on the paper. That is why you should save one version of the
questionnaire for your interviewers and this second one for the data entry
program.
3.
Enter names for each field by placing { } around key words in
each question.
You should still be working in your word processor on the *.QES version
of your questionnaire.
Next you must give each field a name so that you can analyse the data
later. Examples:
How (old) are you? Field name = OLD
Which (method) are you using (now)? Field name = METHOD NOW
(A.l) Which method are you using now? Field name = A.l
If your question is longer than one line, the field name must be in the
last line. For example-.
8. Are you or your husband currently using any family planning
(methods)?
Actually, you do not need to enter field names. This is an optional step,
because Epi Info will create field names automatically if you do not specify
a name. It selects the first 10 non-punctuation characters before each field.
See page 53 of the Epi Info User’s guide for more detail. The major
advantage to entering your own field names is that they will be immediately
recognisable to you.
When finished, save the file in ASCII format with a QES extension.
Example: save the file as RAPIDFPQES
via..
VI.3
Vl'.i
HP
X4C
jjW>
gjun.
go -
How to prepare a questionnaire within EPI info.
1. Load EPI5. At the C prompt type <EPI> and press <Enter>.
2. Open EPED. In the main menu move the cursor to EPED and
press <Enter>.
3. Type the questionnaire onto the screen.
Type the questions, instructions, codes, etc., directly onto the screen,
using the program’s wordprocessing commands to tab, backspace, delete,
indent, etc. Use the Help (Fl) key if you need instructions about the word
processor.
Module 2: Assessing health needs; appendix A
go
_
63
"9
A
If you have a questionnaire on your disk that you want to use or edit,
load the file by pressing <F2>. Enter the file location and name, e.g.,
b:\RAPIDFP.QES. Press <Enter>. Then make your corrections, additions,
etc.
4.
dy
Enter the fields and field names, and remove unwanted
symbols.
You can enter the field symbols directly, as described above. You can
also call up a menu of field symbols by pressing <CTRL + Q>, then <Q>
again. To insert one of these in your questionnaire, first make sure the
cursor is where you want to make the insertion. Then press <CTRL + Q>,
Q, then highlight the symbol you want and press <Enter>. If you know
what the symbols are, it is easier to type them in directly.
mai>sk'p ^'ssteP Vou don’t want to insert any data entry instructions
5.
When finished, save the file. Press <F9>, then <F10> to exit.
Inserting data entry instructions in Epi Info
3
3
3
3
3
(See Chapter 10 of the Epi Info User’s guide)
You can insert codes into your basic questionnaire to check for errors,
to do automatic coding of some entries, and to skip over inappropriate
questions. The instructions describe in this section how to insert the
following into your questionnaire:
Range Checks: Specify the range of values that can be entered; e.g., 1-5.
The programme will reject all numbers outside the range, e.g., Q, 6, 8 etc.
Legal Values: Specify individual values that can be entered; e.g., 2, 8, 9.
The program will reject all other numbers (e.g., 1,3,4, N, etc.).
Must Enter: Specify that an entry must be made in the field, it cannot
be left blank or skipped. The program will not move to the next field until
an entry is made. However, you can override this by pressing the <Down
Arrow> or <Page Down. >
Repeat: Specify that the same value entered into a field will be repeated
in all subsequent records until it is changed. For example, enter Q 3 for
province, which will be entered automatically on ail subsequent question
naires until you change it.
Skips: Specify which questions will be skipped, depending on the
previous answer. For example, "If No, go to Q16."
Module 2: Assessing health needs; appendix A
64
1. Create a data file.
Before you can enter these instructions, you must have a data file in
which to insert them. This is a file with a *.REC extension. You can create
one as part of this step or as part of the data entry step.
Load EP15 by typing EPI and pressing <Enter>. At the main menu,
move the cursor to ENTER and press <Enter>.
At the prompt type in the name of the questionnaire file you just
prepared, e.g., RAP1DFE but leave off the extension. Don’t forget to include
the path name. Example: b:\RAPID and press <Enter>.
Follow the commands. Press <ESC>. Enter the name of your question
naire file, e.g., b:\RAPIDFPQES and <Enter>.
Inspect the file, especially to make sure that all of the fields are included
and are in the correct places. Then press <F10> to exit. If you need to make
corrections, go back to the EPED programme to edit your file.
2. Load the CHECK programme from the main Epi Info menu.
Load EP15 by typing EPI and pressing <Enter>. At the main menu,
move the cursor to CHECK and press <Enter>.
3.
Load your questionnaire.
You should load the data entry version of your questionnaire. That is the
one with the *.QES extension. At the prompt, enter the path and name of
your questionnaire (e.g., b:\RAPlDFPQES) and answer <Y> to the question
"Are you ready?” Press <Enter>.
Enter the appropriate check codes in the appropriate fields.
Place the cursor in the first field to be changed and make the appropriate
entry; see the menu at the bottom of the screen. Move to each field to be
changed until finished.
Range check: Enter the minimum number that will be accepted, press
<F1>, then enter the maximum number that will be accepted, press <F2>.
Example: Age 15-44. Put the cursor on the field symbol in the age
question, type: <15> <F1> <45> <F2> and <Enter>. To remove a range, see
"6. Editing the commands," below.
Legal Values: Enter the letter(s) and/or number(s) that will be
accepted, press <F6>.
Example: Male=M, Female=F. Put the cursor on the field symbol, type:
<M> <F6> <F> <F6>, and <Enter>.
Example: Male=l, Female=2, Unknown=9; Type:
<1> <F6> <2> <F6> <9> <F6> and <Enter>.
Press <SHIFT + F6> to display all legal values for the field.
To remove a legal value, enter it into the field and press <CTRL + F6>.
4.
Module 2: Assessing health needs; appendix A
Q>1M.
fliHu. rr
65
Must enter data in this field: Place the cursor in the field and press
<F4>. Press <F4> again to remove the command.
Repeat entry made in this field in subsequent records: Move the cursor
to the field symbol, enter the number or characters you want repeated, and
press <F3>. Example: Study No <6> <F3>. Press <F3> again to remove
the command.
Skip: Place the cursor in the field. Enter the value that triggers the
skip, press <F7>, move to the question to be skipped to, press <F7>.
Example: Q 8 says "If ’No’, go to Q13." Place the cursor on the field
symbol in.Q8. Type: <N>, press <F7>, (move the cursor to the field symbol
in Q13, press <F7>.
You can have several different skips for the same question. For example,
in addition to the skip above, you might have: "If Yes, go to Q15." Place the
cursor on the field symbol in Q8 again, type <Y>, press <F7>, move the
cursor to the field symbol in Q15, type <F7>. The program will now skip
to Q13 if the response is "no" and to Q15 if it is "yes."
If you want to skip to another question regardless of the response, place
the cursor on the field symbol and press <F7> when the field is blank. Move
to the field symbol in Q15 and press <F7> again. To display all current skips
for a field, place the cursor on the field symbol and press <SHIFT + F7>.
To remove a skip use <CTRL + F7>.
5.
Save your changes.
Press <F10> when finished to save. "Write Data to Disk [Y/N]?" appears.
Press <Y>
6.
Editing the commands.
Place the cursor in a field you wish to change and press <F9>. The
commands for that field will be displayed in an indented hierarchy. You
can edit, add, delete commands directly. Example: To change the Male and
Female codes from M and F to 1 and 2, simply press <F9>, move the cursor
to M and replace with 1, move to F and replace with 2.
How to enter data into EPI info
(Chapters 8 and 17 of the Epi Info User’s guide)
There are two ways to enter data into Epi Info. The first is to enter the
data from one questionnaire at a time directly into the Epi Info data file.
The second, is to import all of the survey data from a spreadsheet, dBase
or ASCII file.
Module 2: Assessing health needs; appendix A
66
How to enter data from questionnaires (see Chapter 8)
1. Load ENTER from the main menu.
Load EPI5 by typing EPI at the C prompt and pressing <Enter>. At
the main menu move the cursor to highlight ENTER and press <Enter>. If
you are creating a new data file, type in the path and name of the
questionnaire file that you want to use, but leave off the extension, e.g.,
a:\RAPIDFP and press <Enter>. The program will create a data file and
give it a *.REC extension, such as RAPIDFR REC. If you are loading a data
file that has already been created, follow the same steps. When you type
the name of the data file (RAPIDFP), the program will find RAPID.REC
and load it. Or you can type in the path, e.g., b:\ and press <F1> to display
a list of REC files. Move the cursor to the one you want to load and press
<Enter>.
Enter the data from each completed questionnaire.
The case identification number <idnum> is entered automatically, and
the number increases by 1 for each record. The cursor will move to the
first field that you specified to receive data. In the sample Family Planning
questionnaire, this field is "Study No" Type in the number (e.g., 6) and then
press <F3>. Since the study number is the same for all questionnaires, you
need to enter that only once. The <F3> key turns the "Repeat" function
on and off. When you turn it on, you will not have to enter the same number
for each questionnaire. The Province number is also the same. The
interviewer number will be the same for 7 or more cases, as will the date
of the interview and cluster number. When the number changes, e.g., from
6 to 7, just type in 7 and it will repeat until you type in a new number.
In most cases, after you enter data in a field, the cursor will automatically
move to the next field. If it does not, press <Enter> to move to the next
field. This happens when the spaces in the field are larger than the number
entered. For example: "How many living children do you have?" Allow 2
spaces for a two-digit number (12,15,10). When you enter two digits, the
cursor goes to the next variable. If you entered one digit (2, 3,1), you would
also need to press <Enter> to move to the next question.
If you have installed range checks and legal numbers, the program will
only accept the numbers you indicated. "How old are you?" will accept any
number between 15 and 45. If you enter 13 or 54, the program will not
accept the entry. For a "yes"/"no" question, the program will accept Y, N,
or blank. If you enter Q by mistake, it will not be accepted. Dates must be
entered in the correct order: dd/mm/yy. The first entry (day) cannot exceed
31, the second (month) cannot exceed 12.
2.
Module 2: Assessing health needs; appendix A
67
'9
3
The program will skip questions that do not apply (identified on the
questionnaire as "Go to QXX"). You cannot enter data in fields that are to
be skipped.
Some fields are designated as "Must enter." The program will beep if
you try to skip by pressing <Enter>. If the data item is missing on the
questionnaire, you can leave the field blank by pressing the down arrow or
<Page Down>.
3.
3
3
3
Make corrections, as needed.
If you make a mistake, use the up or down arrows, the <Home>, <End>,
<PgDn>, and <Pg Up> keys to move the cursor to the error and re-enter
the correct data.
When you have finished a form, the message, "Write data to disk (Y/N)"
will appear at the bottom of the screen. Type <Y> to save the data. The
program will go to the top of the screen so that you can enter the next
record. Notice that the Case ID has increased by one.
You can go back or forward to look at each completed questionnaire by
pressing <F7> or <F8>. You can also make changes at that time, if
necessary.
When you are finished, press <F10> to exit.
3 How to import data from other files (see Chapter 17)
Epi Info can import four kinds of files: ASCII fixed-length records,
3 comma-delimited records, Lotus 1-2-3 *.WKS and *.WK1 files, and dBase II
3
3
files. The following instructions cover the Lotus and dBase files only.
Consult the Epi Info User’s guide for instructions on importing the other
kinds of records.
1. Prepare the file to be imported.
dBase files do not need any special preparation. They can be imported
directly. Lotus 1-2-3 files should contain variable field names on the
first line (and only the first line). Data items should not be on the first
line, since Epi Info will read whatever is on this line as variable names.
The variable names can be of any length and can be different from those
used in the original data set. That is, you can use new, short names for the
variables. An example is shown below:
Age
Sex
VI
V2
V3
V4
23
25
32
M
F
M
1
2
1
0
0
1
2
3
9
3
2
2
variable names
Save the file with a:‘.WKl or ‘.WKS extension.
3 Module 2: Assessing health needs; appendix A
68
2.
Load IMPORT.
Before you import your data, you need to create a ‘.REC file into which
you can put the data.
First load EP15 by typing EPI at the C prompt and pressing <Enter>.
Then at the main menu move the cursor to highlight IMPORT. Press
<Enter>. Type in the destination and name for the .REC file you will create,
(e.g., a:\FAMPLAN).
On the next line type the path and name of the dBase or Lotus file to
be imported (e.g., a:\BALIFP.WKS). Type the appropriate number, 3 or
4, for the format of the imported file, 3 for Lotus, 4 for dBase. Press <F4>
when you are ready to continue.
The program will return to the main menu when finished. It will have
created and saved a file with a *.REC extension. For example,
FAMPLAN.REC. You can now load the ANALYSIS program to analyse the
data.
How to analyse data with EPI info
(See Chapter 9 of the Epi Info User’s guide)
1. Load the data file.
First load EP15 by typing EPI at the c: prompt and pressing <Enter>.
Before you can analyse the data, you need to load the ‘.REC data file into
ANALYSIS and then read it. At the main menu, highlight ANALYSIS and
press <Enter>. The ANALYSIS screen will appear. The cursor will appear
at the bottom left of the screen after EPI >. Type READ and the location
and name of the desired data file. Example: EPI > READ
b:\FAMIPLAN.REC Press <Enter>.
If you are loading a dBase file, just type its name and the DBF extension.
For example: EPI > READ b:\FAPLAN.DBF <Enter>.
If the file has been read correctly, you will see at the top left of the screen
the file name and the number of records that have been read.
2.
Select and run the analysis commands.
After you have read a data file, you can enter analysis commands one
at a time or create a small program to run several commands at once. These
programs can be prepared on your own word processor and saved as an
ASCII file with a ‘.PGM extension. Example: RAPIDFPPGM.
Module 2: Assessing health needs; appendix A
69
'3
13
.J
3
3
3
3
3
3
3
-3
A short program is shown below. This file summarises the major
ANALYSIS commands:
READ b:\FP\FPTESTl
FREQ METHOD METHODONLY HOWLONG1 SUPPLIES FUTURE
SET PERCENTS=ON
ROUTE PRINTER
TABLES CHILDREN METHOD
TABLES SUPPLIES METHOD
ROUTE SCREEN
PIE METHOD
HISTOGRAM METHOD
This program instructs Epi Info to read a data file called FPTEST1. Then
it produces frequency distributions for five variables. The SET PERCENTS=ON command instructs Epi Info to display percentage distributions
as well as counts for the tables that follow. The ROUTE PRINTER command
tells the program to send the tables that follow to the printer. Two cross-tab
ulations are then produced: contraceptive method concurrently used by
number of living children, and method used by source of method. The
program instructs Epi Info to send the next commands to the computer screen
instead of the printer. The first graph is a pie chart showing the distribution
for family planning users and non-users. The second is a histogram of the
distribution of contraceptive methods used.
Examples of the lists, frequency distributions, cross-tabulations, and statis
tics produced are shown on the following pages.
ANALYSIS TABLE. The following are examples of tables that Epi Info produces:
1 LIST
Produces a list of all variables in the data set
2 FREQ Produces a frequency distribution of a single variable
3 TABLES Produces a cross-tabulation of two discrete variables
4 MEANS Produces a table of continuous variables
TABLES and MEANS can be produced with and without percentages by typing SET PER
CENTS ON or SET PERCENTS OFF before typing the calculation command. See the ‘.PGM files
for example.
Mann-Whitney or Wilcoxon Two-sample test ( Kruskai-Wallis for two groups)
Kruskai-Walhs H (equivalent to chi square) =
17.397
Degrees of freedom
=
1
p value=0.000030
3
Module 2: Assessing health needs; appendix A
70
1
LIST
This is a partial listing of the data file, showing all of the values in the top row and the
data for each case in the succeeding rows
This listing was produced by typing LIST* and pressing <Enter>.
Rec Case Study
Prov
Interv
Date
ID
Old Childrn
Mthd
1
1
12
3
4
33333
101
23
1
1
2
2
12
3
4
33333
102
24
3
1
3
3
12
3
4
33333
103
31
1
1
4
4
12
3
4
33333
104
45
2
1
5
5
12
3
4
33333
105
32
1
0
6
6
12
3
4
33333
106
17
1
0
7
7
12
3
4
33333
107
27
4
1
8
8
12
3
4
33333
111
29
1
1
9
9
12
3
4
33333
112
32
2
1
10
10
12
3
4
33333
113
37
1
0
2 FREQUENCY
This is a frequency distribution of age with percents on.
This table was produced by typing FREQ AGE and pressing <Enter>.
AGE
1
2
3
4
5
6
Total
Sum
Mean
Standard deviation
Freq
23
57
42
36
29
32
219
= 744.00
= 3.40
=
1.59
Percent
10.5%
26.0%
19.2%
16.4%
13.2%
14.6%
100.0%
Cum.
This shows the
10.5% distribution of
36.5% respondents by age
55.7% group where
72.1% 1 = 15 - 19 years,
85.4% 2 = 20 - 24 years, etc.
100.0%
These statistics are
produced automatically
by the program.
Module 2: Assessing health needs; appendix A
71
9
3
3 CROSS-TABS: TABLES
This is a cross-tabulation of age and contraceptive method with the percent off.
This table was produced by typing TABLES AGE METHOD and pressing <Enter>.
METHOD
3
3
3
3
AGE
1
2
3
4
5
6
Total
0
14
15
12
15
12
6
74
1
9
42
30
21
17
26
145
Total
23 These are also 5-year age
57 groups.
42
36
29
32
219 These statistics are also
produced automatically.
Chi square
=
14.45
Degrees of freedom
p value
=
5
0.012970389
This is the same cross-tab table with percent set to on.
3
1
■3
2
"3
3
3
4
3
5
3
6
3
Total
3
Chi square
Degrees of freedom
p value
Total This row shows that 14 is 60.9%
of 23 (15-19 yrs).
23
10.5%
0
1
14
60.9%
18.9%
15
26.3%
20.3%
12
28.6%
16.2%
15
41.7%
20.3%
12
41.4%
16.2%
6
18.8%
8.1%
74
33.8%
9
391%
6.2%
42
73.7%
29.0%
30
71.4%
20.7%
21
58.6%
14.5%
17
58.6%
11.7%
26
81.3%
=
=
14.45
5
0.012970389
AGE
145
66.2%
57 This row shows that 15 is 20.3%
26.0% of all 0s (74 using no method in
column 2).
42
19.2%
36
16.4%
29
13.2%
32
14.6%
17.9%
219 This is a row that shows 33.8%
do not use a FP method, 66.2%
do.
Module 2: Assessing health needs; appendix A
72
4 MEANS TABLES
This is a means table comparing number of children (continuous variable) with
method (discrete variable) with percents OFF and statistics OFF
This table was produced by typing MEANS CHILDREN METHOD and pressing <Enter>
METHOD
0
4
44
0
20
6
0
74
CHILDREN
0
1
2
3
4
5
Total
________ _____________________________ _
Total
1
9
5
79
35
29
29
65
45
31
25
6
6
219
145
This is the same cross-tab table with percents on and statistics on.
METHOD
CHILDREN
1
2
3
4
5
6
Total
0
4
44.4%
5,4%
44
55.7%
59.5%
0
0.04
0.04
20
30.8%
27.0%
6
19.4%
8.1%
0
0.0%
74
33.8%
1
5
55.6%
3.4%
35
44.3%
24.1%
29
100.0%
20.0%
45
69.2%
31.0%
25
80.6%
17.2%
6
100.0%
4.1%
145
66.2%
Total
9
4.1% This row shows that 4 is 44.4%
of 9 (no of children).
79
36.1%
This row shows that 44 is 59.5%
29 of all 0s (74 13.2% using no
13.2%
method).
65
29.7%
31
14.2%
6
2.7%
219
Module 2: Assessing health needs; appendix A
73
Method
Obs
Total
Mean
Variance
Std Dev
1162
74
1730
0
128
1.351
1.242
1
1542
145
358
2.469
-0.739
Difference
Method Min.
Maximum
Mode
25%ile
Median
79%ile
4.000
1000
0 0.000
1.000
1000
3.000
5.000
3.000
3.000
1 0.000
1000
3.000
ANOVA
(For normally distributed data only). The p value is equivalent to that for the Student’s T
Test, since there are only 2 samples.
ss
df
MS
F statistic
p-value
.000135
Variation
1
18.117
26.775
26.775
320.705
217
1478
Between
347.479
218
Within
Total
Bartlett’s test for homogeneity of variance
Bartletts chi square=0.419 deg freedom=l p-value=0.517657
The variances are homogeneous with 95% confidence If samples are also normally distributed,
ANOVA results can be used.
Basic analysis commands.
When you are in ANALYSIS, you can view a list of the ANALYSIS
commands by pressing <F2>. Press <Esc.> and then <F3> to see a list of
the variables in your data set. Press <Esc> and then <F4> to see the data
set itself. HELP <F1> provides a handy explanation of each of the analysis
commands.
The following instructions cover only commands to produce frequency
distributions, tables, averages (means), and cross-tabulations. To enter a
command, find the EPI > prompt at the lower left of the screen and type
the command. Example: EPI > LIST OLD SEX and press <Enter>.
LIST This produces a listing of records. Type LIST * to list all of the
variables or to select the variables you want to list. Example: type LIST
OLD SEX METHOD. Press <Enter> to start the listing.
FREQ This produces a list of the frequency, percentage distribution,
and cumulative percentage of each variable listed. For numeric fields, the
program also produces a sum, mean, and standard deviation. Type FREQ
* to produce frequencies for all variables or to select the variables you want.
Example: type FREQ OLD METHOD CHILDREN. Press <Enter>.
3.
Module 2: Assessing health needs; appendix A
TABLES This is used for variables that can be counted, like sex [male
or female] and use [yes or no]. This produces a cross-tabulation table of
two variables to determine if there is a relationship between the two, such
as contraceptive use and number of living children. The results also
produce several statistical tests. Type TABLES and then the names of the
two variables. Example: TABLES CHILDREN METHOD. Press
<Enter>.
MEANS For continuous variables, e.g., age, months of use. This
displays continuous data grouped into selected categories, such as age by
current use of contraception. This will give the mean (average) age of
people who do and do not use contraception. It also provides a number of
statistical tests. Type MEANS OLD METHOD and press <Enter>. Type
the continuous variable first.
4. Select and run graphs.
Epi Info makes histograms, scatter plots, pie charts, and bar line graphs
drawn directly from the data files. To create a graph, enter the type of graph
desired followed by the variable(s). Examples: HISTOGRAM METHOD;
PIE CHILDREN; BAR REASON; LINE OLD; SCATTER OLD HOWLONG1
5. Print the results.
Press <F5> to turn the printer on, and <F5> again to turn it off.
There are two ways to print results. The first is to turn the printer on
and enter the desired analysis command. Example: <F5> EPI > FREQ
OLD METHOD <Enter>, then press to turn the printer off. If you leave the
printer on, all subsequent commands will be printed.
The second way is to use the up arrow (when the cursor is at EPI in the
lower part of the screen). Turn <F5> on, move the up arrow to the command
you want to print, edit if so desired, and then press <Enter> to send it to
the printer. Press again to turn the printer off.
6. Save the results to a file.
Press <F6> instead of <F5> if you want to save your calculations in a
file rather than print them. The first time you press <F6>, you will be asked
to provide a filename. Don’t forget to include the path (e.g.,
c:\DATA\FPRESULT.DOC). After that, when you press <F6> your last
calculations will be added to that file. You can also reload a file and add
new calculations to it. To stop adding to a file, press <F6> again.
pB-
(JMA.ET"
(DIV
,mv
JBH-
DV,>.
Module 2: Assessing health needs; appendix A
»■
75
7.
Some other useful ANALYSIS commands.
ROUTE
This command sends the subsequent out put to
the computer screen (ROUTE SCREEN) or
printer (ROUTE PRINTER).
SET PERCENT
This command produces percentages with the
ON/OFF
tables when it is on and without them when it is
off.
SET STATISTICS Similarly, this produces statistical results when on
ON/OFF
and suppresses them when off.
DEFINE
Use this command to create a new variable and
its field. For example, DEFINE AGE# creates a
variable named AGE with a one-digit numeric
field.
RECODE
Often used together with DEFINE to create new
codes for new variables. Often used together with
DEFINE to create new codes for new variables.
Example:
RECODE OLD TO AGE 15-19=1 20-24=2
25-29=3 30-34=4 35-39=5 40-44=6 ELSE=6.
This changes the codes for the variables named
"OLD" to new codes for the new variable named
"AGE." The new codes create 5-year age groups.
Regrouping. DEFINE and RECODE can be used to regroup age and
other continuous variables in another way. First define the new variable
and give it a "string" field. Then recode by whatever grouping you want (5,
10, 15 years, etc.) using the word BY. In the example, the instruction
specifies a 5-year grouping.
DEFINE AGE STRING
RECODE OLD TO AGE BY 5
Labels. DEFINE AND RECODE can also be used to change numeric
codes into labels. This can help you to avoid having to look up the codes
to interpret the tables. In the following example, the codes for contracep
tives are grouped and given labels of "MODERN" and "TRADITIONAL.
DEFINE CURRENTUSE STRING
RECODE METHOD TO CURRENTUSE 0=NONE 1-7= MODERN
8-9=TRADITIONAL 99=DK/NR ELSE=OTHER
Module 2: Assessing health needs; appendix A
76
If your string includes spaces, you need to put quotation marks around
it. Otherwise, the program will conclude that the first word is the new label.
For example: 1-7="NEW METHODS."
Finally, the labels can be no longer than the variable. If the variable is
six letters in length the tables will allow only 6 characters for the labels.
Thus, you should make your variables as long as needed, up to the maximum
of ten characters.
ILLUSTRATIVE DATA ANALYSIS PROGRAMS
The computer files include an automated data analysis and printing
program in a file called RAPIDFPPGM. You can edit this programme on
your word processor or in EPED. You can also write your own program.
Super short version
Although RAPIDFPPGM includes instructions, identified by * in the first
column, and quite a few recodes designed to change numbers to labels, you
might want to try something simpler. Just type the following commands
into the ANALYSIS program at the EPI > prompt. Don’t forget to READ
your data file first.
DEFINE AGE #
RECODE OLD TO AGE 15-19=1 20-24=2 25-29=3 30-34=4 3539=5 ELSE=6
FREQ METHOD METHODONLY HOWLONG1 SUPPLIES FUTURE
PLANNING NOW LASTTHREM
SET PERCENTS=ON
ROUTE PRINTER
TABLES AGE METHOD
TABLES CHILD METHOD
TABLES SUPPLIES METHOD
TABLES LASTTHREM METHOD
ROUTE SCREEN
PIE METHOD
HISTOGRAM METHODONLY
(7< i
Data analysis program
The computerised analysis program is reproduced on the next two pages.
It can be run by typing the following at the EPI prompt in the ANALYSIS
window:
EPI> READ (filename) <Enter> #
EPI > RUN RAPIDFPPGM <Enter>
Module 2: Assessing health needs; appendix A
W...
77
RAPIDFPPGM Version 1.2, 21 November, 1991,
Revised 18 March, 1992
Load EP15, open the ANALYSIS programme
At the EPI> prompt type READ (filename) and press <Enter>
At the EPI> prompt type RUN RAPIDFP2.PGM and press <Enter>
To print, press <F5> to turn the printer on before running
this file
Type SET PERCENTS=ON if you want the crosstabs to show
percentages
The program will pause if a table is not completely
displayed and show <more>. Press <Enter> to continue
•QUESTION #6
DEFINE AGE STRING
RECODE OLD TO AGE BY 5
‘QUESTION #7
DEFINE CHILD #
RECODE CHILDREN TO CHILD 0=0 1=1 2=2 ELSE=3
•QUESTION #8
DEFINE USINGFP STRING
RECODE METHOD TO USINGFP 1=YES 0=NO 9=DK/NR
•QUESTION #9
DEFINE METHOD NOW STRING
RECODE METHOD ONLY TO METHOD _NOW 1=1.TUBE 2=2.VAS
3=3.IUD 4=4.PILL 5=5.INJECT 6=6.NORPLANT 99=99.DK/NR
ELSE=OTHER
•QUESTION #10
DEFINE TIME USED STRING
RECODE HOWLONG1 TO TIME USED 1="1. 0-3 MO" 2="2. 4-6 MO"
3="3. -12 MO" 4="4.1-2 YR" 5="5.3-4 YR" 6="6.5+ YR" 9="9. DK/NR"
•QUESTION #11
DEFINE CONTINUAL STRING
RECODE INTERRUPT! TO CONTINUAL 1="1.0-3 MO" 2="2.4-6 MO"
3="3.7-12 MO" 4="4.1-2 YR" 5="5.3-4 YR" 6="6.5+ YR" 9=9. DK/NR"
Module 2: Assessing health needs; appendix A
78
’QUESTION #12
DEFINE SPLYSOURCE STRING
RECODE SUPPLIES TO SPLYSOURCE 1="1.GOV HOSP" 2="2.GOV
FW" 3="3.SOC MKT" 4="4.PRIV MD" 5="5.PHARMACY" 6="6.PRIV
HOS" 7="7.NGO CLIN" 8="8.NGO FW" 9=OTHER 99=DK/NR
’QUESTION #13
DEFINE EVERUSEJFP STRING
RECODE HUSBANDEVE TO EVERUSE_FP 1=YES 0=NO 9=DK/NR
’QUESTION #14
DEFINE LASTMETHOD STRING
RECODE LATESTMETH TO LASTMETHOD 1=1.TUBE 2=2.VAS
3=3.IUD 4=4.PILL 5=5.INJECT 6=6.NORPLANT 99=99.DK/NR
ELSE=OTHER
•QUESTION #15
DEFINE FUTURE USE STRING
RECODE FUTURE TO FUTURE„USE 1=YES 0=NO 9=DK/NR
•QUESTION #16
DEFINE WHYNOT USE STRING
RECODE PLANN1NGNO TO WHYNOT . USE 1="1.WANT KID" 2="2.
HUSBN NO" 3="3.HEALTH" 4="4.REL1G RZ" 5="5.SIDE EFF"
6="6.NOTAVAIL" 7="7.STERIL" 8="8.BRESTFEED" 9="9.PREGNANT"
10="10.OTHER" 99="99.DK/NR"
•QUESTION #17
DEFINE CHWNAME STRING
RECODE COMMUNITY TO CHWNAME 1=YES ONO 9=DK/NR
•QUESTION #18
DEFINE CHWVIS1T STRING
The following frequency distributions will be computed
RECODE LASTTHREEM TO CHWVISIT 1=YES 0=NO 9=DK/NR
FREQ AGE CHILD USINGFP METHOD NOW TIME USED CON
Module 2: Assessing health needs; appendix A
79
The following cross tabulations will be computed
TINUAL SPLYSOURCE EVERUSE_FP
FREQ LASTMETHOD FUTUREJJSE WHYNOTJJSE CHWNAME
CHWVISIT
SET PERCENTS=ON
TABLES AGE USINGFP
The following graphs will be prepared
TABLES CHILD USINGFP
TABLES SPLYSOURCE USINGFP
TABLES CHWNAME USINGFP
TABLES CHWVISIT USINGFP
PIE USINGFP
PIE METHOD_NOW
HISTOGRAM TIME_USED
HISTOGRAM SPLYSOURCE
Module 2: Assessing health needs; appendix A
81
Appendix B: Questionnaire design
guidelines
General guidelines for designing questionnaires can be found in any
standard textbook on survey research methods. The following are a few
suggestions specifically related to rapid survey instrument design for PHC.
Physical layout
The way that the questionnaire is laid out on the page is important for
both the interviewer and the coder. The questions should be clearly
separated from one another. The response categories should be next to or
directly beneath the questions so that they are easy to locate. The response
categories should be clearly printed, separated from one another, and easy
to distinguish. Instructions to the interviewer should be easily distinguish
able from the questions so that the interviewer knows which items to read
to the respondent. If some questions may be skipped, depending on the
response, the next question should be clearly identified.
The type size used in the questionnaire should be easy to read. Questions
and pages should be numbered so that the interviewer does not get lost.
Although all of the model questionnaires are presented the same way,
there are other ways to lay them out. One of the easiest to use is the "matrix"
format for the cluster registers, which allows 7-30 interviews to be entered
on a single page. A variation of this is to have one questionnaire for the
interviewer to read and one matrix-like tally sheet on which to record all
the responses.
Question construction
Most rapid survey questions are constructed to permit "yes"/"no" re
sponses. With a little thought, almost any question can be phrased this way.
For example, instead of asking "What do you think about ORT," ask "Do
you believe ORT is effective?"
Multiple choice questions can be analysed as "yes"/"no" questions if
they can be recoded, as explained in Step 4.
Some of the model questions are phrased to test whether the respondent
knows something, can do something, or has some PHC item on hand. This
type of question may require some probing by the interviewer as well as an
assessment of the appropriate response. For example, in the case of "Do
you know what is meant by diarrhoea?" the interviewer would need to know
the correct response and would then record it as "yes," meaning the
Module 2: Assessing health needs; appendix B
82
respondent does know what it means), or "no," does not know what it
means.
Responses should be mutually exclusive. That is, there should be
no overlap between responses, to avoid confusion. Be especially careful with
age and multiple choice questions. A common mistake is to list overlapping
categories for age, e.g., 1-5 yrs, 5-10, 10-15; rather than 1-4, 5-9, 10-14.
Multiple choice questions often include several appropriate responses. For
example, "What is the reason you don’t attend the clinic?" could have
several responses, e.g., too far away, too expensive, poor service. To avoid
this, ask for the major reason and instruct the interviewer to code only
one response.
Screening questions. Sometimes it is necessary to include questions
that are not going to be analysed but which are necessary in order to
determine if a respondent should be asked the next series of questions. An
example: "What are the names of your children and how old are they?"
This question is designed to provide the interviewer with the information
needed to decide which child to gather information about, but the response
would not be coded or analysed. Therefore, this type of question will usually
not be precoded.
Marking responses. The model instruments provide spaces that the
interviewer checks to indicate the response. Options include circling the
code of the response, using an X to cross it out, and writing in the code.
Sequence of questions
Questionnaires are usually designed with an opening statement to be
read by the interviewer to the respondent. This statement usually explains
what the survey is about, who is sponsoring it, why it is being conducted,
how the respondent was chosen to be interviewed, how long the interview
will take, assurance that the responses will be confidential, and a request
for permission to begin asking the questions. This statement can be written
on each questionnaire or on a separate card that the interviewer carries.
The opening questions are usually factual and non-threatening to set a
comfortable tone (age, number of children, etc.). The questions should
follow a logical sequence. When the subject is changed it helps to have an
explanatory statement for the interviewer to read. For example, "Now I am
going to ask a few questions about your experience with the local CHW."
Many questionnaires are designed to get to the most important questions
early in order to maintain the interest of the respondent. Demographic and
other descriptive data are left for last. However, the rapid surveys are so
short that this may not be an important strategy to incorporate.
Module 2: Assessing health needs; appendix B
IKW. r*
83
Sometimes you need to skip some questions if they are not applicable
to a respondent. Include instructions on the questionnaire that tell the
interviewer when to skip and where to go next. For example:
Q 12. Has anyone in this household been sick during the last month?
Yes (1)
No (2), go to Q22
DK/NR (9), go to Q22
Preceding
The variables that are to be examined, e.g., age, sex, use of ORT, should
be given a code number. In the model instruments, this number is the same
as the question number. Sometimes a question includes more than one
variable. In that case the response may include a code for each response,
as in the Breast feeding, Growth monitoring and Immunization rapid survey
instruments. For example:
Optional weighing to determine current nutritional status
Name
Sex
Age (mo)
Wt. (kg)
Height
(24)
(25)
(26)
(27)
Remark
In this example four variables are coded in one item.
The responses should also be precoded. The convention used in the
model questionnaires is to use 1 to mean "yes", 0 to mean "no" and 9 to
mean "don't know" or "no response." Obviously, any other codes could be
used. The important thing is to be consistent so that the interviewers will
not become confused.
Some questions ask whether the respondent knows something in
particular. In these cases a "no" means that he or she does not know, and
would be coded 0. A code of 9 should not include "don’t know," as that
would be confusing. In the models, 9 means "no response."
Identification items
Questionnaires will need to include certain identifying information so
that they can be sorted, classified, followed up, etc. The model question
naires that follow include five standard identification items: 1) the number
of the study, which is optional, unless a large number of studies will be
carried out; 2) province number, which is also optional, unless the study is
to be done in several provinces; but you can then substitute district,
sub-district, village as appropriate; 3) interviewer name or code; 4) date of
interview; and 5) respondent identification number. In this case a 3-4 digit
Module 2: Assessing health needs; appendix B
84
code is used, made up of the cluster number and the respondents number,
e.g., 01-01,1009.
Other identification items that might be needed for special studies are:
time of interview, address of household, telephone number, and national
identification number (or social security number).
Code books
You can usually conduct a rapid survey without needing a code book,
because these types of surveys are so short. But code books are very useful
if your questionnaire isn’t precoded, if it is long and complex, if many
questions are multiple-choice, if the responses are to be coded by someone
other than the interviewer, or if the survey is large. Most code books are
useful in checking for errors, preparing analysis plans, and recoding.
Code books summarise the responses and their codes for each question.
They also include the name of the variable and sometimes other useful
information, such as the variable’s length and format.
Module 2: Assessing health needs; appendix B
!
85
Variable
name
Question
number
ADVICE
Length
Variable
value
117
12
Where sought advice/treatment
Value
Label
1
Government hospital
2
Private hospital
3
Health centre
4
Private clinic
5
Health post
6
Private doctor
7
Nurse/midwife
8
Community health worker
9
Traditional healer
10
Pharmacy/drugstore
11
Shop
12
Other
99
DK/NR
BLANK
Not applicable
TREAT
129
1
Anything to treat diarrhoea
Value
Label
1
Yes
2
No
8
DK/NR
9
Missing value
BLANK
Not applicable
TREATMENT
130
6
Given to treat diarrhoea
Value
Label
1
Capsule
2
Pill
3
Syrup
4
ORS sachet
5
ORS home made
6
Cereal
7
Other
9
DK/NR
BLANK
Not applicable
Module 2: Assessing health needs; appendix B
Variable label
87
Appendix C: Rapid survey questionnaires
GENERAL PHC
Community assessment of primary health care /health education
MATERNAL CARE
Antenatal care, safe delivery, and postnatal care
Family planning
CHILD CARE
Acute respiratory infections
Breast feeding
Diarrhoeal disease control/oral rehydration therapy
Childhood disabilities
Child immunization
Growth monitoring/nutrition education
COMMUNITY HEALTH
Water supply, hygiene, and sanitation
OTHER HEALTH CARE
Accidents and injuries
Chronic, non-communicable diseases
Malaria
Tuberculosis
Sexually-transmitted diseases, HIV/AIDS
MORBIDITY, MORTALITY AND FERTILITY
Vital events and health status
Child morbidity and mortality assessment
Adult morbidity and mortality assessment
The following instruments have been designed to collect the most
important indicators of health knowledge, behaviour and status for each
PHC service. The first instrument, Community assessment of PHC, covers
the most common PHC services, plus some data on household composition,
parity, drug supply, and service availability.
The instruments can be used as presented or modified as appropriate to
any given situation. Yau are encouraged to "mix and match questions and
sections from the various questionnaires, add, delete, revise, and combine
to adapt the instruments to your situation and needs.
Module 2: Assessing health needs; appendix C
The vital events, morbidity and mortality questionnaires can be added
to other rapid surveys such as child immunization, family planning, etc.
However, they will usually require much larger sample sizes. See the User’s
guide for guidelines.
The rapid surveys are designed for cluster samples, typically, 30 clusters
of 7-10 respondents each. The responses should be "yes"/"no", or otherwise
classifiable into dichotomous variables. Please note that these are only the
instruments. Examples of how they can be modified and used with different
sampling techniques are described in the User’s guide.
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Module 2: Assessing health needs; apppndix C
S'
89
Rapid survey questionnaire
Community assessment of primary health care
Complete ALL SECTIONS for each currently married woman aged 15-49. For women
with a child under age two years (24 months), collect information for SECTIONS 2, 4,
5, 6, 8, and 9. If the woman has a second child under age two years, collect the
information for the oldest child. If she has no children under age five years, SKIP
SECTIONS 2, 4, 5, 6,8, 9.
IDENTIFICATION
101.
104.
107.
Study no
Interviewer no
Respondent age
102. Province no
105. Respondent no
108. Respondent sex
103. Cluster no
I
106. Date of interview _/_//
NAME OF RESPONDENT
_
---------------------------------------------------------------------------------------------------------------- ' t
109. How many people live in this household:
(total)
Married women of reproductive age (15-49):
(in household)
Currently pregnant women:
(in household)
Children less than 24 months of age:
(in household)
Children 2-5 years old:
(in household)
110. How many children do you have under two years of age?
(no children.) If none, go to Qlll
What are their names and how old are they?
_______ Age (in months): ________ Sex (m/f):______
Name:
_______ Age (in months):__________ Sex (m/f):
Name:
Sex (m/f):
Age (in months):
__
Name:
111. How many live births have you had?
(number) (If DK/NR enter 99.)
112. How many of these are still living?
(number) (If DK/NR enter 99.)
113. How far away is the nearest health unit or health worker?
(1) < 5 km/60 min. walk
(2) > 5 km/60 min. walk
(9) DK/NR
114-7. Which of the following health services are available there?
14. Maternal and child health
(1) Yes
(0) No
(9) DK/NR
15. Family planning
(1) Yes
(0) No
(9) DK/NR
16. Immunization
(1) Yes
(0) No
(9) DK/NR
17. Medical care services
(1) Yes
(0) No
(9) DK/NR
118. Does anyone in this household need to use prescription or non-prescription
drugs?
(1) Yes
(0) No, go to Q121
_(9) DK/NR go to Q121
119. Are you able to get them easily?
___ (1) Yes, go to Q121
(0) No
(9) DK/NR
120. Why aren’t you able to get them?
Module 2: Assessing health needs; appendix C
90
120. Why aren’t you able to get them?
(1) Too far
(2) Too expensive
(3) Don’t know where to get them
(4) Other:
(9) DK/NR "
What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
__(0) Does not know
(9) NR
122. Has the local Community Health Worker visited or contacted you during the
last three months?
(1) Yes
(0) No
(9) DK/NR
INTERVIEWER: PLEASE CHECK OFF THE SECTIONS TO BE USED FOR
THIS INTERVIEW.
Antenatal care, safe delivery, and postnatal care
Family planning
Acute respiratory infections
Breast feeding
Diarrhoeal disease control/oral rehydration therapy
Childhood disabilities
Child immunization
Growth monitoring/nutrition education
Water supply, hygiene, and sanitation
Accidents/trauma
Chronic, non-communicable diseases
Malaria
Tuberculosis
Sexually-transmitted diseases
121.
GO TO Q200
Section 1: Antenatal care, safe delivery, and postnatal care
Have you been pregnant within the past 24 months?
(1) Yes
(0) No, go to Q301
201. Did you receive antenatal care during your last pregnancy?
(1) Yes
. . (0) No, go to Q204
(9) DK/NR, go to Q204
202. How many times did you get antenatal care?
times (If DK/NR,
enter 99.)
203. Which is the principal place where you received antenatal care?
(1) Hospital, health centre/clinic
(2) Local TBA/healer, other non-prof.
.(9) DK/NR
200.
Module 2: Assessing health needs; appendix C
91
Did you receive a tetanus vaccination during your last pregnancy?
(1) Yes
(0) No, go to Q206
(9) DK/NR, go to Q206
205. How many vaccinations did you receive?
(1) One(2) Two(3) Three or more
(9) DK/NR
206. What was the outcome of your most recent pregnancy?
(1) Live birth
(2) Still birth
(3) Abortion/miscarriage, go to Q301
(9) DK/NR, go to Q301
207. Where did the delivery take place?
(1) Home
(2) Hospital/clinic
(9JDK/NR
208. Who was the main person attending the delivery?
_(1) Doctor, nurse, nurse-midwife
(2) Trained TBA, CHW
(3) Untrained TBA, CHW, relative, neighbour
___(9) DK/NR
204.
GO TO Q 301
Section 2: Family planning
Are you or your husband currently using any family planning method?
(1) Yes
(0) No, go to Q304
(9) DK/NR, go to Q304
302. Which method are you/your husband using now?
(select principal method only)
(1) Tubectomy
(6) NORPLANT
(2) Vasectomy
(7) Condom
(3) IUD
(8) Foam, emco, jelly, cream, diaphragm
(4) Oral pill
(9) Safe period, withdrawal, abstinence
(5) Injection
(10) Other:
(99) DK/NR
303. What is the main source of your family planning service or supplies?
(Record response and go to Q400.)
(1) Govt hospital/clinic
(6) Private hospital/clinic
(2) Govt, field worker
(7) NGO clinic
(3) Social marketing prog.
(8) NGO field worker
(4) Private physician
(9) Other:
__ (5) Pharmacy
(99) DK/NR
304. Do you/your husband intend to practice family planning in the future?
(1) Yes
.
(0) No
(9) DK/NR
301.
Module 2: Assessing health needs; appendix C
92
305.
What is the most important reasonyou are not using family planning now?
(6) Method/service unavailable
(1) Want more children
(7) Sterility
(2) Husband objects
(8) Breast feeding
(3) Health reasons
(9) Pregnant
(4) Religious reasons
__ (10) Other:
(5) Fear side effects
(99) DK/NR
GO TO Q400
Section 3: Acute respiratory infections__________________________
Check Q110 or ask: Do you have children under the age of two years?
(1) Yes(0) No, go to Q502
401. Have any of your children been sick from a respiratory illness within the last
two weeks?
(1) Yes
(0) No, go to Q501
(9) DK/NR, go to Q501
402. Did you seek treatment for the illness?
(1) Yes
(0) No, go to Q501
(9) DK/NR, go to Q501
403. Did you give the medicine for the prescribed length of time? (Probe for
correct response)
(1) Yes
(0) No
.(9) DK/NR
400.
GO TO Q501
Section 4: Breast feeding
Are you now breast feeding your baby or a child under age two years?
(1) Yes, go to Q503
(9) DK/NR, go to Q502
502. At what age of the baby did you stop breast feeding?
months.
(9) DK/NR
503. At what age of the baby will you/did you begin giving it supplementary
foods?
months.
(9) DK/NR
501.
GO TO Q601
Module 2: Assessing health needs; appendix C
(0) No
93
4
Section 5: Diarrhoeal disease control/oral reyhdration therapy
Has (name of oldest child under age two years) had diarrhoea in the last month?
(1) Yes
(0) No, go to Q603
(9) DK/NR, go to Q603
602. Did you give your child ORS?
(1) Yes(0) No
(9) DK/NR
603. Do you know how to mix ORS solution? If no, please explain (explanation
includes the following: pour the contents of the ORS packet into the correct
amount of clean water, e.g., cooled boiled water or rainwater).
(1) Yes, knows ho
601.
3
■‘3
GOTO Q701
Section 6: Childhood disabilities
3 701. Is any child afflicted by disability?
3
3
3
•3
(1) Yes, go to Q702
(0) No, go to Q801
(9) DK/NR, go to Q801
What type of disability? Please fill the following:
Disability type
(1) Movement
(5) Speech
(2) Deformity
(6) Behaviour
(3) Hearing
_(7) Other
(4) Blindness
(9) DK/NR
703. Do you know how your child became disabled? (Probe for explanation.)
(1) Yes
(0) No
(9) NR
704. Do you know how to prevent a similar disability from occurring again?
(Probe for correct response: e.g., immunization, safe maternal and child
care, iodine, Vitamin A.)
(1) Yes
(0) No
(9) NR
705. Have you sought treatment or therapy for your child?
(1) Yes
(0) No, go to Q707
(9) DK/NR, go to Q707
706. Where has your child received treatment?
Record response and, go to Q801
(1) Therapy or treatment centres
(2) Community groups
(3) Special schools
(4) Other
702.
Module 2: Assessing health needs; appendix C
94
707.
Do you know of available centres which provide services to help your child?
Therapy or treatment centres:
(1) Yes
(0) No
(9) DK/NR
Community groups:
(1) Yes
(0) No
(9) DK/NR
Special schools:
(1) Yes
(0) No
(9) DK/NR
Other
(1) Yes
(0) No
(9) DK/NR
GO TO Q801
Section 7: Child immunization
801. Do you know at what age children should be vaccinated against measles?
(1) Yes (9-12 months)
(0) No
(9) DK/NR
802. Has (name of oldest child under age 2) been immunized?
(1) Yes
_(0) No, go to Q901
(9) DK/NR, go to Q901
803. Do you have the immunization card for this child?
(1) Yes, has card correctly filled out
(2) Yes, has card but incorrectly filled out
(0) No, does not have card
. __ (9) DK/NR
Check card or probe for immunization history. Check each vaccination received:^^
Pol2
Pol3
Measles
DPT1
DPT2
DPT3
Poll
BCG
___
___
___
___
___
810
811
804
805
806
807
808
809
812. For children aged 12-24 months: Child is fully vaccinated
(BCG, DPT3, Poiio3, Measles)
(1) Yes
(0) No
_ J9) DK/NR
GO TO Q 901
Section 9: Growth monitoring/nutrition education
Is (name of oldest child under age 2) registered for growth monitoring?
(1) Yes
(0) No
(9) DK/NR
902. Has this child ever been weighed by a health worker, nurse, or doctor?
(1) Yes
(0) No, go to Q1001
(9) DK/NR, go to Q1001
903. Please show me your child’s growth card. (Show sample card.)
(1) Yes, has growth card
(0) No, cannot find it, go to Q1001
904. (Interviewer: record weighing history from growth card): Total no. times
weighed
905. Times weighed last 3 months
901.
Module 2: Assessing health needs; appendix C
95
906.
Can you explain the information on the growth card to me?
(1) Yes, mother can correctly interpret the information
(0) No, mother cannot interpret the information or incorrectly interprets
GO TO Q1001
Section 9: Water supply, hygiene, and sanitation
Where do you usually get your drinking water?
(1) Clean source: faucet/tap, pipe, covered well, other
(2) Unclean source: open well, pond, dirty stream, other
(9) DK/NR
1002. Do you usually boil water for drinking?
(1) Yes
(0) No
(9) DK/NR
1003. How long does it take you to get to your source of water?
(1) Less than 15 minutes walk
(2) More than 15 minutes walk
(9) DK/NR
1004. Do you have enough water all year?
(1) Yes
(0) No
(9) DK/NR
1005. What type of sanitary facility do you use?
(1) Clean facility: water-seal, pit privy, WC
(2) Unclean facility: open field, bucket
(9) DK/NR
1001.
GOTO Q1101
Section 10: Accidents and injuries
1101.
1102.
1103.
Has anyone in this household had an injury in the past year?
(1) Yes
(0) No, go to Q1106
(9) DK/NR, go to Q1106
What was the injury?
(1) Fall
(4) Poisoning
(2) Occupational injury
(3) Traffic injury
(9) DK/NR
What was the outcome of the injury?
(1) Permanent disability
(4) Other
(2) Lost time away from normal activity
(9) DK/NR
(3) Death
Module 2: Assessing health needs; appendix C
96
1104.
1105.
1106.
Where did they receive treatment?
(1) Hospital
(4) Traditional healer
(2) Health care centre
(5) Other (specify)
(3) CHW
(9) DK/NR
What was the treatment?
(1) Treatment for wounds or bleeding
(5) Treatment for shock
(2) Resuscitation
(6) Treatment for head,
neck, or back injury
(3) Treatment for poisoning
(7) Treatment for burns
(4) Setting or splinting bones
(9) DK/NR
Where are the nearest emergency care facilities?
(Probe for correct answer.)
(1) Yes (respondent knows correct answer)
(2) No (respondent does not know correct answer)
(9) DK/NR
GO TO Q1201
Section 11: Chronic, non-communicable diseases
Q
Diabetes
1201.
Have you or any household member ever been diagnosed with diabetes?
Is the prescribed treatment being followed? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
1203. Do you and your family members know how to handle a diabetic
emergency? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
1202.
Hypertension
B
Q
CM- ~
B
|
=
Have you or any household member ever been told by a health care
provider that you have hypertension?
(1) Yes
(0) No, go to Q1208
__ (9) DK/NR, go to Q1208
1205. Have you been prescribed medication or a special diet to control your
hypertension?
(1) Yes
(0) No, go to Q1207
(9) DK/NR, go to Q1207
1204.
1206. Do you follow the prescribed diet or medication plan?
(1) Yes
(0) No
(9) DK/NR
1207.
(1)
Have you ever been told by a health care provider you have complications
due to hypertension?
(1) Yes
(0) No
(9) DK/NR
Module 2: Assessing health needs; appendix C
B
—
B
..B
B
™
97
Anaemia
Have you or any household member ever been diagnosed as having
anaemia?
(1) Yes
(0) No
(9) DK/NR
1209. Does anyone in this household have anaemia now?
(1) Yes
1210. Has this person been prescribed a special diet or supplements to control
the anaemia?
(1) Yes
(0) No, go to Q1301
(9) DK/NR, go to Q1301
1211. Is the prescribed treatment being followed? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
1208.
GO TO Q1301
Section 12: Malaria
Interviewer: ask the questions in this section only in areas where
malaria is endemic
Do you know how malaria is spread? (Probe for explanation: Malaria is
spread by mosquitoes.)
(1) Yes
(0) No
(9) NR
What
1302.
are you currently doing to protect yourself and your household
members against malaria?
Using mosquito nets?
(1) Yes
(0) No
(9) NR
Using household sprays?
(1) Yes
(0) No
(9) NR
Eliminating standing water?
(1) Yes
(0) No
(9) NR
Using anti-malarial drugs?
(1) Yes
(0) No
(9) NR
Others?
(1) Yes
. _(0) No
(9) NR
1303. Have you or any household member experienced unexplained and/or
repeated fevers within the last month?(1) Yes(0) No
(9) NR
1301.
Have you or any household member experienced vomiting, fits, or
convulsions?
(1) Yes
(0) No
(9) NR
1305. Have you or any household member been given a blood test for malaria?
(1) Yes
(0) No
(9) DK/NR
1306. Have you or any household member been treated for malaria in the last
six months?
(1) Yes
(0) No, go to Q1401
(9) DK/NR, go to Q1401
1304.
Module 2: Assessing health needs; appendix C
(0) No,
98
What treatment was received?
Anti-malarials (probe for type)
(1) Yes
(0) No
(9) NR
Antipyretic drugs:
(1) Yes
(0) No
(9) NR
Other:
(1) Yes
(0) No
(9) NR
1308. If anti-malarials have been prescribed, do you know the correct treatment
schedule? (Probe for explanation.)(1) Yes
(0) No
(9) NR
1307.
GO TO Q1401
Section 13: Tuberculosis
Have you or any family members ever been diagnosed/tested for TB?
(Sputum or skin test)
(1) Yes
(0) No
(9) DK/NR
1402. Have you ever sought treatment of TB for yourself or your family?
(1) Yes
(0) No, go to Q1501
(9) DK/NR, go to Q1501
1403. If so, is or was treatment taken for the prescribed length of time? (Probe
for explanation.)
(1) Yes
(0) No
(9) DK/NR
1401.
GO TO Q1501
Section 14: Sexually-transmitted diseases, HIV/AIDS
Do you know what is meant by a sexually-transmitted disease? (Probe for
explanation and example.)
(1) Yes
(0) No
(9) DK/NR
1502. Do you know what HIV or AIDS is? (Probe for explanation: HIV is the
virus that infects a person and eventually causes a person to get AIDS.)
(1) Yes
(0) No
(9) DK/NR
1503. Do you know how people get STDs, HIV/AIDS?
(Probe for correct answers.)
(1) Yes
(0) No
(9) DK/NR
1504. What is your primary source of STD/HIV/A1DS knowledge?
(1) Friends/relatives
(4
(2) CHW or other health s
(3) Radio
(9
1501.
1505.
What are you doing to protect yourself against STDs or HIV/AIDS?
(Probe for explanation.)
Using a condom:
(1) Yes
(0) No
(9) DK/NR
Using safe sex practices
(1) Yes
(0) No
(9) DK/NR
Module 2: Assessing health needs; appendix C
99
Have you ever been diagnosed with STD, HIV/AIDS?
(1) Yes
(0) No
(9) DK/NR
1507. Have you ever used a condom?
(1) Yes
(0) No
(9) DK/NR
1508. Do you know how to use a condom correctly? (Probe for correct response.)
(1) Yes
(0) No
(9) DK/NR
1509. Where have you obtained condoms during the last 6 months?
(1) Govt, hospital/clinic/health centre
(2) Private hospital/clinic/health centre
(3) Local dispensary/pharmacy
(4) Health worker delivered at home
(5) Other
(9) DK/NR
1510. Can a person who looks healthy be infected with STDs/HIV?
(1) Yes
(0) No
(9) DK/NR
1511. Can a person get HIV through ordinary social contact like shaking hands
with someone infected with the virus?
(1) Yes
(0) No
(9) DK/NR
1512. Can a pregnant woman who is infected with HIV give the virus to her
unborn child?
(1) Yes
(0) No
(9) DK/NR
1513. Should an HIV infected mother continue to breast feed?
(1) Yes
(0) No
(9) DK/NR
1514. Can STDs/HIV be transmitted by having sex with someone who is
infected with STDs/HIV?
(1) Yes
(0) No
(9) DK/NR
1515. Is there a cure for AIDS?(1) Yes
(0) No
(9) DK/NR
1506.
This concludes the interview. Thank you for taking
part in this survey.
Module 2: Assessing health needs; appendix C
100
Rapid survey questionnaire
Health education
Complete for each household. Interview the female head of household, if possible.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no _
8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
9.
10.
11.
12.
13.
14.
15.
How many people live in this household:
(total)
Is anyone in this household a married woman of reproductive age?
(1) Yes
(0) No, go to Q12
(9) DK/NR, go to Q12
Has a health worker visited this household in the last three months to discuss:
Family planning?
(1) Yes
(0) No
(9) DK/NR
Malaria?
(1) Yes
(0) No
' (9) DK/NR
Tuberculosis?
(1) Yes
(0) No
(9) DK/NR
STDs?
(1) Yes
(0) No
(9) DK/NR
Water and sanitation
(1) Yes
(0) No
(9) DK/NR
Chronic/noncomm. diseases?
(1) Yes
(0) No
(9) DK/NR
Others (specify)?
(1) Yes
_(0) No
(9) DK/NR
Do you know the importance of the topic(s) discussed? (Probe.)
(1) Yes
(0) No
(9) DK/NR
Is anyone in this household pregnant?
(1) Yes
(0) No
(9) DK/NR
Are there children under 24 months old in this household?
(1) Yes
(0) No
(9) DK/NR
Are there children 24-60 months old in this household?
(1) Yes
(0) No
(9) DK/NR
Has a health worker visited or contacted you in the last 3 months’
(1) Yes
(0) No
(9) DK/NR
What type of health worker visited (check all that apply)’
(l)CHW
(4) Doctor
(2) Public health nurse
(5) Other (specify)
(3) Midwife
(9) DK/NR
Module 2: Assessing health needs; appendix C
101
16. What did the health worker discuss (check all that apply)?
A. Maternal care
Antenatal care/delivery
(9) DK/NR
_(1) Yes
___ (0) No
Safe delivery
___ (1) Yes
___ (9) DK/NR
___ (0) No
Postnatal care
___ (9) DK/NR
___ (1) Yes
___ (0) No
B. Child care
Acute respiratory infections _(1) Yes
___ (9) DK/NR
(0) No
Breast feeding
___ (9) DK/NR
___ (1) Yes
-JO) No
Diarrhoeal disease control
___ (9) DK/NR
___ (0) No
_ JI) Yes
Oral rehydration therapy
__ (9) DK/NR
_ (0) No
_ (1) Yes
_ (9) DK/NR
Childhood disabilities
(1) Yes
_(0) No
(9) DK/NR
Child immunizations
(0) No
_ (1) Yes
Growth monitoring/
nutrition education
_ (9) DK/NR
„._(!) Yes
___ (0) No
C. Community health
(9) DK/NR
Water supply
___ (0) No
_ _(1) Yes
__ (9) DK/NR
Hygiene
_J0) No
_ (1) Yes
(9) DK/NR
Sanitation
_ (0) No
_ _(1) Yes
D. Other health care
(9) DK/NR
(0) No
Accidents and injuries
(1) Yes
___ (9) DK/NR
Chronic/noncomm. diseases ___ (l)Yes
_(0) No
(9) DK/NR
(0) No
(1) Yes
Malaria
(9) DK/NR
(0) No
Tuberculosis
_ (1) Yes
Sexually-transmitted
___ (9) DK/NR
___ (0) No
diseases, H1V/A1DS
... .. (1) Yes
17. Do you believe you have enough information about these topics or do you
need to know more?
DK/NR
Enough
Know more
A. Maternal care
___ (9) DK/NR
___ (1) Yes
Antenatal care/delivery
_ (0) No
(9) DK/NR
_J1) Yes
___ (0) No
Safe delivery
(9) DK/NR
_(0) No
_(1) Yes
Postnatal care
B. Child care
(1) Yes
Acute respiratory infections
(1) Yes
Breast feeding
(1) Yes
Diarrhoeal disease control
- (1) Yes
Oral rehydration therapy
(1) Yes
Childhood disabilities
___ (1) Yes
Child immunizations
Growth monitoring/
(0) No
(0) No
(0) No
_J0) No
(0) No
JO) No
(9) DK/NR
(9) DK/NR
(9) DK/NR
__(9) DK/NR
(9) DK/NR
(9) DK/NR
102
C. Community health
___ (0) No
___ (1) Yes
___ (9) DK/NR
Water supply
___ (1) Yes
___ (0) No
___ (9) DK/NR
Hygiene
___ (0) No
___ (1) Yes
___ (9) DK/NR
Sanitation
D. Other health care
___ (0) No
___ (1) Yes
___ (9) DK/NR
Accidents and injuries
___ (0) No
___ (9) DK/NR
Chronic/noncomm, diseases ___ (1) Yes
___ (1) Yes
___ (0) No
___ (9) DK/NR
Malaria
___ (0) No
___ (1) Yes
___ (9) DK/NR
Tuberculosis
Sexually-transmitted
___ (0) No
___ (9) DK/NR
___ (1) Yes
diseases, HIV/AIDS
18. What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
WW..
(0) Does
This concludes the interview. Thank you for taking the time to
participate in this survey.
CM;-
pv.
OsM...
Module 2: Assessing health needs; appendix C
103
Rapid survey questionnaire
Antenatal care, safe delivery, and postnatal care
Complete for all women currently living in the household who have had a pregnancy
outcome during the past 24 months. The outcome may be a live birth, stillbirth, or
abortion. If the woman has had more than one pregnancy, ask about the most recent
pregnancy outcome.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
9.
10.
11.
12.
13.
14.
How many live births have you had so far? Number of live births:
(99) DK/NR
Did you receive antenatal care during your last pregnancy?
(1) Yes
(0) No, go to Q14
(9) DK/NR, go to Q14
How many times did you get antenatal care?times
(If DK/NR, enter 99)
How many months had you been pregnant before you got antenatal care?
(1) 3 mo. (first trimester)
(2) 4-6 mo. (second trimester)
(3) 7-9 mo. (third trimester)
(9) DK/NR
Which is the principal place you received antenatal care?
(1) Hospital
(2) Health centre/clinic
(3) Private hospital/clinic
(4) Local TBA/healer
(5) Other site of care specify:
(9) DK/NR
Did anyone advise you to get antenatal care?
(0) No
Yes;
(1) Physician, nurse
(5) Mother, relative
(2) Community nurse/midwife
(6) Friend, neighbour
___ _(3) CHW/volunteer
(7) Other:
(4) Traditional birth attendant
(9) DK/NR
Module 2: Assessing health needs; appendix C
104
15.
16.
17.
18.
19.
20.
21.
22.
Did you receive a tetanus vaccination during your last pregnancy?
(1) Yes
(0) No, go to Q17
(9) DK/NR, goto Q17
How many vaccinations did you receive?
(1) One
(2) Two
During your pregnancy, did you take iron pills to keep you strong?
(1) Yes
(0) No
___ (9) DK/NR
What was the outcome of your most recent pregnancy?
(1) Live birth
(2) Still birth
(3) Abortion/miscarriage, go to Q20
(9) DK/NR, go to Q20
Where did the delivery take place?
(1) Home
(2) Hospital/clini
Who was the main person attending the delivery?
(1) Doctor, nurse, nurse-midwife
(2) Trained TBA, CHW
(3) Untrained TBA, CHW
(4) Relative, neighbour, friend
(5) Other:
(9) DK/NR
What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
(0) Does not know
(9) NR
Has the local Community Health Worker visited or contacted you during
the last three months?
(1) Yes
(0) No
(9) DK/NR
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
105
Rapid survey questionnaire
Family planning
Complete for all married women aged 15-49 years who are currently living in the
household.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
NAME OF RESPONDENT
9.
10.
11.
12.
13.
14
15.
16.
17.
3. Cluster no
_ 6. Date of interview / /
_________________
Are you currently married or living with a partner?
(1) Yes, go to Q10
(0) No, go to Q24
(9) DK/NR, go to Q24
How many living children do you have?
(if DK/NR, enter 99)
Have you given birth in the past 12 months?
_J1) Yes, go to Q12
(0) No, go to Q13
(9) DK/NR, go to Q13
When was the child born?
MM/
YR
DK/NR
_(99)
Can you name one modern method of contraception? (Probe.)
(1) Yes
(0) No, go to Q15
(9) DK/NR, go to Q15
Do you know where you can obtain this method? (Probe.)
(1) Yes
(0) No
_(9) NR
Are you or your husband currently using any family planning method?
(1) Yes
(0) No, go to Q20
(9) DK/NR, go to Q20
Which method are you/your husband using now?
(Select principal method only.)
(1) Tubectomy
(6) NORPLANT
(99) DK/NR
(2) Vasectomy
(7) Condom
(3) IUD
(8) Foam, emco, jelly, cream, diaphragm
(4) Oral pill
(9) Safe period, withdrawal, abstinence
(5) Injection
(10) Other:
(99) DK/NR
For how long have you been continually using (current method)?
(1) <3 months
(4) 1-2 years
(2) 4-6 months
(5) 3-4 years
__(3) 7-12 months
(6) 5 years or more
(9) DK/NR
Module 2: Assessing health needs; appendix C
106
18.
19.
For how long have you been continually practicing family planning, i.e., contin
ually using one method or another without interruption?
(1) <3 months
(3) 7-12 months
(5) 3-4 years
(2) 4-6 months
(4) 1-2 years
(6) 5 years or more
(9) DK/NR
What is the main source of your family planning service or supplies?
(1) Govt, hospital/clinic
(6) Private hospital/clinic
(2) Govt, field worker
(7) NGO clinic
(3) Social marketing prog
(8) NGO field worker
(4) Private physician
(9) Other:
(5) Pharmacy
(99) DK/NR
P»i W,
go to Q24
/■—•
If you are not using family planning now, have you or your husband ever used
any method in the past?
(1) Yes
(0) No, go to Q22
(9) DK/NR, go to Q22
21. Which method did you/your husband use most recently?
(Select latest method only.)
(1) Tubectomy
(6) NORPLANT
(2) Vasectomy
(7) Condom
(3) IUD
(8) Foam, emco, jelly, cream, diaphragm
(4) Oral pill
(9) Safe period, withdrawal, abstain
(5) Injection
(99) Other:
22. Do you/your husband intend to practice family planning in the future?
(1) Yes
(0) No
(9) DK/NR
23. What is the most important reason you are not using family planning now?
(1) Want more children
(6) Method/service unavailable
(2) Husband objects
(7) Sterility
(3) Health reasons
(8) Breast feeding
(4) Religious reasons
(9) Pregnant
(5) Fear side effects
(10) Other:
(99) DK/NR
24. What is the name of the local Community Health Worker?
(1) Knows (said name)(0) Does not know(9) No response
25. Has the Community Health Worker visited or contacted you during the
last three months?
(1) Yes
(0) No
(9) DK/NR
20.
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
f|W.: ’T’
107
Rapid survey questionnaire
Acute respiratory infections
Complete for women with children under five years of age currently living in the
household.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
9.
10.
11.
12.
13.
How many living children do you have under five years of age?
children (If DK/NR, enter 99)
What are their names and ages?
Name:
Age:
(in months) Sex:
Name:
Age:
(in months) Sex:
Name:
Age:(in months) Sex:(M/F)
(M/F)
(M/F)
How many children <5 sleep in the same room as adults or other children?
DK/NR (99)
How many people in your household smoke inside the house?
smokers (If DK/NR, enter 99.)
Are open fires for cooking or heating used inside your house?
(1) Yes
(0) No
(9) DK/NR
Have any of your children been sick with a respiratory illness within the last 2
weeks?
(1) Yes
(0) No, go to Q18
(9) DK/NR, go to Q18
14.
Did you seek treatment for the most recent episode?
(1) Yes
(0) No, go to Q18
(9) DK/NR, go to Q18
15.
Where did you seek treatment?
(1) Treated at home
(2) Visited the health centre
(3) Contacted the CHW
(4) Other:
__j(9) DK/NR
Module 2: Assessing health needs; appendix C
108
16.
17.
18.
19.
What treatment were you given?
(1) Anti-microbial drugs
(2) Bronchodilator and/or cough
(3) Antipyretic drugs
(4) Other:
(9) DK/NR
Did you take the medicine for the prescribed length of time? (Probe for cor
rect response.)
.(1) Yes(0) No
(9) DK/NR
What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
(0) Does not know(9) NR
Has the CHW visited or contacted you in the last three months?
(1) Yes
(0) No
(9) DK/NR
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
109
Rapid survey questionnaire
Breast feeding
Complete for the oldest child under two years of age currently living in the
household. Interview the mother of the child, if possible. See questionnaire on
Growth monitoring/nutrition education for related questions.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
How many living children do you have under two years of age?
(no. children) If none, terminate the interview.
Are you now breast feeding your youngest child?
. __(l)Yes . _(0) No
(9) DK/NR
After your baby was born, when did you begin breast feeding?
(1) Within 3 hours
(2) 3-12 hours
(3) 13-24 hours
.. _(4) >24 hours
(5) Not breast-fed, go to Q16
(9) DK/NR, go to Q16
Did you give the baby the colostrum (local word)?
(1) Yes, go to Q14
(0) No, go to Q13
_(9) DK/NR, go to Q13
Why didn’t you give the baby the colostrum (local word)?
(1) Problem with breast milk
(3) Other
2_(2) Baby could not suck
(4) DK/NR
Do you know why it is important to give the baby the colostrum (local word)?
(Probe.)
(1) Yes, mother knows correct reason
(0) No, mother names incorrect reason
___ (9) DK/NR
At what age of the baby will you/did you stop breast feeding?
..months DK/NR
(9)
At what age will you/did you begin giving your baby formula or milk other
than breast milk?
months
(9) DK/NR
Water?
months
(9) DK/NR
Other liquids?
months
(9) DK/NR
Solid foods?
months
.... (9) DK/NR
Module 2: Assessing health needs; appendix C
110
Questions about breast feeding education
20.
21.
22.
23.
24.
25.
Did any health worker teach you about the benefits of breast feeding?
(1) Yes
(0) No
(9) DK/NR
Can you explain why it is important to breast feed? (Probe.)
(1) Knows
(0) No
Were you taught about the supplemental foods and when they should be
introduced? (Probe.)
(1) Yes, does know
Were you taught how to care for your breasts? (Probe.)
(1) Yes
(0) No
(9) DK/NR
What is the name of the local Community Health Worker (CHW)?
(1) Knows (said nam
Has the CHW visited or contacted you in the last 3 months?
(1) Yes
(0) No
(9) DK/NR
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
Ill
Rapid survey questionnaire
Diarrhoeal disease control/ORT
Complete for first woman encountered who is currently living in the household and
who has a child under two years of age. If the woman has more than one child
under two, take the information for the oldest child under age two. See Water,
sanitation and hygiene questionnaire for related questions on diarrhoeal disease
control.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
3. Cluster no
_ 6. Date of interview / /
NAME OF RESPONDENT
9.
10.
11.
12.
13.
How many children do you have under two years of age?
(no. children) If none, terminate interview.
What are their names and how old are they?
Name:
Age (in months):
Sex (m/f):
Name:
Age (in months):
Sex (m/f):
Name:Age (in months):Sex (m/f):
Do you know what is meant by "diarrhoea?" (Probe for explanation:
Three or more watery stools within past 24 hours?)
(1) Knows
(0) Does not know
(9) No response
Explain what WE mean by diarrhoea and say, "I would like to ask you some
questions about diarrhoea among your young children.”
Has (name of oldest child under 2) had diarrhoea in the last month?
(1) Yes
(0) No
(9) DK/NR, go to Q15
How long did it last (
hours;
days).
Classify as "severe" if three or more days.
(1) Severe
(2) Not severe
(9) DK/NR
Did you do anything to treat it or just let it run its course?
(1) Treated it
(2) Let it run its course, go to Q15
(9) DK/NR, go to Q15
Module 2: Assessing health needs; appendix C
112
14.
15.
16.
17.
18.
19.
20.
21.
22.
How did you treat it?
(1) Treated it myself with packet ORS
(2) Treated it myself with homemade SSS
(3) Treated it myself with gruel/cereal-based sol.
(4) Took child to relative
(5) Took child to neighbour
(6) Took child to local health worker
(7) Took child to CHW health provider
(8) Took child to health clinic, hospital
(9) Other (specify):
(99) DK/NR
Have you ever heard of ORT, ORS, SSS or (local name)?
(1) Yes:Specify, if answer to Q14 was 1, 2, or 3.
(0) No, go to Q21
(9) DK/NR, go to Q21
Is there any source of ORS in your village (around here)?
(1) Yes
(0) No
(9) DK/NR
Is there a person in your village (around here) who has been trained to use
ORS?
(1) Yes
_(0) No
(9) DK/NR
Do you know how to mix ORS? (Probe.)
If "no," please explain, explanation includes the following:
Pour the contents of the ORS packet into the correct amount of clean water,
e.g., cooled boiled water or rainwater.
(1) Yes, knows how to mix ORS
(0) Does not know
(9) NR
How long can this solution be used?
(1) Knows (1 day)
(0) Does not know
(9) NR
How long can you administer ORS to a child with diarrhoea?
(1) Knows (until the diarrhoea ends)
(0) Does not know
(9) NR
Do you give extra fluids during diarrhoea?
(1) Yes (If any of those listed are mentioned)
(0) No
(9) DK/NR
a. gruel?
Yes
No
b. soup?
Yes
No
c. rice water?
Yes
No
d. milk solutions with twice the water?
Yes
No
e. other fluid:Yes
No
If the child is still breast feeding, do you continue breast feeding during
diarrhoea?
(1) Yes
(0) No
(9) DK/NR
Module 2: Assessing health needs; appendix C
113
23.
24.
25.
When your child has diarrhoea how often do you feed it?
(1) At least every 3-4 hours
(0) Less often than every 3-4 hours
(9) DK/NR
What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
(0) Does not know
(9) NR
Has the local CHW come to visit you in the last three months?
(1) Yes
(0) No(9) DK/NR
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
114
Rapid survey questionnaire
Childhood disabilities
Complete for head of household or primary caretaker in the home regardless of the
presence/absence of disabled persons. Disabled persons will refer to those children
who are crippled, who have trouble moving, speaking, seeing, hearing, or learning,
and who have physical, mental, or emotional handicaps.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
_ 3. Cluster no
___
6. Date of interview / /
NAME OF RESPONDENT
9.
10.
11.
12.
13.
14.
How many children do you have?___ no. of children
What are their names, ages, type of disability?
Name
Name
Age___ Sex____ (M/F)
Age___ Sex____ (M/F)
Disability type
Disability type
(1) Movement
(l)Movement
__ (2) Deformity
_ (2) Deformity
_(3) Hearing
__ (3) Hearing
(4) Blindness
(4) Blindness
__ (5) Speech
_ (5) Speech
(6) Behaviour
(6) Behaviour
_(7) Other
(7) Other
_(9) DK/NR
_(9) DK/NR
How did your child become disabled?
(1) Illness
(3) Injury
(2) Birth
(4) Other: (9) DK/NR
Do you know how to prevent a similar disability from occurring again?
(Probe for correct responses, e.g., immunization, safe maternal and child care,
Vit A.)
(1) Yes
(0) No
(9) DK/NR
Have you sought treatment or therapy for your child?
(1) Yes
(0) No, go to Q15
(9) DK/NR, go to Q15
Where did your child receive treatment or therapy?
(1) Therapy or treatment centre
(2) Community group
(9) DK/NR
(3) Special school
Module 2: Assessing health needs; appendix C
(4)
115
15.
16.
17.
What are the available centres which could provide services to help your child?
(1) Therapy or treatment centre
(2) Community group
(3) Special school
(4) Other
(9) DK/NR
What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
Has a community health worker visited or contacted you during the
past three months?
(1) Yes
(0) No
(9) DK/NR
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
116
Rapid survey questionnaire
Child immunization
Complete for the oldest child under two years of age currently living in the
household Interview the mother of the child, if possible. See questionnaire on
antenatal care for related questions on tetanus toxoid immunization.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
3. Cluster no
_
6. Date of interview / /
NAME OF RESPONDENT
9.
10.
11.
12.
13.
14.
How many living children do you have under two years of age?
(no. children) If none, terminate the interview.
What are their names and how old are they?
Name:
Age (in months):
Sex (m/f):
Name:
Age (in months):
Sex (m/f):
Name:
Age (in months):
Sex (m/f);
Has anyone from the health centre ever talked to you about vaccinating
your chiid(ren)?
_(1) Yes
(0) No
(9) DK/NR
Do you know which childhood diseases can be prevented by immunization?
(Check all named. Must have one correct answer for'"yes" response.)
Diphtheria
Whooping cough
Tetanus
Measles
Tuberculosis
Polio
JI) Yes
(0) No
(9) DK/NR
Do you know at what age children should be vaccinated against measles?
. _(D Yes (9-12 months)
. (0) No
(9) DK/NR
Has (name of oldest child under age 2) been immunized?
(1) Yes
(0) No, go to Q26
(9) DK/NR, go to Q26
Do you have the immunization card for this child?
(1) Yes, has card correctly filled out, go to Q16
(2) Yes, has card but incorrectly filled out, go to Q16
(0) No, does not have card
(9) DK/NR
Module 2: Assessing health needs; appendix C
117
15.
(If no EPI card) Can you remember when your child was vaccinated?
(1) Yes
(0) No, go to Q26
(9) DK/NR, go to Q26
Transfer information from the EPI card.
If no EPI card but remembers vaccination dates, enter as such.
Birthdate:
16. BCG
17. DPT1
18. DPT2
19. DPT3
20. Polio 1
21. Polio 2
22. Polio 3
23. Measles
Date received
Agefmo.)
mo
mo
mo
mo
mo
mo
mo
mo
Received on/off
schedule
On
(2)
(1) Off
On
(2)
(1) Off
On
(2)
(1) Off
On
(2)
(1) Off
On
(2)
(1) Off
On
(2)
(1) Off
On
(2)
(1) Off
On
(2)
(1) Off
24. Child is on schedule for age:
(1) Yes
(0) No
25. For children 12-24 months:
Child is fully vaccinated (BCG, DPT3, Polio3, Measles):
.
(1) Yes
(0) No
(9) DK/NR
26.
Not
received
No
(0)
No
(0)
No
(0)
No
(0)
No
(0)
No
(0)
No
(0)
No
(0)
(9) DK/NR
When will you take your child for the (next) vaccination?
Date
Compare response with the EPI card data. If no EPI card,
compare response with child’s age
(1) Mother correctly knows next vaccine appointment
(0) Mother doesn’t know
_(2) Fully vaccinated (not applicable)
I___(9) DK/NR
What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
(0) Does not know
(9) NR
28. Has the Community Health Worker visited or contacted you during the
last three months?
(1) Yes
(0) No
(9) DK/NR
27.
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
118
Rapid survey questionnaire
Growth monitoring/nutrition education
Complete for the oldest child under two years of age currently living in the
household. Interview the mother of the child, if possible. See questionnaire on breast
feeding for related questions.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
9.
10.
How many living children do you have under two years of age?
(no. children) If none, terminate the interview.
What are their names and how old are they?
Name:Age (in months):
Sex (m/f):
Name:Age (in months):
Sex (m/f):
Name:Age (in months):
Sex (m/f):
Is (name of oldest child under age two) registered for growth monitoring?
(1) Yes
(0) No
(9) DK/NR
Has any health worker ever explained growth monitoring cards to you?
(1) Yes
. (0) No .
_(9) DK/NR
12. Has this child ever been weighed by a health worker, nurse, or doctor?
(1) Yes
(0) No, go to Q19
(9) DK/NR, go to Q19
13. Do you have your child’s growth card at home? (Show sample card.)
(1) Yes
_(0) No, go to Q19
(9) DK/NR, go to Q19
14. Please show me the card.
(1) Yes, has growth card
(0) No, cannot find it, go to Q19
15. (Interviewer: inspect card. Does the growth card have age and weight data
plotted?)
(1) Yes, plotted correctly
(2) Yes, but plotted incorrectly
_(0) No, not plotted, go to Q19
(9) DK/NR, go to Q19
11.
Module 2: Assessing health needs; appendix C
119
16.
17.
(Interviewer-, record weighing history from growth card):
Total no. times weighed)
Times weighed last quarter
18.
Can you explain the information on the growth card to me?
(1) Yes, mother can interpret the information correctly
(0) No, mother cannot interpret the information or interprets incorrectly
19.
During the last prenatal and/or postnatal care visit, were you educated about
how to improve the nutritional status of your child?
(1) Yes
(0) No
(9) DK/NR
20.
What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
(0) Does not know
(9) NR
Has the local CHW visited or contacted you during the past three months?
(1) Yes
(0) No
(9) DK/NR
21.
This concludes the interview. Thank you for taking the time to
participate in this survey.
OPTIONAL WEIGHING TO DETERMINE CURRENT NUTRITIONAL STATUS.
Name
Sex
Age (mo) Wt. (Kg.) Ht. (Cm) Remarks:
(22)
(23)
(24)
(25)
Module 2: Assessing health needs; appendix C
120
Rapid survey questionnaire
Water supply, hygiene, and sanitation
Complete for each household. Interview the female head of household, if possible.
IDENTIFICATION
1. Study no
2. Province no
4. Interviewer no ____ 5. Respondent no
7. Respondent age
8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
Where do you usually get your drinking water?
(1) Clean source: faucet/tap, pipe, bore hole, covered well
J2) Unclean source: open well, pond/river/stream, rain water catchment
(3) Other(specify)
(9) DK/NR
10. Is your water supply chlorinated?
. .. _(1) Yes
(0) No
(9) DK/NR
11. Do you usually boil water for drinking?
_J1) Yes
. __(0) No
(9) DK/NR
12. How long does it take you to walk to your source of water?
(1) < 15 minutes
(2) > 15 minutes
(9) DK/NR
13. Can you get enough water all year?
_J1) Yes
... JO) No
J9) DK/NR
14. Do you always wash your hands before handling food?
(1) Yes
„
(0) No
(9) DK/NR
15. Please explain why it is important to wash your hands? (Probe.)
JI) Knows
(0) Doesn’t know
(9) NR
9.
16.
17.
18.
What is the primary way this household disposes of human waste?
(1) water-seal latrine
__ (4) open field
(2) pit privy
(5) bucket
.(3) WC
(9) DK/NR
Please explain why it is important to use a structured/sanitary facility?
(Probe.)
(1) Knows
(0) Doesn’t know
(9) NR
What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
(0) Does not know
.(9) NR
Module 2: Assessing health needs; appendix C
121
19.
Has the local CHW visited or contacted you during the past three months?
(1) Yes
JO) No
(9) DK/NR
Interviewer observations of household
20.
Does water container have a clean cover/lid?
JI) Yes
(0) No
(9) DK/NR
21.
Do pots, pans, plates, and glasses appear clean?
(1) Yes
(0) No
(9) DK/NR
22.
Are fruits, vegetables, meats covered and stored away from small domestic
animals?
(1) Yes
JO) No
(9) DK/NR
23.
Does the latrine appear to be used?
(1) Yes
_(0) No
(9) DK/NR
Are the animals penned away from water and food?
(1) Yes
JO) No
(9) DK/NR
24.
25.
Does garbage appear to be disposed of in a sanitary way?
. JI) Yes
(0) No
. (9) DK/NR
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
122
Rapid survey questionnaire
Accidents and injuries
Complete for each household.
IDENTIFICATION
3. Cluster no
6. Date of interview / /
1. Study no
2. Province no
4. Interviewer no
5. Respondent no
7. Respondent age ___ 8. Respondent sex
NAME OF RESPONDENT
9.
Has anyone in this household had a serious accident or injury in the past year?
(1) Yes, ask for information in matrix. For each person, enter codes listed.
(0) No, go to Q10
(9) DK/NR, go to Q10
Name
Age
Sex
Type injury
Treated?
Where
treated
Outcome
Types of injury codes: Where treated codes:
Outcome codes:
(01) Fall
(01) Hospital
(01) Cured/recovered
(02) Occupational injury (02) Health care centre (02) Still recovering
(03) Traffic injury
(03) CHW
(03) Permanent disability
(04) Poisoning
(04) Traditional healer (04) Death
(05) Other (specify)
(05) Other (specify)
(05) Other
(09) DK/NR
(09) DK/NR
10. If someone in your household was injured, what would you do to help
him/her?
(Probe for correct answer.)
(1) Yes, knows how to help
_(0) No, doesn’t know
_(9) No response
Module 2: Assessing health needs; appendix C
123
11.
Where are the nearest emergency care facilities? (Probe for correct answer.)
(1) Yes (respondent knows correct answer)
(2) No (respondent does not know correct answer)
(9) No response
12.
What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
___ (0) Does not know
(9) NR
Has the local CHW visited or contacted you during the past three months?
(1) Yes
(0) No
(9) DK/NR
13.
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
124
Rapid survey questionnaire
Chronic, non-communicable diseases
Complete for each household. Interview the female head of household, if possible.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
Diabetes
9
10.
11.
Do you know what diabetes is? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
Have you or any household member ever been diagnosed as having diabetes?
(1) Yes
(0) No
(9) DK/NR
Does anyone in this household have diabetes now?
(1) Yes
(0) No, go to Q16
(9) DK/NR, go to Q16
12.
Is this person being treated now?
(1) Yes
(0) No, go to Q15
13.
Is the prescribed treatment being followed? (Probe for explanation.)
(1) Yes
.(0) No
(9) DK/NR
14.
Do you monitor glucose level at home?
(1) Yes
(0) No
(9) DK/NR
Do you and your household members know how to handle a diabetic
emergency?
(Probe for explanation.)
.(1) Yes
(0) No
_ (9) DK/NR
15.
___ (9) DK/NR, go to Q15
Hypertension
16.
17.
18.
Do you know what hypertension is? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
Have you or any household member ever been diagnosed as having
hypertension?
(1) Yes .
(0) No
(9) DK/NR
Does anyone in this household have hypertension now?
JI) Yes
(0) No, go to Q22
(9) DK/NR, go to Q22
Module 2: Assessing health needs; appendix C
125
Is this person being treated now?
(1) Yes
(0) No, go to Q21
(9) DK/NR, go to Q21
20. Is the prescribed treatment being followed? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
21. Do you and your household members know what to do in case of a heart at
tack or stroke? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
19.
Anaemia
22.
Do you know what anaemia is? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
23.
Have you or any household member ever been diagnosed as having anaemia?
__ (1) Yes
(0) No
(9) DK/NR
Does anyone in this household have anaemia now?
(1) Yes
(0) No, go to Q27
(9) DK/NR, go to Q27
Is this person being treated now?
_J1) Yes
(0) No, go to Q27
(9) DK/NR, go to Q27
24.
25.
26.
27.
28.
Is the prescribed treatment being followed? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
What is the name of the local Community Health Worker (CHW)?
_(1) Knows (said name)
(0) Does not know
(9) NR
Has the local CHW visited or contacted you during the last 3 months?
(1) Yes
(0) No
(9) DK/NR
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
124
Rapid survey questionnaire
Chronic, non-communicable diseases
Complete for each household. Interview the female head of household, if possible.
IDENTIFICATION
1. Study no
2. Province no
4. Interviewer no
5. Respondent no
7. Respondent age 8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
Diabetes
9.
10.
11.
12.
13.
14.
15.
Do you know what diabetes is? (Probe for explanation.)
(1) Yes
(0) No
__ (9) DK/NR
Have you or any household member ever been diagnosed as having diabetes?
(1) Yes
(0) No
(9) DK/NR
Does anyone in this household have diabetes now?
JI) Yes
(0) No, go to Q16
(9) DK/NR, go to Q16
Is this person being treated now?
JI) Yes
(0) No, go to Q15
__(9) DK/NR, go to Q15
Is the prescribed treatment being followed? (Probe for explanation.)
_(1) Yes
(0) No
(9) DK/NR
Do you monitor glucose level at home?
JI) Yes
(0) No
(9) DK/NR
Do you and your household members know how to handle a diabetic
emergency?
(Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
Hypertension
Do you know what hypertension is? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
17. Have you or any household member ever been diagnosed as having
hypertension?
JI) Yes
(0) No
(9) DK/NR
18. Does anyone in this household have hypertension now?
(1) Yes
(0) No, go to Q22
(9) DK/NR, go to Q22
16.
Module 2: Assessing health needs; appendix C
125
Is this person being treated now?
(1) Yes
(0) No, go to Q21
(9) DK/NR, go to Q21
20. Is the prescribed treatment being followed? (Probe for explanation.)
(1) Yes
(0) No
(9) DK
21. Do you and your household members know what to do in case of a heart at
tack or stroke? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
19.
Anaemia
22.
23.
24.
25.
26.
27.
28.
Do you know what anaemia is? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
Have you or any household member ever been diagnosed as having anaemia?
(1) Yes
(0) No
(9) DK/NR
Does anyone in this household have anaemia now?
_(1) Yes
(0) No, go to Q27
(9) DK/NR, go to Q27
Is this person being treated now?
(1) Yes
(0) No, go to Q27
(9) DK/NR, go to Q27
Is the prescribed treatment being followed? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
(0) Does not know(9) NR
Has the local CHW visited or contacted you during the last 3 months?
(1) Yes
(0) No
(9) DK/NR
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
126
Rapid survey questionnaire
Malaria
Complete for target groups in known endemic region, especially pregnant women
and/or children under five needing malaria treatment services.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age_
2. Province no
5. Respondent no
_ 8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
Can you explain to me what malaria is? (Probe.)
(1) Knows
(0) Doesn’t know
(9) NR
10. Has anyone in your household had malaria (local term) since the beginning of
the year? (Or determine appropriate starting point for recall period.)
(1) Yes (Ask names.)
JO) No, go to Q13
(9) DK/NR, go toQ13
Relation:
Age:
Sex:
Name:
Relation;
Age:
Sex:
Name:
Relation:
Name:
Age:
Sex:
How
did
you
know
that
it
was
malaria
(local
term)?
11.
In endemic areas where malaria is a well known disease, the interviewer could
forego asking about symptoms of malaria and instead directly ask about disease.
(1) High fever
•aw
(2) Shivers
(3) Headache
(4) Other (specify)
(9) DK/NR
9.
12.
How many days did the malaria episode prevent that person from conducting
his/her normal daily activities?
No. of days
13.
Do you know how malaria (local term) is spread? (Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
14.
What are your household members currently doing to protect themselves
from malaria?
JI) Using mosquito nets
(2) Using household sprays
(3) Eliminating standing water
(4) Using anti-malarial drugs
Module 2: Assessing health needs; appendix C
127
(5) Other:
(9) DK/NR
15.
16.
17.
18.
19.
________
Has anyone in your household died in the last 12 months?
(1) Yes
(0) No, go to Q18 . _(9) DK/NR, go to Q18
Which symptoms were present one week before death?
(1) High fever
(2) Shivers
(3) Headache
(4) Other (specify)
_(9) DK/NR
What do you think was the cause of death? (Probe for answer.)
What is the name of the local Community Health Worker (CHW)?
_(1) Knows (said name)
(0) Does not know
(9) NR
Has the local CHW visited or contacted you in the last 3 months?
(1) Yes
(0) No
(9) DK/NR
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
128
Rapid survey questionnaire
Tuberculosis
Complete for households with known case of TB and/or for high-risk segments of
the population including known HIV positives, occupational groups (miners, etc.),
low SES, densely-packed populations.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
3. Cluster no
___
6. Date of interview / /
NAME OF RESPONDENT
9.
10.
Can you explain to me what tuberculosis (local word) is? (Probe.)
(1) Knows
(0) Doesn’t know
(9) NR
Do you know how TB is spread? (Probe for explanation.)
(1) Knows
(0) Doesn’t know
(9) NR
Do you know how to prevent infection? (Probe for explanation.)
(1) Knows
(0) Doesn’t kno
12. Were all your children vaccinated at birth with BCG?
(1) Yes
(0) No
13. Have you or any family members experienced a persistent cough lasting more
than 2 weeks?
(1) Yes
14. Did this person seek treatment for TB?
(1) Yes
(0) No, go to Q18
11.
15.
16.
Where did this person go to seek treatment?
(1) Health centre
(2) CHW/volunteer
(3) Other
(9) DK/NR
Was this person given medicine to treat TB?
(1) Yes
Did they take the medicine for the prescribed length of time
(Probe for explanation.)
(1) Yes
(0) No
(9) DK/NR
18. What is the name of the local Community Health Worker?
17.
(1) Knows (said name)
Module 2: Assessing health needs; appendix C
129
19.
Has the CHW visited or contacted you in the last three months?
(1) Yes
.(0) No
(9) DK/NR
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
130
Rapid survey questionnaire
Sexually-transmitted diseases, HIV/A1DS
Complete for individuals at risk of acquiring infection, especially sexual partners of
individuals practising high-risk behaviour, or clients with STDs.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
Do you know what is meant by a sexually-transmitted disease?
(Probe for correct response.)
(1) Yes
(0) No
(9) DK/NR
10. Do you know the difference between HIV infection and AIDS (local term)?
(Probe for correct response.)
(1) Yes
(0) No
(9) DK/NR
11. Can a person who looks healthy be infected with an STD?
(1) Yes
(0) No
(9) DK/NR
9.
Can a person get the AIDS virus by shaking hands with someone who is
infected with the virus?
(1) Yes
(0) No
_(9) DK/NR
13. Can a pregnant woman who is infected with HIV pass on the virus to her
unborn child?
(1) Yes
(0) No
(9) DK/NR
12.
Can STDs be transmitted by having sex with someone who is infected with
an STD?
(1) Yes
(0) No
(9) DK/NR
15. Is there a cure for AIDS?
(1) Yes
(0) No
(9) DK/NR
14.
1
Portions of this instrument are adapted from a baseline instrument in Lamptey
P. and P. Piot. The handbook for AIDS prevention in Africa. Family Health
International, 1990.
Module 2: Assessing health needs; appendix C
131
16.
What are you currently doing to prevent yourself or others from becoming
infected with an STD?
(1) Using a condom
(2) Practicing safer sex (Probe for explanation.)
(9) Other (specify)
(0) Nothing
17.
Do you know how to use a condom correctly? (Probe for correct response.)
(1) Yes
(0) No
(9) DK/NR
Where have you obtained condoms during the last six months?
(1) At a government hospital
(2) At a government clinic or health centre
(3) At a private hospital
(4) At a private clinic or health centre
(5) At a local dispensary
(6) A health worker came to you
(7) Other
(9) DK/NR
18.
19.
Have you been diagnosed with an STD in the past 12 months?
(1) Yes
20.
21.
22.
23.
24.
What was your diagnosed illness? (Probe for response.)
_(1) HIV/AIDS
(2) Other STD:
(9) DK/NR
Where did you go for treatment?
(1) To a government hospital
(2) To a government clinic or health centre
(3) To a private hospital
(4) To a private clinic or health centre
(5) Contacted a health worker
(6) Other:
(9) DK/NR
How did you first learn about STDs?
(1) By word of mouth
(2) From a CHW or other health staff
(3) Heard about it on the radio
(4) Other:
(9) DK/NR
What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
(0) Does not know
(9) NR
Has the local CHW visited or contacted you in the last three months?
(1) Yes
(0) No
(9) DK/NR
Module 2: Assessing health needs; appendix C
(0) No, g
132
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
133
Rapid survey questionnaire
Vital events and health status
Complete for each household. List all people currently living in the household, by
age and sex.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
9.
How many people live in this household:______ (total)
I would like to ask you for the name, age, and sex of each person living in this
household. (List age of children under age two in months.)
10.
Married women of reproductive age (15-49):_______ (in household)
10.1 Name:_____________ Age (in years):_______ Pregnant? (Y/N/DK)_____
10.2 Name:_____________
Age (in years):____ Pregnant? (Y/N/DK)_____
10.3 Name:_____________
Age (in years):____ Pregnant? (Y/N/DK)_____
Children less than 24 months old:_______ (in household)
11.1 Name:_____ ._________ Age (in months):_____ Sex (m/f):_____
11.2 Name:______________ Age (in months):_____ Sex (m/f):______
11.3 Name:______________ Age (in months):____
Sex (m/f):______
12. Children 24-60 months old:_______ (in household)
12.1 Name:_______________ Age (in years):_____
Sex (m/f):______
12.2 Name:_______________ Age (in years):_____
Sex (m/f):______
12.3 Name:_______________ Age (in years):_____
Sex (m/f):______
13. Other men, women, and children:_______ (in household)
13.1 Name:_______ _
Age (in years):_____
Sex (m/f):______
13.2 Name:_______________ Age (in years):_____
Sex (m/f):______
13.3 Name:______________ Age (in years):____
Sex (m/f):______
(Total of questions 10-13 should equal total shown in Item 9.)_______
11.
Module 2: Assessing health needs; appendix C
134
Morbidity
14. Is there anyone in your household who has been sick this week?
(1) Yes
(0) No, go to Q60
(9) DK/NR, go to Q60
Who is/are sick? (Probe and fill out following table, using SI. No. from Q10-Q13,
e.g, 10.3,12.2):
15
SI
No
Name
16
17
Age Sex
m/y M/F
18
Disease
(code,
01,02,etc.)
19
Treated
(Y/N)
20
Where
treated
(1,2,3,etc.)
21
Outcome
(1,2,3,etc.)
If more than one person is ill, continue coding with 25, 35, 45, etc.
18.
21.
Disease code:
20. Where treated:
01 Diarrhoea/dysentery 08 Polio
1 Government clinic/hospital
02 Anaemia
09 Tuberculosis
2 Mobile clinic
03 Scabies
10 Acute respiratory inf. 3 Private clinic/hospital
04 Diphtheria
11 Fever
4 Private doctor
05 Whooping cough
12 Malaria
5 Private midwife/nurse
06 Tetanus
13 Other:
6 Traditional practitioner
07 Measles
99 DK/NR
7 Pharmacy/drug store
8 Other:__________________
9 DK/NR
Outcome
1 Cured/recovered
4 Died
2 Still recovering
5 Other:
3 Permanent disability 6 DK/NR
Module 2: Assessing health needs; appendix C
135
Mortality
60. Were there any deaths in this household during the last 12 months?
(1) Yes(0) No, go to Q100
_(9) DK/NR, go to Q100
Who died? (Probe and fill out following table):
61
SI No
Name
62
63
Age Sex
m/y M/F
64
65
66
Cause of Date died
Died
death
dd/mm/yy
where?
Code 01,
code: 01,02,
02, etc.
etc.
67
Death
Y7N
If more than one death, continue coding with 71, 81, 91 etc.
64. Cause of death code:
66. Where died
01 Diarrhoea/Dysenteryll Preg.-related
1 Government clinic/hospital
02 Anaemia
12 Heart disease
2 Mobile clinic
03 Scabies
13 Cancer
3 Private clinic/hospital
04 Diphtheria
14 Diabetes
4 Private doctor’s office/clinic
05 Whooping Cough
15 Typhoid
5 Private midwife/nurse’s clinic
06 Tetanus
16 Accident
6 Traditional practitioner’s centre
07 Measles
17 Pneumonia
7 Home
08 Polio
18 Hepatitis
8 Relative’s house
19 Malaria
9 Other:
09 Tuberculosis
10 ARI
20 Other
99 DK/NR
99 DK/NR
Module 2: Assessing health needs; appendix C
136
Fertility
100. Were there any births in this household in the last 12 months?
(1) Yes
(0) No, end interview
(9) DK/NR, end interview
Who was born? (Probe and fill out following table, using SI No. from QU,
e.g., 11.1,11.2, etc.):
101
SI No
Name
104
102 103
Age Sex Outcome
m/y M/F Code 01,
02, etc.
105
106
Born
where?
01, 02, etc.
107
Birth
certificate
Y/N
If more than one birth, c:ontinue coding with 111, 121, etc.
106. Where born
104. Outcome:
01 Government clinic/hospital
01 Live birth (single)
02 Live birth (twins)
02 Mobile clinic
03 Live birth (2)
03 Private clinic/hospital
04 Stillbirth
04 Private doctor’s office/clinic
05 Died within 1 week
05 Private midwife/nurse's clinic
06 Died within 1 month
06 Traditional practitioner’s centre
07 Home
09 DK/NR
08 Relative’s house
09 Other:
99 DK/NR
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
137
Rapid survey questionnaire
Child morbidity and mortality assessment
Complete for each woman aged 15-49 who was ever married (i.e, married,
separated, widowed, divorced). If there is more than one eligible woman in each
household, use separate forms. Give each woman residing in the household a
number starting from the oldest to the youngest. Use Q9-22 (Module A111
) if it is
possible to have a more complete birth history. If not, use Q23-38 (Module B2). You
can use data from Module A to determine infant and child mortality rates. If this
survey is translated, it is important to maintain the wording and order of questions
in Modules A and B.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
3. Cluster no
5. Respondent no ____ 6. Date of interview / /
8. Respondent sex
NAME OF RESPONDENT
Module A: Child mortality
10.
11.
In what month and year were you born?
MM/
YR
(99) DK/NR
How many of your sons are now living with you? (99) DK/NR
How many of your sons are now living elsewhere?(99) DK/NR
12.
How many of your daughters are now living with you?(99) DK/NR
13.
How many of your daughters are now living elsewhere?
9.
(99) DK/NR
14. Have you ever given birth to a child who later died, even if she/he lived only
a short time?
(1) Yes
(0) No, go to Q17
(9) DK/NR, go to Q17
15.
16.
17.
How many of your sons have died?
(99) DK/NR
How many of your daughters have died?
(99) DK/NR
INTERVIEWER: Sum the answers to Questions 10,11, 12,13,15, and 16:
total
1
Module A is adapted from: David, P.H., et al. Measuring childhood mortality: A
guide for simple surveys, UNICEF, 1990, pp. 152-154.
Module B is adapted from: David, P.H., et al, ibid. pp. 155-156.
2
Module 2: Assessing health needs; appendix C
138
Apart from these (Total # from Q 17) births, have you had any other live
births?
(1) Yes
(0) No, go to Q20
(9) DK/NR, go to Q20
19. INTERVIEWER: If yes, ask if now living or dead, and correct where necessary.
20. Could you give me the following information on all your children born alive,
even if they are now dead, beginning with your last delivery?
INTERVIEWER: Begin to list with the woman’s most recent live birth and ask
the questions that follow for each child born in the last five years (this will allow
for calculation of death rate in children under five years):
18.
Name of
child
Month/year
of birth
Last child
Next to last
Second to last
Third to last
Fourth to last
Fifth to last
Twin
/
/
/
/
/
/
/
Sex
M/F
Now alive?
Y/N/DK
If dead, date
of death
MM/YR
/
/
/
/
/
/
/
21.
(1) woman herself
(2) her mother
(3) her sister living in same house
(4) other
(Marriage duration option; to be included if only ever-married women are
interviewed):
22.
How many years has it been since you were first married?
(That is, since your first marriage, even if you have married more than once.)
Date of marriage: mm/yy
Month
Year
or Completed years
Respondent is:
Module B: Child mortality (Optional: Use if difficult to construct
histories)
23.
In what month and year were you born?
MM/
YR
(99) DK/NR
Module 2: Assessing health needs; appendix C
139
24.
25.
26.
27.
How many of your sons are now living with you?
How many of your sons are now living elsewhere?
How many of your daughters are now living with you?
How many of your daughters are now living elsewhere?
(99) DK/NR
(99) DK/NR
(99) DK/NR
(99) DK/NR
Have you ever given birth to a child who later died, even if she/he lived only
a short time?
(!) Yes
_(0) No, go to Q31
(9) DK/NR, go to Q31
29. How many of your sons have'died?
(99) DK/NR
30. How many of your daughters have died?
(99) DK/NR
28.
31.
INTERVIEWER: Sum the answers to Questions 24, 25, 26, 27, 29, and 30:
Total
32.
Apart from these (total # from Q31) births, have you had any other live births?
_(1) Yes
_(0) No, go to Q34
(9) DK/NR, go to Q34
INTERVIEWER: If yes, ask if now living or dead, and correct where necessary.
Could you give me the following information on all your children born alive,
even if they are now dead, beginning with your last delivery?
In what month and year was your last live birth?
MM/__ YR
(9) DK/NR
Was this child a boy or a girl?
(l)Boy
_(2) Girl __.(9)DK/NR
Is she/he still alive?
(1) Yes
(0) No
(9) DK/NR
Did you have another live birth before this last one?
(1) Yes
(0) No, go to
33.
34.
35.
36.
37.
38.
39.
Was this baby a boy or a girl?
(1) Boy
(2) Girl
_(9) DK/NR
Is she/he still alive today?
(1) Yes
Respondent is:
(1) woman herself
(0) No
(9) DK/NR
_(2) her mother
(3) her sister living in same house
(Marriage duration option (Q42); to be included if only ever-married women are
interviewed):
42. How many years has it been since you were first married? (That is, since
your first marriage, even if you have married more than once.)
Date of marriage: mm/yy
Month
Year
or Completed years
40.
41.
INTERVIEWER: Please check Q22 (Module A) or Q31-40 (Module B) to see if
any infant or child from this household is dead. For the most recent death, ask
the following questions:
Module 2: Assessing health needs; appendix C
(4
140
43.
Did (name of deceased child) die because of an accident or an illness?
(1) Accident, go to Q44
(2) Illness, go to Q45
(9) DK/NR, go to Q45
What was the accident?, go to Q49
From what illness did (name of deceased child) die?
(9) DK/NR
46. What were the signs or symptoms present two weeks before death?
(1) Diarrhoea
(6) Fever
(2) Diarrhoea with blood
(7) Seizures
(3) Cold
(8) Other symptoms (specify)
(4) Difficulty breathing
(9) DK/NR
(5) Rash or pimples
47. (IF INTERVIEWER IS TRAINED IN IDENTIFYING CAUSE OF DEATH)
In the opinion of the interviewer, of what did the child die?
(1) Infection (specify)(5) Other (specify)
(2) Diarrhoea
(6) Vaccine preventable disease
(3) ARI (pneumonia)
(specify) .
(4) Malnutrition
(9) DK/NR
44.
45.
48.
49.
50.
51.
52.
53.
54.
55.
How long did (name of deceased child) have the illness?
days;months;
(9) DK/NR
Was she/he taken somewhere to receive treatment for the illness/accident
before dying?
(1) Yes
(0) No
. _(9) DK/NR
Where was she/he taken?
_(1) Public hospital
(5) Pharmacy
(2) Health centre
(6) Traditional healer
(3) Doctor's office
(7) Other (specify)
_(4) Clinic/private hospital
(9) DK/NR
Where did she/he die?
(1) Public hospital
(4) At the house
(2) Health centre
(5) Other(specify)
(3) Clinic/Private hospital
(9) DK/NR
Do you have a death certificate?
(1) Yes
(0) No, go to Q55
_(9) DK/NR, go to Q55
May 1 see that certificate?
(1) Yes, shows certificate (2) No, does not show certificate, go to Q55
What was the cause of death, according to the certificate?
Has anyone else in this household died in the last six months?
(1) Yes
(0) No, go to Q57
(9) DK/NR, go to Q57
Module 2: Assessing health needs; appendix C
141
56.
Name?
Symptoms prior to death?
Treatment received?
____ Age?
________________
Child morbidity
57.
58.
59.
60.
61.
62.
Has any child under the age of two been sick in the last two weeks?
(1) Yes
(0) No, go to Q73
__(9) DK/NR, go to Q73
What were the symptoms of sickness?
(1) Fever
Ask Q 59-74
(2) Diarrhoea
Ask Q 59-74
(3) Difficulty breathing
Ask Q 63-74
(4) Poor weight gain/weight loss Ask Q 65-74
(5) Other (specify)
__(9) DK/NR
If diarrhoea, how long was/is the episode?
Does the child have diarrhoea today?
_j(1) Yes
(0) No
_J.(9) DK/NR
Did you give the sick child ORS?
„__j(1) Yes
(0) No
(9) DK/NR
days
(99) DK/NR
Do you/did you continue breast feeding your baby during illness?
(1) Yes
(0) No
(9) DK/NR
If coughing etc., for how many days (has the cough lasted/did the cough last)?
(If less than one day, 00.)
Day
(99) DK/NR, go to Q65
64. When the child had the illness with a cough, did she/he breathe faster than
usual with short, rapid breaths?
(1) Yes
(0) No
(9) DK/NR
63.
65.
If poor weight gain, has the child had any of the following symptoms:
swollen feet
dry eyes
thin hair
blindness
sores inside mouth
no desire to laugh or play
failure to develop intelligence
(1) Yes
(0) No
(9) DK/NR
66.
Did you seek advice or treatment for the illness?
(1) Yes
(0) No, go to Q68
(9) DK/NR; go to Q68
Where did you seek advice or treatment?
(1) Government clinic/hospital
(5) Traditional practitioner
_(2) Mobile clinic
(6) Pharmacy/drug shop
(3) CHW
(9) Other (specify).
(4) Private doctor
67.
68.
Was anything given to treat the illness?
(1) Yes
. ... JO) No, go to Q71
Module 2: Assessing health needs; appendix C
__._(9) DK/NR, go to Q71
142
69.
70.
71.
72.
73.
What was given to treat the illness?
(1) Injection
(5) Other pill or syrup
(2) Antibiotic
(6) Unknown pill or syrup
__(3) Anti-malarial
(7) Home remedy/herbal medicine
(4) Cough syrup
(8) Other (specify)
(9) DK/NR
Were you told by the health care provider what illness your child had?
(1) Yes specify:
(0) No
(9) DK/NR
Does the child have the symptoms (mentioned above) today?
(1) Yes
(0) No
(9) DK/NR
(IF INTERVIEWER IS TRAINED IN IDENTIFYING CAUSE OF ILLNESS)
In the opinion of the interviewer, what illness does/did the child have?
(1) Infection (specify)
(2) Diarrhoea
(3) ARI (pneumonia)
(4) Malnutrition
(5) Other (specify)
(6) Vaccine preventable disease (specify)
(9) DK/NR
Has anyone else in this household been sick in the last two weeks?
(1) Yes
74.
Name?
Age?
Symptoms?
Treatment received?
75. What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
(0) Does not know
(9) NR
76 Has the local CHW visited or contacted you in the last three months?
(1) Yes
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
143
Rapid survey questionnaire
Adult morbidity and mortality assessment
Complete for each household. List all adults currently living in the household, by
age and sex.
IDENTIFICATION
1. Study no
4. Interviewer no
7. Respondent age
2. Province no
5. Respondent no
8. Respondent sex
3. Cluster no
6. Date of interview / /
NAME OF RESPONDENT
9.
How many adults live in this household:(total)
I would like to ask you for the name, age, and sex of each adult living in this
household.
10.
Married women of reproductive age (15-49): (in household)
Name:Age:
Pregnant? (Y/N/DK)
Name: Age:
Pregnant? (Y/N/DK)
Name:Age:
Pregnant? (Y/N/DK)
Other men and women:(in household)
Name:■
Age:
Sex (m/f):
Name: Age:
Sex (m/f):
Name:Age:
Sex (m/f):
(Total of questions 10-11 should equal total shown in Q9.)
11.
Adult morbidity
12.
Has any adult in this household been sick in the past 2 weeks?
(1) Yes
(0) No
(9) DK/NR
Please tell me their names and when they were sick:
Name: When?:days ago
Name: When?:
days ago
Name: When?:days ago
14. Is there any adult in your household who is sick today?
(1) Yes
(0) No, go to Q23
(9) DK/NR, go to Q23
13.
INTERVIEWER: For the person who is sick today, or sick most recently in the
last two weeks, please ask the following questions.
Module 2: Assessing health needs; appendix C
144
15. What were/are the symptoms of the illness?
(6) Earache or ear discharge
(7) Seizures
(8) Weakness or lethargy
(9) Other (specify)
__(99) DK/NR
(1) High fever
(2) Diarrhoea
(3) Weight loss
(4) Persistent cough
(5) Cough with sputum
16.
How long did the illness last?
Days
Weeks
17.
Was advice or treatment sought?
(1) Yes
_(0) No, go to Q19
(9) DK/NR, go to Q19
18.
Where was advice or treatment sought?
(1) Government clinic/hospital
(2) Mobile clinic
(3) CHW
(4) Private doctor
(5) Traditional practitioner
(6) Pharmacy/drug shop
(7) Other (specify)
(9) DK/NR
_
dk/nr
Was anything given to treat the illness?
__(1) Yes
(0) No, go to Q21
(9) DK/NR, go to Q21
20 What was given to treat the illness?
_(1) Injection
(5) Other pill or syrup
(2) Antibiotic
(6) Unknown pill or syrup
(3) Anti-malarial
(7) Home remedy/herbal medicine
(4) Cough syrup
(8) Other (specify)
_(9) DK/NR
21. In the opinion of the interviewee, what is/was the illness?
(use disease code from Q22)
(9) DK/NR
22. (IF INTERVIEWER IS TRAINED IN IDENTIFYING CAUSE OF ILLNESS)
In the opinion of the interviewer, what illness does/did the person have?
Disease code:
(01) Dysentery
(11) Polio
(02) Anaemia
(12) Tuberculosis
, (03) Scabies
(13) Acute respiratory infection
(04) Diphtheria
(14) Fever
(05) Whooping cough
(15) Malaria
(06) Tetanus
(16) Other:
(07) Measles
_(99) DK/NR, go to Q23
(08) Diabetes
(09) Hypertension
(10) STD/H1V
19.
Module 2: Assessing health needs; appendix C
145
Adult mortality
Was there any death in this household during the last 12 months?
(1) Yes (0) No, end interview
(9) DK/NR, end interview
24. Who died? (Probe and fill out following table):
Name: Age:
Sex:
When?weeks/months ago
Name: Age:
Sex:
When?weeks/months ago
(Interviewer: Ask Q. 25-36 for each person who has died in the last year.)
23.
25.
What symptoms were present 2 weeks before death?
(1) High fever
(6) Earache or ear discharge
(2) Diarrhoea
(7) Seizures
(3) Weight loss
(8) Weakness or lethargy
(4) Persistent cough
(9) Other (specify)
(5) Cough with sputum
(99) DK/NR
26. How long did (name of deceased) have the illness?
____ Days
____ Weeks
_____DK/NR
27. Was advice or treatment sought?
____ (1) Yes ___ (0) No, go to Q29 ____ (9) DK/NR, go to Q29
28. Where was advice or treatment sought?
___ (5) Traditional practitioner
____ (1) Government clinic/hospital
(2) Mobile clinic
____ (6) Pharmacy/drug shop
___ (7) Other (specify)___________
_____ (3) CHW
____ (4) Private doctor
_ ___ (9) DK/NR
29. Was anything given to treat the illness?
____ (1) Yes___ (0) No, go to Q31 ____ (9) DK/NR, go to Q31
30. What was given to treat the illness?
___ (5) Other pill or syrup
____ (1) Injection
____ (2) Antibiotic
____ (6) Unknown pill or syrup
____ (3) Anti-malarial
____ (7) Home remedy/herbal medicine
_____(4) Cough syrup
____ (8) Other (specify)_____________
___ (9) DK/NR
31.
Where did the person die?
_____(1) Government clinic/hospital ____ (5) At the house
___ (6) Other (specify)___________
_____(2) Health centre
____ (3) Private clinic/hospital
_ ___ (9) DK/NR
_____(4) Doctor’s office
32. Do you have a death certificate?
_____(1) Yes _____(0) No _____(9) DK/NR
33. May I see that certificate?
_____(1) Yes, shows certificate
____ (2) No, does not show certificate
Module 2: Assessing health needs; appendix C
146
What was the cause of death, according to the certificate?
In the opinion of the interviewee, what was the illness?
(Use Disease Code from Q36)
(9) DK/NR
36. (IF INTERVIEWER IS TRAINED IN IDENTIFYING CAUSE OF DEATH) In
the opinion of the interviewer, what did the person die of?
Cause of Death Code:
____ (01) Diarrhoea/Dysentery ____ (11) Pregnancy-related
_____(02) Anaemia
____ (12) Heart disease
____ (03) Scabies
(13) Cancer specify
_____(04) Diphtheria
(14) Diabetes
_____ (05) Whooping cough
____ (15) Typhoid
(16) Accident
____ (06) Tetanus
____ (07) Measles
(17) Pneumonia
____ (08) Polio
____ (18) Hepatitis
(09) Tuberculosis
(19) Malaria
_____ (10) Hypertension
____ (20) Other Specify:________
____ (99) DK/NR
37. What is the name of the local Community Health Worker (CHW)?
(1) Knows (said name)
(0) Does not know
(9) NR
38. Has the local CHW visited or contacted you in the last three months?
(1) Yes
(0) No
(9) DK/NR
34.
35.
This concludes the interview. Thank you for taking the time to
participate in this survey.
Module 2: Assessing health needs; appendix C
it)
Appendix D: Cluster-survey registers
lt>
Health education
<i>
Antenatal care, safe delivery, and postnatal care
Family planning
it)
(£)
147
Acute respiratory infections
Breast feeding
Diarrhoeal disease control/oral rehydration therapy
Childhood disabilities
Child immunization
Growth monitoring/nutrition education
GENERAL PHC
MATERNAL CARE
(»■
(t)
W W
m a t vispi
ii)
il>
'i)
i|>
'i)
it)
w!, w,
CHILD CARE
COMMUNITY HEALTH
WATER SUPPLY, HYGIENE, AND SANITATION
OTHER HEALTH CARE
Accidents and injuries
Chronic, non-communicable diseases
Malaria
Tuberculosis
Sexually-transmitted diseases, HIV/AIDS
MORBIDITY, MORTALITY AND FERTILITY
Vital events and health status
Child morbidity and mortality assessment
Adult morbidity and mortality assessment
The following instruments are similar to the Rapid survey questionnaires,
only in a different format. The answers of up to ten respondents can be
recorded on a single register.
These instruments can also be used as presented or modified as appro
priate to any given situation. You are encouraged to "mix and match"
questions and sections from the various questionnaires, add, delete, revise,
and combine to adapt the instruments to your situation and needs.
Please note that these are only the instruments. Examples of how they
can be modified and used with different sampling techniques are described
in this User’s guide.
Module 2: Assessing health needs; appendix D
148
Cluster form: Health education
N
(1) Study No.__________
A
(2) Province No.____________
M
(3) Cluster No.______________
E
(4) Interviewer
1
(5) Respondent No.
(6) Date
/
/
(7) Aqe
(8) Sex
(9) How many people live in this
household?
(10) Is anyone in this household a married
woman of reproductive aqe?
(11) Is anyone in this household preqnant?
(12) Are there any children under 24 mos.
in this household?
(13) Are there children 24 - 60 mos. in this
household?
(14) Has a health worker visited/contacted
vou in the last three months?
(15) What type of health worker visited?
(16) What did the health worker discuss?
Maternal care
Antenatal care
Safe delivery
Postnatal care
Child care
Acute respiratory infections
Breast feedinq
Diarrhoea diseases control
Oral rehydration therapy
Childhood disabilities
Child immunization
Growth monitorinq/nutrition education
Community health
Water supply
Hyqiene
Sanitation
Other health care
Accidents and injuries
Chronic, non-communicable diseases
Malaria
Tuberculosis
Sexually-transmitted diseases, HIV/AIDS
2
3
4
5
6
7
8
9
10
Module 2: Assessing health needs; appendix D
149
-—
(17) Do you believe you have enough
information on these topics or do you
want to know more?
Maternal care
Antenatal care
Safe delivery
Postnatal care
Child care
Acute respiratory infections
Breast feeding
Diarrhoea diseases control
Oral rehydration therapy
Childhood disabilities
Child immunization
Growth monitorinq/nutrition education
Community health
Water supply
Hygiene
Sanitation
Other health care
Accidents and injuries
Chronic, non-communicable diseases
Malaria
Tuberculosis
Sexually-transmitted diseases
HIV/AIDS
(18) What is the name of the local CHW?
Key (15) 1 CHW; 2 Public health nurse; 3 Midwife; 4 Doctor; 5 Other (specify}, 9 DK/NR,
Module 2: Assessing health needs; appendix D
IB
150
Cluster form: Antental care, safe delivery, and postnatal care
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7) Age
(8) Sex
(9) How many live births have you had so
far?
(10) Did you receive antenatal care during
your last pregnancy?
(11) How many times did you get
antenatal care?
(12) How many months had you been
pregnant before you got antenatal
care?
(13) Which is the principal place you
received antenatal care?
(14) Did anyone advise you to get
antenatal care?
(15) Did you receive a tetanus vaccination
during your last pregnancy?
(16) How many vaccinations did you
receive?
(17) During your pregnancy, did you take
iron pills to keep you strong?
(18) What was the outcome of your most
recent pregnancy?
(19) Where did the delivery take place?
(20) Who was the main person attending
the delivery?
(21) What is the name of the local CHW?
(22) Has the CHW visited/contacted you
during the last three months?
Key (12)
1) three mo. (first trimester)
2) 4-6 mo. (second trimester)
3) 7-9 mo. (third trimester)
9) DK/NR.
•
. •
N
A
M
E
1
2
3
4
5
6
7
8
9
10
(18)
1) Live birth
2) Stillbirth
3) Abortion/miscarriage
4) DK/NR
4
Module 2: Assessing health needs; appendix D
151
(13)
1) Hospital
2) Health centre/clinic
3) Private hospital/clinic
4) Local TBA/healer
5) Other site of care
9) DK/NR____________
(20)
1) Doctor, nurse, nurse-midwife
2) Trained TBACHW
3) Untrained TBA, CHW
4) Relative, neighbor, friend
5) Other:
9) DK/NR_________________
(14)
1) Physician, nurse
2) Community nurse, midwife
3) CHW/volunteer
4) Traditional birth attendant
5) Mother, relative
6) Friend, neighbour
7) Other:
9) DK/NR
At' H c
- I (JO
Module 2: Assessing health needs; appendix D
152
Cluster form: Family planning
(1) Study No.________________
(2) Province No._____________
(3) Cluster No.______________
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7) Age
(8) Sex
(9) Are you currently married or living
with a partner?
(10) How many living children do you have?
N
A
M
E
1
2
3
4
5
6
7
8
9
10
(11) Have you given birth in the past 12
months?
(12) When was child born?
(13) Can you name one modern method of
contraception?
(14) Do you know where you can obtain
this method?
(15) Are you or your husband currently
using any family planning method?
(16) Which method are you/your husband
using now?
(17) For how long have you been
continually using (current method)?
(18) For how long have you been
continually practicing family planning
without interruption?
(19) What is the main source of your
family planning service or supplies?
(20) If you are not using family planning
now, have you or your husband ever
used any method in the past?
(21) Which method did you/your husband
use most recently?
(22) Do you/your husband intend to
practice family planning in the future?
(23) What is the most important reason you
are not using family planning now?
(24) What is the name of the local CHW?
(25) Has the CHW visited/contacted you
during the last three months?
Module 2: Assessing health needs; appendix D
153
Key (16) and (21)
1) Tubectomy
2) Vasectomy
3) IUD
4) Oral pill
5) Injection
6) NORPLANT
7) Condom
8) IUD, 8 Foam, emco jelly, cream, diaphram
9) Safe period, withdrawal
10) Other
99) DK/NR
(19)
1) Govt hospital/clinic
2) Govt field worker
3) Social marketing prog.
4) Private physician
5) Pharmacy
(23)
1) Want more children
2) Husband objects
3) Health reason
4) Religious reasons
5) Fear side effects
Module 2: Assessing health needs; appendix D
(17) and (18)
1) < three months
2) pit privy
3) 7-12 months
4) 1-2 years
5) 3-4 years
6) 5 years or more
9) DK/NR
6) Private hospital/clinic
7) NGO clinic
8) NGO field worker
9) Other
99) DK/NR
6) Method/service unavailable
7) Sterility
8) Breast feeding
9) Pregnant
10) Other
99) DK/NR
154
Cluster form: Acute respiratory infections
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7) Age
(8) Sex
(9) How many living children do you have
under five?
(10) How many children < five years sleep
in the same room as adults or other
children?
(11) How many people in your household
smoke inside your house?
(12) Are open fires for cooking or heating
used inside your house?
(13) Have any of your children been sick
with a respiratory illness within the
last two weeks?
(14) Did you seek treatment for the most
recent episode?
(15) Where did you seek treatment?
N
A
M
E
1
2
3
4
5
6
7
8
9
10
(16) What treatment were you given?
(17) Did you take the medicine for the
prescribed length of time?
(18) What is the name of the local CHW?
(19) Has the CHW visited/contacted you
during the last three months?
Key (15)
1) Treated at home
2) Visited the health centre
3) Contacted the CHW
4) Other:__________
9) DK/NR
(16)
1) Anti-microbial drugs
2) Bronchodilator and/or cough mixture
3) Antipyretic drugs
4) Other
9) DK/NR
Module 2: Assessing health needs; appendix D
155
Cluster form: Breast feeding
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
Date
/
/
_JZ1 Age
Sex
(9) How many living children do you have
under two?
(10) Are you breast feeding your youngest
child?
(11) After your baby was born, when did
you begin breast feeding?
(12) Did you give the baby the colostrum?
(13) Why didn’t you give the baby colostrum?
(14) Do you know why it is important to
give the baby the. colostrum?
(15) At what age of the baby will you/did
you stop breast feeding?
(16) At what age will you/did you begin
giving your baby formula or milk
other than breast milk?
(17) Water?
N
A
M
E
1
(18) Other liquids?
(19) Solid foods?
(20) Did any health worker teach you
about the benefits of breast feeding?
(21) Can you explain why it is important
to breast feed?
(22) Were you taught about the
supplemental foods and when they
should be introduced?
(23) Were you taught how to care for your
breasts?
J241 What is the name of the local CHW?
(25) Has the CHW visited/contacted you
during the last three months?
Module 2: Assessing.health needs; appendix D
2
3
4
5
6
7
8
9
10
156
Key (11)
1) Within three hours
2) 3-12 hours
3) 13-24 hours
4) < 24 hours
5) Not breast fed
9) DK/NR-
(13)
1) Problem with breast milk
2) Baby could not suck
3) Other
9) DK/NR
Module 2: Assessing health needs; appendix D
157
Cluster form: Diarrhoeal disease control/ORT
(1) Study No.
N
(2) Province No.
A
(3) Cluster No.
M
(4) Interviewer
E
(5) Respondent No.
(6) Date
/
/
(7) Age_____________________________
(8) Sex
(9) How. many living children do you have
under five?
(10) Do you know what is meant by
"diarrhoea?"
(11) Has (oldest child under two) had
diarrhoea in the last month?
(12) How long did is last?
(13) Did you do anything to treat it or just
let it run its course?
(14) How did you treat it?
(15) Have you ever heard of ORT, ORS,
SSS or (local name)?
(16) Is there any source of ORS in your
village?
(17) Is there a person living in your village
who has been trained to use ORS?
(18) Do you know how to mix ORS?
(19) How long can this solution be used?
(20) How long can you administer ORS to
a child with diarrhoea?
(21) Do you give extra fluids during
diarrhoea?
gruel?
soup?
rice water?
milk solutions with twice the water?
other fluids?
(22) If the child is still breast feeding, do
you continue breast feeding during
diarrhoea?
1
(23) When your child has diarrhoea how
often to you feed it?
Module 2: Assessing health needs; appendix D
2
3
4
5
6
7
8
9
10
158
(24) What is the name of the local CHW?
(25) Has the CHW visited/contacted you
in the last three months?
Key (13)
1) Treated it
2) Let it run its course
1) Treated it myself with packet of ORS
2) Treated it myself with homemade SSS
3) Treated it myself with gruel/cereal-based solid
4) Took child to relative
5) Took child to neighbour
9) DK/NR
6) Took child to local health worker
7) Took child to CHW health provider
8) Took child to health clinic, hospital
9) Other (specify):
99) DK/NR
Module 2: Assessing health needs; appendix D
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
/
/
(6) Date
(7) Age
|8) Sex
(?) How many children do you have?
(10) What are their names, ages, type of
disability?
(11) How did your child become disabled?
(12) Do you know how to prevent a similar
disability from occurring again?
(13) Have you sought treatment or therapy
for your child?
(14) Where did your child receive
treatment or therapy?
(15) What are the available centres which
could provide services to help your
child?
(16) What is the name of the local CHW?
(17) Has the CHW visited/contacted you
in the last three months?
N
A
M
E
Key (10)
1) Movement
2) Deformity
3) Hearing
4) Blindness
5) Speech
6) Behaviour
7) Other
9) DK/NR
(14)
1) Therapy or treatment centre
2) Community group
3) Special school
4) Other________
9) DK/NR
(11)
1) Illness
2) Birth
3) Injury
4) Other
9) DK/NR
1
ii)
>y
*b
ifc)
y
>b
<v
;a>
(
v
Cluster form: Childhood disabilities
id
tW itW lW iiW iW IW iiW H W ■ !
159
Module 2: Assessing health needs; appendix D
2
3
4
5
6
7
8
9
10
160
Cluster form: Child immunization
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7) Age
(8) Sex
(9) How many living children do you have
under two years?
(10) Has anyone from the health centre
ever talked to you about vaccinating
your children9
(11) Do you know which childhood
diseases can be prevented by
immunization?
Diptheria
Measles
Whooping cough
Tuberculosis
Tetanus
Polio
(12) Do you know age children should be
vaccinated against measles?
(13) Has oldest child under two been
immunized?
(14) Do you have the immunization card
for this child?
(15) If no card, can you remember when
your child was vaccinated?
Transfer info, from EPl card
(16 BCG
(17) DPT 1
(18 DPT 2
(19) DPT 3
(20) Polio 1
(21) Polio 2
(22) Polio 3
(23) Measles
N
A
M
E
1
2
3
4
5
6
7
8
9
10
Module 2: Assessing health needs; appendix D
I
:■
■
161
——--------
(24) Child is on schedule for age?
(25) For children 12-24 months:
Child is fully vaccinated
(26) When will you take your child for the
(next) vaccination?
Mother knows
Mother doesn’t know
Fully vaccinated (NA)
DK/NR
(27) What is the name of the local CHW?
(28) Has the CHW visited/contacted you
in the last three months?
Key (16) through (23): 1) Received on schedule; 2) Received off schedule; 3) Not received
Module 2; Assessing health needs; appendix D
162
Cluster form: Growth monitoring/nutrition education
N
(1) Study No.
A
(2) Province No.
M
(3) Cluster No.
E
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7) Age
(8) Sex
(9) How many children do you have
under two years?
(10) Is (name of oldest child under two)
registered for growth monitoring?
(11) Has any health worker ever explained
growth monitoring cards to you?
(12) Has this child ever been weighed by a
health worker, nurse or doctor?
(13) Do you have your child’s growth card
at home?
(14) Please show me the card.
(15) Interviewer: inspect card. Does growth
card have age and weight data plotted?
(16) Interviewer: record weighing history
from growth card. Total number of
times weighed.
(17) Times weighed in last quarter.
(18) Can you explain the information on
the growth card to me?
(19) During the last prenatal and/or
postnatal care visit, were you educated
about how to improve the nutritional
status of your child?
(24) What is the name of the local CHW?
(25) Has the CHW visited/contacted you
in the last three months?
Key (15)
1) Yes, plotted correctly
2) Yes, but plotted incorrectly
1
2
3
4
5
6
7
8
9
10
0) No, not plotted
9) DK/NR
Module 2: Assessing health needs; appendix D
163
Cluster form: Water supply, environmental sanitation and hy
giene
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7). Age________________________ _
(8) Sex
(9) Where do you usually get your
drinking water?
(10) Is vour water supply chlorinated?
(11) Do you usually boil water for
drinking?
(12) How long does it take you to walk
to vour source of water?
(13) Can you get enough water all year?
(14) Do you always wash your hands
before handling food?
(15) Please explain why it is important
to wash vour hands?
(16) What is the primary way this
household disposes of human
waste?
(17) Please explain why it is important
to use a structured / sanitary
facility?
(18) What is the name of the local
CHW?
(19) Has the CHW visited/contacted
you in the last three months?
INTERVIEWER OBSERVATIONS OF
HOUSEHOLD
(20) Does water contianed have a clean
cover/lid?
(21) Do pots, pans, plates and glasses
appear clean?
(22) Are fruits, vegetables, meats
covered and stored away from
small domestic animals?
(23) Does latrine appear to be used?
(24) Are the animals penned?
N
A
M
E
1
Module 2: Assessing health needs; appendix D
2
3
4
5
6
7
8
9
10
164
(25) Does garbage appear to be
disposed of in a sanitary way?
(26) What is the name of the local
CHW?
(27) Has the CHW visited/contacted
you in the last three months?
Key (12)
1)
< 15 minutes
2) > 15 minutes 9) DK/NR
(9)
1) Clean source: faucet/tap, pipe, bore hole, covered well
2) Unclean source: open well, pond/river/stream/rain water catchment
3) Other (specify):
9) DK/NR
(16)
1) water-seal latrine 4) open field
2) pit privy
5) bucket
3) WC
9) DK/NR
Module 2: Assessing health needs; appendix D
165
Cluster form: Accidents and injuries
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7) Age
(8) Sex
(9) Has anyone in this household had
a serious accident or injury in the
past year?
9.1 Name
9.2 Age
9.3 Sex
9.4 Type of injury codes
9.5 Treated?
9.6 Where treated?
9.7 Outcome?
(10) If someone in your household was
injured, what would you do to help
them?
(11) Where are the nearest emergency
care facilities?
(12) What is the name of the local
CHW?
(13) Has the CHW visited/contacted
you in the last three months?
N
A
M
E
Key 9.4 Type of injury codes
01) Fall
02) Occupational injury
03) Traffic injury
04) Poisoning
05) Other (specify)______________
09) DK/NR
9.6 Where treated codes
01) Hospital
02) Health care centre
03) CHW
04) Traditional healer
05) Other (specify)_____________
9.7 Outcome codes
01) Cured/recovered
02) Still recovering
03) Permanent disability
04) Death
05) Other
09) DK/NR
1
2
Module 2: Assessing health needs; appendix D
3
4
5
6
7
8
9
10
166
Cluster form: Chronic, non-communicable diseases
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7) Age
(8) Sex
N
A
M
E
1
2
3
4
5
6
7
8
9
10
Diabetes
(9) Do you now what diabetes is?
(10) Have you or any household
member ever been diagnosed as
having diabetes?
(11) Does anyone in this household
have diabetes now?
(12) Is this person being treated?
(13) Is the prescribed treatment being
followed?
(14) Do you monitor glucose level at
home?
(15) Do you and your household
members know how to handle a
diabetic emergency?
Hypertension
(16) Do you know what hypertension
is?
(17) Have you or any household
member ever been diagnosed as
having hypertension?
(18) Does anyone in this household
have hypertension now?
(19) Is this person being treated now?
(20) Is the prescribed treatment being
followed?
(21) Do you and your household
members know what to do in case
of a heart attack or stroke?
Anaemia
(22) Do you know what anaemia is?
(23) Have you or any household
member ever been diagnosed as
having anaemia?
Module 2: Assessing health needs; appendix D
167
(24) Does anyone in this household
have anaemia now?
(25) Is this person being treated now?
(26) Is the prescribed treatment being
followed?
(27) What is the name of the local
CHW?
(28) Has the CHW visited or contacted
you during the last three months?
Module 2: Assessing health needs; appendix D
168
Cluster form: Malaria
N
(1) Study No.
A
(2) Province No.
(3) Cluster No.
M
(4) Interviewer
E
(5) Respondent No.
/
/
(6) Date
(7) Age
(8) Sex
(9) Can you explain to me what malaria
is?
(10) Has anyone in your household had
malaria since the beginning of the
year?
(11) How did you know that it was malaria?
(12) How many days did the malaria
episode prevent that person from
conducting his/her daily activities?
(13) Do you know how malaria is spread?
(14) What are your household members
currently doing to protect themselves
from malaria?
(15) Has anyone in your household died in
the last 12 months?
(16) Which symptoms were present 1 week
before death?
(17) What do you think was the cause of
death?
(18) What is the name of the local CHW?
(19) Has the CHW visited/contacted you
in the last three months?
Key (11) and (16)
1) High fever
2) Shivers
3) Headache
4) Other _____
9) DK/NR
1
2
3
4
5
6
7
8
9
10
(14)
1) Using mosquito nets
2) Using household sprays
3) Eliminating standing water
4) Using anti-malarial drugs
5) Others
9) DK/NR
Module 2: Assessing health needs; appendix D
169
Cluster form: Tuberculosis
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7) Age__________
(8) Sex
(9) Can you explain to me what
tuberculosis is?
(10) Do you know how TB is spread?
(11) Do you know how to prevent
infection?
(12) Were al! your children vaccinated
with BCG?
(13) Have you or any family members
experienced a persistent cough
lasting more than two weeks?
(14) Did this person seek treatment for
TB?
(15) Where did this person go to seek
treatment?
(16) Was this person given medicine to
treat TB?
(17) Did they take the medicine for the
prescribed length of time?
(18) What is the name of the local
CHW?
(19) Has the CHW visited/contacted
you in the last three months?
Key (15)
1) Health centre
2) CHW/volunteer
N
A
M
E
1
2
3
4
5
6
7
8
9
10
3) Other
9) DK/NR
Module 2: Assessing health needs; appendix D
if
170
Cluster form: Sexually-transmitted diseases
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7) Age
(8) Sex
(9) Do you know what is meant by a
sexually-transmitted disease?
(10) Do you know what the difference
is between HIV infection and
AIDS? Probe for explanation.
(11) Can a person who looks healthy
be infected with an STD?
(12) Can a person get the AIDS virus
by shaking hands with someone
who is infected with the virus?
(13) Can a pregnant woman who is
infected with the HIV pass on the
virus to her unborn child?
(14) Can STDs be transmitted by
having sex with someone who is
infected with an STD?
(15) Is there a cure for AIDS?
(16) What are you currently doing to
prevent yourself or others from
becoming infected with an STD?
(17) Do you know how to use a
condom correctly?
(18) Where have you obtained
condoms during the last six
months?
(19) Have you been diagnosed with an
STD in the past 12 months?
(20) What was your diagnosed illness?
(21) Where did you go for treatment?
(22) How did you first learn about
STDs?
(23) What is the name of the local
CHW?
(24) Has the CHW visited/contacted
you in the last three months?
N
A
M
E
1
2
3
4
5
6
7
8
9
10
Module 2: Assessing health needs; appendix D
171
Key (16)
(21)
1) Using a condom
1) Government hospital
2) Practicing safer sex
2) Government clinic or health centre
9) Other
3) Private hospital
0) Nothing
4) Private clinic or health centre
(18)
5) Contacted a health worker
1) Government hospital
6) Other_______________
2) Government clinic or health centre 9) DK/NR
3) Private hospital
(22)
4) Private clinic or health centre
1) By word of mouth
5) Local dispensary
2) From a CHW or other health staff
6) Health worker came to you
3) Heard it on the radio
7) Other _________________
4) Other:______________
9) DK/NR
9) DK/NR
(20)
1) HIV/AIDS
2) Other STD
9) DK/NR
Module 2: Assessing health needs; appendix D
172
Cluster form: Vital events and health status
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7) Age
(8) Sex
(9) How many people live in this
household?
(10) Married women of reproductive age
(15 - 49):
Age
Pregnant?
(11) Children less than 24 months old:
N
A
M
E
1
2
3
4
5
6
7
8
9
10
Name
Age
Sex
(12) Children 24 - 60 months old:
Name
Age
Sex
(13) Other men, women and children.
Name
Age
Sex
Morbidity
(14) Is there anyone in your household
who has been sick this week?
Who is/are sick?
(15) SI number
Name
(16) Age
(17) Sex
(18) Disease code
(19) Treated?
(20) Where treated?
(21) Outcome
Module 2: Assessing health needs; appendix D
173
Mortality
(60) Were there any deaths in this
household during the last 12 months?
(61) SI number
Name
(62) Age_____________________________
(63) Sex
(64) Cause of death
(65) Date died
(66) Died where
(67) Death "yes"/"no"
(100) Were there any births in this
household in the last 12 months?
(101) SI number
Name
(102) Age
(103) Sex
(104) Outcome
(105) Date born
(106) Born where
(107) Birth certificate "yes"/"no"
Key (18)
1) Diarrhoea/dysentery
2) Anaemia
3) Scabies
4) Diphtheria
5) Whooping cough
6) Tetanus
7) Measles
8) Polio
(20)
\
\
1) Government clinic/hospital
2) Mobile clinic
3) Private clinic/hospital
4) Private doctor
5) Private midwife/nurse
6) Traditional practitioner
7) Pharmacy/drug store
8) Other:________________
9) DK/NR
9) Tuberculosis
10) ARI
11) Fever
12) Malaria
13) Other:__________
99) DK/NR
(21)
1) Cured/recovered
2) Still recovering
3) Permanent disability
4) Died
5) Other.-_____________
9) DK/NR
Module 2: Assessing health needs; appendix D
IB
174
(64)
1) Diarrhoea/Dysentery
2) Anaemia
3) Scabies
4) Diphtheria
5) Whooping cough
6) Tetanus
7) Measles
8) Polio
9) Tuberculosis
10) Acute respiratory inf.
Key (66) and (106)
1) Government clinic/hospital
2) Mobil clinic
3) Private clinic/hospital
4) Private doctor’s office/clinic
5) Private midwife/nurse’s clinic
6) Traditional practitioners centre
7) Home
8) Relatives house
9) Other:
99) DK/NR
11) Pregnancy related
12) Heart disease
13) Cancer
14) Diabetes
15) Typhoid
16) Accident
17) Pneumonia
18) Hepatitis
19) Malaria
20) Other
99) DK/NR
(104)
1) Live birth (single)
2) Live birth (twins)
3) Live birth (2)
4) Stillbirth
5) Died within 1 week
6) Died within 1 month
9) DK/NR
Module 2: Assessing health needs; appendix D
175
Cluster form: Child morbidity and mortality assessment
N
(1) Study No.
A
(2) Province No.
M
(3) Cluster No.
E
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7) Age_____________________________
(8) Sex
1
Module A: Child mortality
(9) In what month and year were you
born?
(10) How many of your sons are now
living with you?
(11) How many of your sons are now
living elsewhere?
(12) How many of your daughters are now
living with you9
(13) How many of your daughters are now
living elsewhere?
(14) Have you ever given birth to a child
who later died, even if she/he lived
only a short time?
(15) How many of your sons have died?
(16) How many of your daughters have
died?
(17) INTERVIEWER: Sum the answers to
questions 10-16.
(18) Apart from these births, have you had
any other live births?
(19) INTERVIEWER: If yes, ask if now
living or dead, and correct where
necessary.
(20) Could you give me the following
information on all your children born
alive, even if they are now dead,
beginning with your last delivery?
Child 1 month/year
Child 1 sex
Child 1 alive? If no, date of death.
Child 2 month/year
Child 2 sex
Child 2 alive? If no date of death.
(21) Respondent is:
Module 2: Assessing health needs; appendix D
2
3
4
5
6
7
8
9
10
176
(22) How many years has it been since you
were first married?
Module B: Child mortality
(OPTIONAL. Use if difficult to construct
histories)
(23) In what month and year were you
born?
(24) How many of your sons are now
living with you?
(25) How many of your sons are now
living elsewhere?
(26) How many of your daughters are now
living with you?
(27) How many of your daughters are now
living elsewhere?
(28) Have you ever given birth to a child
who later died, even if she/he lived
only a short time?
(29) How many of your sons have died?
(30) How many of your daughters have
died?
(31) INTERVIEWER: Sum the answers to
Questions 24 - 30.
(32) Apart from these births, have you had
any others?
(33) INTERVIEWER. If yes, ask if now
living or dead and correct where
necessary.
(34) Could you give me the following
information on all your children born
alive, even if they are now dead,
beginning with your last delivery?
(35) In what month and year was your last
live birth?
(36) Was this child a boy or a girl?
(37) Is she/he still alive?
(38) Did you have another live birth before
this last one?
(39) Was this baby a boy or a girl?
(40) Is she/he still alive today?
(41) Respondent is:
(42) How many years has it been since you
were first married?
Module 2: Assessing health needs; appendix D
177
INTERVIEWER: Check Q20 or Q28-33 to
see if any infant or child from this
household is dead. For most recent death,
ask the following questions:
(43) Did (deceased child) die due to
accident/iilness?
(44) What was the accident?
(45) From what illness did child die?
(46) What were the signs/symptoms
present two weeks before death?
(47) In opinion of the interviewer, of what
did child die?
(48) How long did child have the illness?
(49) Was she/he taken somewhere to
receive treatment for the
illness/accident before dying?
(50) Where was she/he taken?
(51) Where did she/he die?
(52) Do you have a death certificate?
(53) May I see that certificate?
(54) What was the cause of death, stated
on certificate?
(55) Has anyone else in this household
died in last 6 mos?
(56) Name
Age
Symptoms prior to death
Treatment received?
Child morbidity
(57) Has any child under two years been
sick in last two weeks?
(58) What were the symptoms of sickness?
(59) If diarrhoea, how long was/is the
episode?
(60) Does the child have diarrhoea today?
(61) Did you give the sick child ORS?
(62) Do you/did you continue breast
feeding your baby during illness?
Module 2: Assessing health needs; appendix D
178
—
(63) If coughing etc., for how many days?
(64) When the child had illness with cough,
did she/he breathe faster than usual
with short rapid breaths?
(65) If poor weight gain, has child had any
of the following symptoms?
swollen feet?
thin hair?
sores inside mouth?
dry eyes?
blindness?
no desire to laugh or play?
failure to develop intelligence?
(66) Did you seek advise or treatment for
the illness?
(67) Where did you seek advice or
treatment?
(68) Was anything given to treat the illness?
(69) What was given to treat the illness?
(70) Were you told by the health care
provider what illness your child had?
(71) Does the child have the symptoms
(mentioned above) today?
(72) In opinion of interviewer, what illnes
does/did child have?
(73) Has anyone else in this household
been sick in the last two weeks?
(74) Name
___ Age_____________________________
Symptoms
Treatment received?
(75) What is the name of the local CHW?
(76) Has the CHW visited/contacted you
in the last three months?
Key (21) and (41)
1) Woman herself
2) Her mother
3) Her sister living in same house
4) Other
(46)
1) Diarrhoea
2) Diarrhoea with blood
3) Cold
4) Difficulty breathing
5) Rash or pimples
6) Fever
7) Seizures
8) Other
(specify):__
9) DK/NR
Module 2: Assessing health needs; appendix D
179
(47?^^^
1) Infection (specify) _
2) Diarrhoea
3) ARI (pneumonia)
4) nutrition
5) Other (specify) _________
6) Vaccine preventable disease (specify)
9) DK/NR
(50) and (51)
1) Public hospital
2) Health centre
3) Doctor’s office
4) Clinic/private hospital
5) Pharmacy
6) Traditional healer
7) Other (specify)
9) DK/NR
(58)
1) Fever
2) Diarrhoea
3) Difficulty breathing
4) Poor weight gain/weight loss
5) Other (specify)______
9) DK/NR
(67)
1) Government clinic/hospital
2) Mobile clinic
3) CHW
4) Private doctor
5) Traditional practitioner
6) Pharmacy/drug shop
9) Other (specify)_________
(69)
1) Injection
2) Antibiotic
3) Anti-malarial
4) Cough syrup
5) Other pill or syrup
6) Unknown pill or syrup
7) Home remedy/herbal medicine
8) Other (specify)___
9) DK/NR
(72)
1) Infection (specify)___________
2) Diarrhoea
3) ARI (pneumonia)
4) Malnutrition
5) Other (specify)___________
6) Vaccine preventable disease (specify)
9) DK/NR
Module 2: Assessing health needs; appendix D
180
Cluster form: Adult morbidity and mortality assessment
(1) Study No.
(2) Province No.
(3) Cluster No.
(4) Interviewer
(5) Respondent No.
(6) Date
/
/
(7) Age____________
(8) Sex
(9) How many adults live in this
household?
(10) Married women of reproductive age
(15-44):
Name
Age
Pregnant?
(11) Other men and women9
Name
Age
Sex
N
A
M
E
1
2
3
4
5
6
7
8
9
10
Adult morbidity
(12) Has any adult in this household been
sick in the past two weeks?
(13) Please tell me their names and when
sick?
Name
When sick?
(14) Is there any adult in your household
who is sick today?
(15) What were/are the symptoms of the
illness?
(16) How long did the illness last?
(17) Was advice or treatment sought'9
(18) Where was advice or treatment
sought?
(19) Was anything given to treat the illness?
(20) What was given to treat the illness?
(21) In the opinion of the interviewee,
what is/was the illness?
(22) In the opinion of the interviewer, what
illness does/did the person have?
Adult mortality
(23) Was there any death in this household
during the last 12 months?
(24) Who died?
Module 2: Assessing health needs; appendix D
181
—
(25) What symptoms were present two
weeks before death?
(26) How long did (deceased), have illness?
(27) Was advice or treatment sought?
(28) Where was advice or treatment
sought?
(29) Was anything given to treat the illness?
(30) What was given to treat the illness?
(31) Where did the person die?
(32) Do you have a death certificate?
(33) May I see that certificate?
(34) What was the cause of death,
according to certificate?
(35) In the opinion of the interviewee,
what was the illness?
(36) In the opinion of the interviewer,
what did the person die of?
(37) What is the name of the local CHW?
(38) Has the local CHW visited/contacted
you during the last three months?
Key (15) and (25)
1) High fever
2) Diarrhoea
3) Weight loss
4) Persistent cough
5) Cough w/sputum
6) Earache/ear discharge
7) Seizures
8) Weakness or lethargy
9) Other (specify)
99) DK/NR
(20) and (30)
1) Injection
2) Antibiotic
3) Anti malarial
4) Cough syrup
5) Other pill or syrup
6) Unknown pill or syrup
7) Home remedy/herbal medicine
8) Other (specify)
9) DK/NR
(18), (28) and (31)
1) Government clinic/hospita
2) Mobile clinic
3) CHW
4) Private doctor
5) Traditional practitioner
6) Pharmacy/drug store
7) Other (specify)__________
9) DK/NR
(22)
1) Dysentery
10) STD/HIV
2) Anaemia
11 Polio
3) Scabies
12) Tuberculosis
4) Diphtheria
13) ARI
5) Whooping cough 14) Fever
6) Tetanus
15) Malaria
7) Measles
16) Other:
8) Diabetes___________
9) Hypertension
99DK/NR
Module 2: Assessing health needs; appendix D
182
(35) and (36)
1) Diarrhoea/Dysentery
2) Amemia
3) Scabies
4) Diphtheria
5) Whooping cough
6) Tetanus
7) Measles
8) Polio
9) Tuberculosis
10) Hypertension
20) Other specify
11) Pregnancy- related
12) Heart disease
13) Cancer specify
14) Diabetes
15) Typhoid
16) Accident
17) Pneumonia
18) Hepatitis
19) Malaria
99) DK/NR
Module 2: Assessing health needs; appendix D
183
Appendix E: Guidelines for training and
supervising interviewers
Detailed guidelines can be found in any standard textbook on survey
methods. The following is a brief list of some hints that are especially
relevant for rapid surveys in PHC.
ASSIGNMENTS
• Assign caseloads that can be easily completed within a few days.
Don’t assign too many cases or clusters. A rule of thumb: one
interviewer can finish approximately 8-15 interviews, or 1-2 clusters
per day.
• Assign each interviewer to clusters close to one another to reduce
travel time and cost.
• It’s better to assign interviewers to areas where they are not known,
but also close to their homes.
• Prepare the assignments before sending the interviewers to the field.
Make sure they know exactly where they are to go and what they
are to do.
MATERIALS
• Interviewers should have the following: folder or three-ring binder,
enumeration forms, respondent assignments, questionnaires, map of
survey area, letter of introduction, pencil, eraser.
BRIEFING AND TRAINING
• Even experienced interviewers need to be given an orientation to
the survey so they can become familiar with the instrument and the
sampling plan, and raise questions.
• Brief the interviewers as a group in order to develop team spirit and
a common understanding of the survey, and to share their experi
ences, suggestions, and questions.
• Share pre-test results and experience with similar surveys, if it is
available.
• Develop a specific agenda for the briefing/training. Distribute it to
the interviewers so they will know what to expect.
• Use an overhead projector or newsprint to review the instruments
and sampling procedures.
Module 2: Assessing health needs; appendix E
184
• If your questionnaire includes open-ended questions or probes, make
sure that the interviewers know the most typical responses for the
former and the correct responses for the latter.
• Have two experienced interviewers conduct an interview in front of
the group. Critique the interview and invite the group to join in the
critique.
• Give each interviewer a chance to practice an interview, either with
another interviewer or in a practice session with a cluster.
• Emphasize the importance of interviewing the selected individuals,
of not substituting, of setting up a convenient time to call back for
the interview, if necessary, and of travelling to the household even
if it is far away and the respondent may not be home.
• Review the "Interviewer’s Code." Explain to new interviewers the
rationale behind each item.
INTERVIEWER’S CODE
1. Be completely honest in your work.
2. Be reliable and conscientious.
3. Be completely objective in manner.
4. Be accurate and neutral in asking and recording answers to
questions.
5. Write the responses fully and legibly.
6. Be understanding, patient, but do not prod or lead the respondent.
Never suggest an answer.
7. Be presentable: neat, groomed, clean.
8. Be prepared — read and understand the questions and responses.
9. Be neutral. Don’t show reactions, emotions, agreement, or
disagreement with responses. Don’t give your opinion.
10. Repeat a question if the respondent doesn’t understand it.
11. Use an informal, casual manner when asking the questions. Try to
build rapport and trust. Avoid appearing to be superior more
intelligent, judgmental, or impatient.
12. Don’t share the responses with others: neighbours, relatives. They
are confidential.
13. Keep note of any problems or unexpected reactions that occur
during the interviews. They may help improve the survey.
Module 2: Assessing health needs; appendix E
185
SUPERVISION
• Begin supervision during the briefing/training. Look for those who
may not be motivated in or knowledgeable about the survey. Work
with them. If they do not respond, replace them before beginning
the survey.
• If enumeration is involved, have a larger number of enumerators
than needed for interviewing. Select the best enumerators to be
interviewers.
• Tell the interviewers that there will be spot checks, re-interviews to
check validity, and perhaps a post-enumeration survey. Spot check
five to ten percent of the sample. The smaller the sample, the
greater the percentage of spot checks should be.
• Do spot checks and some re-interviews early on the first day.
• Have the interviewers check their completed questionnaires before
they leave the cluster so that they can re-interview respondents, if
necessary.
• At the end of the first day, have the interviewers review one another’s
completed questionnaires and respondent disposition forms to iden
tify problems and to suggest solutions.
Module 2: Assessing health needs; appendix E
187
Appendix F: Cluster sampling programme
This appendix contains a computer program (Cluster identification
worksheet) for selecting cluster samples. It uses a spreadsheet program.
You can load the computer file into Lotus 1-2-3, Quattro, or any similar
program that will accept 1-2-3 files. You fill in the required information
about the survey population in the first three columns. The program
generates a listing of clusters and their locations in the last two columns.
The program can be used for single and multi-stage cluster sampling.
Cluster identification worksheet
This worksheet is the computerised version of the manual form shown
in Step 5. It is a Lotus 1-2-3 spreadsheet named CLUSTER.WK1. Load it
into your computer from the PHC MAP diskette.
Although most people think of clusters as natural groupings of people
(villages, census tracts, urban blocks), this is incorrect. In cluster sampling
you will divide your total survey population into 30 equal groups. Each of
these groups will be a "cluster." Then you will identify seven respondents
in each of these clusters.
You need to know the total population of your survey population to
determine the size of each cluster. Simply divide the total population by
30. For example, if your catchment area has 45,000 people, each cluster
will include 1,500 people (45,000/30 - 1,500).
It doesn’t matter if there are fewer or more than 30 "natural clusters,"
since you will define the clusters by dividing the total population into 30
groups of equal size.
It also doesn’t matter if the population is scattered over a large area.
People can even be on islands or in remote areas and still be included in
the sample. If you want your sample to represent all of your target
population, then do not leave any "natural clusters" out. However, if it is
not feasible to include some areas, then leave them out. BUT, your sample
will not represent those who are left out. If you limit your sample to people
within one kilometre of a health centre, then that is all it represents.
Complete the cluster identification worksheet
You must have estimates of the size of sample sub-units. List these
sub-units (villages, census tracts, voting precincts, towns) in Columns A and
B of the Cluster identification worksheet. Record the population of each
subunit in Column C. This figure does not have to be exact. The relative
Module 2: Assessing health needs; appendix F
188
size of each subunit is what is important. Thus, you can use recent census
data even if it is a few years old.
The computer will calculate the cumulative population in Column D and
the total population. In the example, this is 29,481, which you can see at
the bottom of Column C and on the second line at the top of the page.
Enter the number of clusters you want at the top of the form (in most
cases this will be 30). The computer divides the total population (29,481)
by the number of clusters (30) to get the cluster size (983), which is displayed
on the third line at the top.
This figure is also called the sampling interval: the interval between one
cluster and the next. That is, the cluster start numbers will each be 983
units from one another.
The computer will now do two things when you press <Enter>. It will
select a random start number and place it on the fourth line. The
example shows 491. Then it will use that number to identify the start
numbers for each cluster. These will appear in Column F. Column E gives
you the numerical order of your 30 clusters.
DO NOT MAKE ANY CHANGES. That will generate a new list of start
numbers. Print this list out first so that you have a record.
The last step is to identify the communities where those start numbers
are located. Compare the first number in Column F (491) with the
cumulative figures (Column D). Find the first number in Column D that is
greater than 491. That is 548 (Pagai). Thus, the first start number is in
Pagai. Write that on the first line in Column G. Do the same thing with the
second start number in Column F (1,474). The first number in Column D
that is greater than 1,474 is 1,964 (Serina). Write that in Column G next
to 1,474. Continue until you have identified all 30 communities where your
start numbers are located.
Communities that have large populations (such as # 14 and # 16, Pingra
and Srivish) are likely to have more than one start number. That is because
their population is two or three times larger than the cluster size (983).
Therefore, two or three of your clusters may be in one community.
Multi-stage sampling for large clusters
If your population is very large, you can select your sample in stages.
Start with the largest administrative unit, say districts. Select your 30
cluster start numbers and identify the districts that will be in the sample.
You are going to list the population of the sub-units (say sub-districts)
of each of these districts. Then you are going to find the sub-district where
the random start number is located.
Module 2: Assessing health needs; appendix F
189
Lets use Serina as an example. Use the cluster identification form to
list all of Serinas subdistricts in Column A and each subdistrict’s estimated
population in Column C, just as before. However, in the first row enter the
name of the district (Serina) and the corresponding cumulative population
figure that was generated in the first worksheet (1,278). You need to add
that number to Serina’s population to match the start number with your
subdistricts.
The following example shows what your worksheet might look like.
Column D will give you a cumulative population for Serina. Then find the
first number in Column D that is larger than the start number for Serina
(1,474), which is in Barley.
CLUSTER IDENTIFICATION WORKSHEET
=
=
=
Number of clusters
Sample population size
Cluster size (sampling interval)
Random start number
30
29,482
983
491
A
B
C
D
E
Community Community Estimated Cumulative Selected
Name
Number Population Population Cluster
Serina
Kota
Barley
Sanburn
Geneva
N. Barn
S. Barn
TOTAL
1
2
3
4
5
6
129
123
142
78
106
108
686
1278
1407
1530
1672
1750
1856
1964
1964
2
F
Start
Number
1474
Repeat this process for each of the 30 districts chosen. Note that you
do not need to produce the output data (Columns E and F) except for the
first selection of start numbers.
You can also repeat this process for each selected subdistrict to identify
the villages where the start numbers are located. If the households in the
villages are numbered, you can actually identify the individual household
where you would start your interviews.
However, it would be better to select your households at random once
you identify the smallest administrative unit. Simply number them and
Module 2: Assessing health needs; appendix F
190
select 7-10 households at random, more if the households do not all include
eligible respondents.
Module 2: Assessing health needs; appendix F
191
Appendix G: Other sampling tools
This appendix includes five computerised tools that you can use for
sampling. They are:
APPENDIX G.l: ESTIMATES OF TARGET GROUP SIZES
APPENDIX G.2: SAMPLE SIZE ESTIMATION FOR WHO TWO-STAGE
CLUSTER SURVEY
APPENDIX G.3: RANDOM NUMBER TABLE
APPENDIX G.4: RANDOM SAMPLING PROCEDURES
APPENDIX G.5: ESTIMATING FERTILITY AND CHILD MORTALITY
RATES AND RATIOS
Appendix G.l: Estimates of target group sizes
The following file (TARGET.WK1) is used to estimate the size of the
principal target groups in a given population. You will need to know the
approximate size of the total population under study and the percentages
of women and children by age. It also helps to have approximate rates for
births and deaths. Insert the required information in the "USER INPUT"
column, and the programme will make all the necessary calculations.
For example, the data currently in the file show that in a population of
4,196 there will probably be 1,096 married women aged 15-49. This would
usually be a large enough group to draw from for most samples. However,
there would be only two maternal deaths each year in that population. To
have a large enough sample of maternal deaths (say 20), you would have to
have a much larger population. You can determine how large that popula
tion would have to be by increasing the estimated total population number
in the "USER INPUT" column until the "Maternal death" figure reaches 20.
If you do not have the population size but know the number of
households and household size, multiply the two and enter the estimated
population size in cell F23. Then insert the household size and number of
households in the appropriate cells (F24 and GG25). You could also change
the formula in cell F23 to (F24*G25).
Insert population estimates in the "USER INPUT" column. Estimates of
eligible subjects are computed and shown in the "COMPUTER CALCU
LATED" column. The estimates in this table are based on data from Dhaka,
Bangladesh. Enter data in WORKSHEET.
Module 2: Assessing health needs; appendix G.l
192
SUMMARY OF SAMPLES:
Population
Households
Children
4,196
800
Live Births
Under 5
0-11 mo
12-23 mo
24-60 mo
Women
2,037
15-49 yrs
1,096
Maried women 15-49 829
Pregnacies (1 yr)
357
"Detectable"
238
Maternal deaths
2
147
565
89
101
375
Deaths
0-11 mo
1-4 yr
20
3
USER
INPUT
WORKSHEET
1. Estimated total population’(see note)
2 Estimated household size
3. Estimated number of households
4. Estimated male/female ratio:
5. Estimated number females
6. Population age distribution:
Males
Females
<5 yrs
5-14 yrs
15-49 yrs
> 49 yrs
4,196
5.2
800
100
106
2,037
13.5%
28.2%
53.8%
4.4%
COMPUTER
ESTIMATES
0.94
274
575
1,096
89
7. Estimated married women 15-49:
Married
Un-married
Widowed
Separated
Divorced
0-11 mo.
12-23 mo
24-60 mo.
89
101
375
IMR
CMR
MMR
0.1340
0.0066
0.0110
20
3
2
8. Estimated pregnancies (1 year):
Est. crude birth rate
Est. pregnancy wastage
Est. pregnancy detection rate
Est. no. detected pregnancies
9. Estimated number of births (1 year):
10. Estimated number children 5 years:
11. Estimated mortality:
Infant deaths lyr
Child deaths 1-4 yrs
Maternal deaths
829
219
36
6
5
75.7%
20.0%
3.3%
0.6%
0.4%
357
0.0350
0.0500
66.6%
238
147
565
15.7%
17.9%
66.4%
” NOTE If you do not have the population size but have the number of households and
household size, then multiply the two and enter the estimated population size in cell
F23.
Module 2: Assessing health needs; appendix G.l
193
Appendix G.2: Sample size estimation for WHO twostage cluster survey
The program shown on the next two pages was developed by Ralph
Frerichs. It can be used by the manager to determine the sample size
needed for a cluster and a random sample based on the information
summarised at the beginning of Step 5: Sampling. The manager merely
needs to have:
• an estimate of the proportion of the population with a particular
attribute (children fully immunized);
• the desired confidence interval (e.g., 90 percent);
• the number of clusters (usually 30);
• the average number of respondents per cluster (usually 7-10);
• and the estimated "intraclass correlation coefficient" (see below).
By trying different estimates of these five items, the program can
compute various sample sizes for both random and cluster samples. The
program also computes the design effect and indicates with a Yes or No
whether the sample size is acceptable or not. The estimated confidence
intervals at 90, 95, and 99 percent are also computed.
This program is designed to estimate the sample size for a single
population. This could be used, for example, to assess health needs in a
single district. The "Hypothesis testing" program is used for two samples.
It could be used, for example, to compare health needs in two districts, or
in a "before and after" survey to assess changes over time.
Note: The intraclass correlation coefficient is an estimate of the homo
geneity of subjects within a cluster. The value ranges from 0 to 1, with 0
meaning that there is no difference between people in one cluster and those
in the others and Figure 1 meaning that the people within a cluster have
similar characteristics, e.g., they have all been immunized.
Frerichs summarised examples of coefficient values from several studies.
Infant deaths = 0.00 means that there is no difference in the pattern of
infant deaths froml cluster to another. Immunization coverage = 0.23
means that there is a moderate tendency for children within a given cluster
to have a similar immunization history. The tendency for children in a given
cluster either to have or not to have received the third dose of DPT is even
higher.
Module 2: Assessing health needs; appendix G.2
194
0.00
0.002
0.049
0.099
0.23
0.26
0.27
0.31
0.47
1. Infant deaths
2. Tetanus
3. Pertussis
4. Measles
5. Immunization coverage
6. First dose DPT
7. Trained birth attendant
8. Second dose DPT
9. Third dose DPT
The computer file is reproduced on the next two pages.
Sample Size Estimation For WHO Two-stage, Cluster Survey
INSTRUCTIONS: Fill in estimates where indicated in the first block. The program computes
sample sizes needed for: 1) random; and 2) cluster samples. It computes the design effect for
a cluster sample, and determines whether the sample size is acceptable. There are two
programs: the first (below) is for INTERVAL estimation (of one population). The second (page
down) is for HYPOTHESIS TESTING (of two populations).
Interval estimation
To be completed by the investigator
Fill In
0.300
0.070
V V
1.96
30
7
0.03
V V V V
Estimated proportion with the attribute
One-half length of confidence interval
Desired level of confidence
(90% = 164; 95% = 1.96; 99% = 2.58)
Number of clusters (should be >25)
Average number per cluster
Intraclass correlation coefficient (ROH)
Derived by the program
Necessary variance of sample proportion
Sample size if SIMPLE RANDOM SAMPLE
Variance of proposed cluster sample
Sample size for proposed CLUSTER SAMPLE
Est. DESIGN EFFECT for cluster sample
Sample size specifications are OK
0.001276
165
0.001180
210
1.18
Yes
Interval estimation
Estimated Confidence Interval
for Prop, with Attribute of Interest
Confidence Level
Proportion
II
90%
95%
99%
Upper
0.3563
0.3673
0.3886
Lower
0.2437
0.2327
0.2114
ScaHng^^________^^^^^____—____________ 02______
Module 2: Assessing health needs; appendix G.2
195
Hypothesis testing —Two samples of equal size
Fill in
Est. proportion with the attribute in FIRST
population
Est. proportion with the attribute in
SECOND population
Desired level of statistical significance
(<10=1.64; <.05=1.96; <01=2.58)
Desired power of the test to statistically
detect the est. difference in proportions
(9096=128; 95%-1.64; 99%=2 34)
Average number per cluster
Intraclass correlation coefficient (ROH)
0.30000
<—
0.45000
<—
1.96
<—
1.28
<—
7.0
0.30
<—
<—
Derived by the program
Necessary sample size if SIMPLE RANDOM
SAMPLE
Necessary sample size per study group using
indicated TWO-STAGE CLUSTER SAMPLE
Necessary number of cluster
(should be >25)
277
268
38
Hypothesis testing
Estimated confidence interval comparing two proportions
Confidence level
95%
90%
Proportion
Group
2
1
1
2
Upper
0.344 0.504
0.360 0.477
Lower
0.250
0.396 0.240 0.385
Scaling
0.1
1.
99%
1
0.379
0.221
2
0.535
0.365
Appendix G.3: Random number table
The following is an excerpt from a computer file that you can use to
generate a random number table to fit the exact size of your population.
Simply insert the population total in cell A5 (next to the "name of the site")
and press F9 to compute a new table. The table shown below can also be
used if desired.
Module 2: Assessing health needs; appendix G.3
196
Instructions: Insert population of area in cell A5, and name of site in B5. Press F9 to generate
a new table.
POPULATION LOCATION
54333 Name of site
___
_
_
_________________ ____________________—--------- ----------------------------
24915
2872S
4083
48145
52967
20539
53034
25748
15222
26093
17262
34054
12052
38180
11757
5655
38328
13608
5880
22224
2305
38875
19594
52698
1676
24436
1350
8549
34395
22343
49105
50569
22489
52809
6607
44172
17752
49278
35294
41389
12835
6903
10018
42747
44501
36997
17150
54096
4739
50795
26923
31465
4052
32750
18660
14822
46328
44573
31431
45381
23786
33666
21510
41315
21776
23736
10521
5382
4727
32856
4337
22374
9904
13927
3849
9810
8926
29411
34179
729
40717
22841
33466
27195
50807
6742
48931
27909
34790
50084
32584
53626
11545
4857
28178
44561
20125
39882
21661
14308
32240
6268
21327
52275
16134
10623
18930
21490
46373
20010
14221
8854
53612
6570
34326
18696
33842
18710
21015
25697
48932
48878
36688
34894
15185
52622
19397
5018
37853
52805
13997
28443
30296
7396
1187
33790
18916
17057
34
4524
31494
16299
21785
40710
33350
24051
6453
4103
46711
8030
45891
12900
32394
37076
3935
38135
19613
22626
2583
48516
11411
48799
14255
1657
39772
35774
22326
20213
21128
847
45947
51890
20533
50608
41180
6660
24685
36335
21685
3187
17188
16658
51940
13339
16290
50604
34248
18475
41654
22904
41918
17744
40221
53259
7454
34666
6400
38115
43457
29066
37938
48663
13207
54106
26353
38992
646
25245
53795
42416
37839
4944
49488
3268
29828
31719
25218
8000
54091
1387
10599
47298
11475
40299
5581
44313
44970
43092
22395
4123
53023
20522
39512
35042
38566
38110
53018
21217
52834
9691
28755
52022
5913
53454
9748
39988
27152
5900
41546
29899
26564
43852
21391
21571
777
42471
18507
42773
30803
49582
17849
33623
22557
50095
4911
14953
50149
15620
43759
3743
5070
46817
39767
16971
16508
49742
21519
52255
26407
17498
45044
20970
19092
22916
191
13238
14520
33512
28660
33586
45367
21949
16742
5034
4606
34919
15502
8596
2494
48441
24557
17006
52744
47826
41735
24707
29182
30101
22846
25948
22941
46061
41316
51594
11655
13294
13885
18902
44388
32140
5591
38674
17344
43322
18216
343
39203
41768
43724
21602
25396
38128
10141
4849
44768
23598
37091
16631
52886
3113
24174
25385
37387
5213
7725
18291
16164
45430
9772
1635
8887
13177
49086
15432
33470
48481
33613
21779
22956
36736
30252
21223
31288
3831
14346
30653
30707
6967
28512
45098
37737
37292
14776
48411
2876
38916
46928
20001
35314
530
12032
26052
47288
45279
41895
51900
26258
17915
47449
23819
19199
42379
19565
17527
21543
43601
16230
42163
32857
3619
48956
15042
52169
9642
24455
45602
48868
12106
6764
3057
27829
8733
46640
27891
1943
4840
43158
13938
10807
43355
26639
10509
8557
51371
53639
40324
29272
43727
53479
32643
20883
40714
7581
52465
24645
19246
52994
30613
27726
48323
21174
37907
51804
31090
22218
30054
3500
25983
36971
9694
721
49434
30191
28057
10290
5645
47968
20234
21049
35440
10047
16982
29559
49152
43912
43427
54206
32397
33145
39256
32509
40301
26077
52602
39403
51674
47975
39018
738
34710
27716
13263
41228
39624
42164
21643
17618
34878
31496
10376
16433
51256
19555
53949
53580
37567
20427
1890
8027
6334
3690
27925
37262
25135
33802
13097
32877
48587
6003
12384
30155
48123
36516
41157
45985
24960
23239
31036
43539
24279
Module 2: Assessing health needs; appendix G.3
i
:i
3
rut
a
3
3
ou- - -
197
Appendix G.4: Random sampling procedures
The random number spreadsheet shown in Appendix G.3 can also be
used to generate a random sample for you. It can be used to generate a
complete sample or the last stage of a cluster sample. It can be used for
any size population as well, from 100 cases to more than 100,000 cases.
The basic principle behind random sampling is that every unit has the
same chance of being selected. To make this possible, you need a complete
and up-to-date listing of all members of the target population that you wish
to sample. If you go to a village of 100 households, you can enumerate the
households (give each one a number) and draw your sample from that
listing. Usually you don’t want to include all households, only those with
eligible respondents. Thus, your enumeration could be designed to list only
those households with children under age two years. Then you draw your
sample from that listing.
Many PHC programmes do a complete listing of all households in their
catchment area every year. Some have computerised records of each family
and each family member. If you have either of these, you can probably
draw a random sample. Stratified random samples are preferred if the
population is made up of significantly different sub-populations. This is
because they provide more accurate data on each subgroup in your
population. So if your population is made up of rural and urban subgroups,
poor and middle-class, or Hindu, Moslem, Christian, and Buddhist sub-pop
ulations, AND your household registration system includes information on
these characteristics, then you can draw a random sample fairly easily. If
the size of each group is known, it is best to draw the sample in proportion
to the total. For example, if Moslems constitute 60 percent of the popula
tion, then the Moslem stratum should be 60 percent of the sample.
Once you have your listing of your population, follow these steps:
Use TARGET.WK1 to estimate the size of each target group in your
population. You may skip this step if you have precise data on the
characteristics of each target group. For example, if you know how
many pregnant women there are in your area, go to the next step. If
you don’t know, use TARGET to make an estimate.
2. Use SIZE.WK1 to determine the required sample size for each target
group. Suppose that you want to get information about pregnant
women who are enrolled in your programme. If you estimate that 30
percent of them are enrolled, then you can use SIZE.WK1 to estimate
1.
Module 2: Assessing health needs; appendix G.4
198
3.
the size of the sample of pregnant women. At a 95 percent confidence
level, that would be 165 women (see Appendix G.2).
Use RANDOM.WK1 to generate a random sample of each target
group. Finally, make sure that each pregnant woman in your register
has a sequential number (from 1 to N). Assume that there are 250 of
these women. Enter this number (250) into cell B4 of the Random
number table (RANDOM. WK1). Press F9 to generate a random
listing of these 250 women. Take the first 165 listed as your sample.
The following excerpt from the Random number table displays this
listing. If some of the women listed are not eligible or available, substitute
the next numbers on the list.
Instructions: Insert population of area in cell A5, and name of area in
cell B5.
Press F9 to generate a new table.
POPULATION LOCATION
250 Pregnant women
194
173
109
107
124
216
23
34
151
17
7
169
113
45
91
154
91
98
206
166
130
104
128
45
24
1
169
41
10
152
112
141
135
130
207
76
214
115
151
74
69
137
204
219
24
174
137
200
184
130
35
231
201
209
50
235
129
14
129
27
191
134
16
1
115
106
55
233
213
226
24
236
7
50
71
41
95
207
106
205
18
81
130
15
130
75
90
216
222
28
219
90
162
235
198
12
193
49
162
125
24
173
99
27
111
174
186
2
82
98
183
106
213
38
162
70
15
124
5
115
109
208
51
61
51. 81
210
26
172
207
54
170
223
8
122
136
17
47
249
56
233
52
208
248
174
67
70
185
220
18
192
114
142
112
66
240
49
68
18
2
238
42
Module 2: Assessing health needs; appendix G.4
199
Appendix G.5: Estimating fertility and child
mortality rates and ratios
The vital events and mortality questionnaires (Appendix C) produces the
data you will need to construct both fertility and mortality estimates. A
rough rule of thumb is that you will need about 200 respondents in each
5-year age group to have a large enough sample to compute the estimates.
Since there are normally 7 age groups, that means that you will need a
sample of about 1,400 married women aged 15-49. That would give you
about 300 live births (an average of 30-50 per age group). That is enough
to compute fertility rates directly.
That same sample of 1,400 women would not provide enough cases to
compute child mortality rates directly, however. You would identify
only about 30-40 infant deaths and 4-6 child deaths in the past year.
Obviously, you would have to expand your sample -Significantly to get
enough cases to compute mortality rates directly. If you use the TARGET.WK1 program to make some estimates, you will find that you need to
interview over 7,000 married women to find 20 child deaths over the past
year.
There are a number of indirect techniques that demographers use to
estimate mortality and fertility rates. These techniques produce "life tables"
that show the probability of deaths or births among different age groups.
An example is shown below of a table that provides estimates of child
mortality by ages 1, 2, 3, 5, 10, 15, and 20. Child mortality (age 2-5) is
computed by subtracting infant mortality from under 5 mortality (0.50 .028 = 0.022).
Indirect measures of childhood mortality
Age group of
women
Number of
women
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Total
2,826
2,648
1,818
1,334
1,010
1,029
629
11,294
Number of
children born
285
3,052
5,851
6,978
7,054
8,544
5,641
37,405
Number of
children dead
Percent
Dead
Mortality
measures
8
105
318
350
437
705
559
2,482
0.028
0.034
0.054
0.050
0.061
0.083
0.099
0-1 yr
0-2 yrs
0-3 yrs
0-5 yrs
0-10 yrs
0-15 yrs
0-20 yrs
Module 2: Assessing health needs; appendix G.5
200
If you use indirect methods, you should be able to get enough cases with
a sample of 1,700-2,000 married women. That is because these methods
rely on birth and death histories of women, not just the events of the past
year. Thus, each woman interviewed can contribute information about
several years of experience, which may include two or three births or deaths.
Indirect methods are rather complex to compute, and you should get
help from a trained demographer before deciding to undertake this kind of
analysis.
The UNICEF handbook on Measuring childhood mortality shows how to
collect and process child mortality data using a short questionnaire that we
have included in Appendix C (Child mortality). You can use this question
naire just like any other in this module. However, the authors caution not
to change the order of wording or questions. They have been extensively
tested and any revisions could bias the results. On the other hand, you may
combine this questionnaire with others to carry out a multiple survey of
several topics.
You can also use the cluster sampling methodology described in this
module. Of course, your sample will have to be 10 times larger than the
typical 30 cluster x 7 respondent sample. You can use the SIZE.WK1
program in this appendix to examine various combinations of clusters and
respondents. The following list will give you a rough idea of these
combinations and the associated design effects for samples of about 2,000.
These combinations are all based on the following assumptions:
• Estimated proportion with the attribute (mortality)
5%
• One-half the length of the confidence interval
.02
• That is, the true value will be between 4 and 6%
• Desired level of confidence
95% = 1.96
• Estimated intraclass correlation coefficient
.005
Let us assume that you decide to draw 60 clusters of 34 respondents
each. Use the CLUSTER.WK1 file to select your cluster start numbers.
Follow the instructions to draw 34 respondents from each cluster (prefer
ably at random). Although the UNICEF methodology allows you to inter
view all eligible women in a selected household, it would be better to
interview only one per household. That will ensure that your results are
more representative of the area’s population.
Module 2: Assessing health needs; appendix G.5
201
The UNICEF Handbook describes how to construct life tables and other
estimates of mortality. But as mentioned above, the calculations are
complex, and you should seek expert assistance before trying to estimate
mortality indirectly.
'&
*
•£>
30
40
50
60
70
80
90
100
Respondents
67
50
40
34
29
25
23
20
Sample size
Design Effect
2010
2000
2000
2040
2030
2000
2070
2000
1.33
1.25
1.20
1.17
114
1.12
1.11
1.10
Note: Obviously, you should change the assumptions to reflect your
u>
■
&
■
&
particular situation. However, all of these combinations would produce
results at the 95 percent confidence level that are within two percentage
points of the true mortality rates.
> %
w
h fltw a » wiiw
w. ■ ■ ■
Clusters
Module 2: Assessing health needs; appendix G.5
203
Appendix H: Survey management forms
The two forms on the next pages can be used to: 1) enumerate eligible
respondents within a cluster; and 2) record interview experience with
selected respondents.
Form 1 (Household enumeration) should be used at the final stage of
cluster sampling to identify all households in the cluster that include an
eligible respondent. If there were 30 clusters, then 30 of these forms would
be filled out. The top portion of the form includes routine data (study name,
date, etc.), a statement of the eligibility criteria for respondents (e.g., all
married women age 15-49; children under two years old), and the cluster
number and community name (to make it easier to identify). It also includes
the estimates taken from the sample design (see Appendix F) of the total
population in the cluster, the expected number of households there, and
the expected number of respondents. These last figures will give the
enumerator an idea of the task at hand and can serve to verify the
population estimates.
The enumerator would go to each household in the cluster, and give it
an identifying number (HH No.). If it doesn’t have one, the enumerator
should determine whether the household is occupied (HH Occ: Yes, No).
The enumerator should then interview a household resident to determine
how many eligible respondents live there (Elig Resp) and note anything
unusual in the Remarks column (e.g., away on holiday for two mo.).
After all of the households have been enumerated in all of the clusters,
the study team would use a random number table to select the desired
number of respondents (e.g., seven) from each of these lists. Those selected
would be marked on the form (Selected). Those households would then be
transferred to Form 2.
Form 2 (Respondent disposition) would contain a list of the households
to be contacted. A master list can be made out in the office and copies of
the assigned households given to each interviewer. If there were to be seven
interviews per cluster, and an interviewer were assigned three clusters, then
each of ten interviewers would be given a list of 21 households to contact
(3 clusters x 7 respondents).
The interviewer would note the date that the first attempt was made to
interview the respondent (Attempted interview). If the respondent is not
at home or for some reason cannot be interviewed, then up to two
"call-back" attempts would be made. The interviewer would write in the
dates of these attempts. He or she would indicate in the next column
Module 2: Assessing health needs; appendix H
204
(Interviewed Yes, No) whether the respondent was successfully interviewed,
and include any relevant comments (e.g., refused, sick).
After the interviews are completed, the totals for each cluster should be
calculated.
This example assumes that there is no substitution for respondents who
are not at home or cannot be interviewed. If substitution is permitted, then
the list of eligible respondents can be increased. For example, instead of
selecting seven respondents at random from Form 1, an addition number
(say three) could be added to be interviewed if one of the original seven
cannot be.
STUDY NAME:
FORM 1: Household enumeration
DATE:
ELIGIBILITY CRITERIA:
COMMUNITY NAME:
CLUSTER NO:
ENUMERATOR.
ELIGIBLE
RESPONDENTS:_______________
HH:
EST. POPULATION:
Remarks
1
2
3
4
5
6
7
8
9
10
SEQ
No.
*26
*27
*28
*29
*30
*31
*32
*33
*34
*35
11
12
13
14
15
16
*36
*37
*38
*39
*40
*41
SEQ
No.
HH
No-
HH
Occ
Elig
Resp.
Selected
17
*42
18
*43
19
*44
20
*45
21
*46
22
*47
23
*48
24
*49
25
*50
Total
Total
HH
No.
HH
Occ.
Elig Selected
Resp.
Remarks
Module 2: Assessing health needs; appendix H
205
Form 2:
Study name:
Respondent disposition
Date:
Interviewer:
Clus
No.
SEQ
No.
Attempted
Interview
HH
No.
1
2
Interview
3
Y
Remarks Clus SEQ
No. No.
N
HH
No.
1
TOTAL
Module 2: Assessing health needs; appendix H
Attempted
Interview
2
3
Interview
Y
N
Remarks
Appendix I: Tabulation and analysis
templates
This appendix includes three tools that can help you organize and carry
out your analysis more easily. They are:
Appendix 1.1: Analysis plan
Appendix 1.2: Data entry and analysis templates
Appendix 1.3: Confidence interval estimation template
Appendix 1.1: Analysis plan
The following is an illustrative analysis plan for a rapid survey. The plan
is a list of suggested frequency distributions, averages (means), and cross
tabulations. The first frequency distribution shows how a table would be set
up, with subclassifications of the variable (age) and the number and percent
distributions laid out. The numbers in parentheses refer to the variables
coding numbers on the questionnaire.
RAPID SURVEY QUESTIONNAIRE: Breastfeeding and growth
monitoring
Frequency distributions
1.
Number of women by age (6) N and percent
Categories
N
%
aged 15 to 19 years
aged 20 to 24 years
aged 25 to 29 years
aged 30 to 34 years
aged 35 to 39 years
aged 40 to 44 years
aged over 44 years
Total
100 %
Mean age of respondents:
Yrs.
2.
Number of women by number of children under age two (7)
No. children
(0)
One child
(1)
Two children
(2)
Three or more children
(3)
Module 2: Assessing health needs; appendix 1.1
20S
3.
Number of women currently BREAST FEEDING (8)
Yes
(1)
No
(0)
Don’t Know (9)
4.
Time after birth that BREAST FEEDING began (9)
Within 3 hours
(1)
3-12 hours
(2)
13 - 24 hours
(3)
More than 24 hours (4)
DK/NR
(9)
5.
Number for women who fed baby colostrum (10)
Yes
(1)
No
(0)
DK/NR
(9)
6.
Mean age at which BREAST FEEDING will/did stop:
7
Mean age at which mothers will/did begin supplementary foods:
months (12)
8.
Proportion of children under 2 registered for growth monitoring (13)
Yes
(1)
No
(0)
DK/NR
(9)
9.
Proportion of mothers who have had growth monitoring explained to
them by health workers (14)
Yes
(1)
No
(0)
DK/NR
(9)
10.
Proportion of women who have had their children weighed by a
health worker, nurse, or doctor (15)
Yes
(1)
No
(0)
DK/NR
(9)
if
months (11)
Module 2: Assessing health needs; appendix 1.1
209
11.
Proportion of mothers who have growth card at home (16)
Yes
(1)
No
(0)
DK/NR
(9)
12.
Proportion of mothers with card who were able to find it (17)
Yes
(1)
No
(0)
DK/NR
(9)
13.
Proportion of cards with weight and age correctly plotted (18)
Yes, correctly plotted
(1)
Plotted, but incorrectly
(2)
Not plotted
(0)
DK/NR
(9)
14.
Total number of times children with cards have been weighed (19)
Mean number of times weighed:
15.
Total number of times children with cards weighed in the past
quarter (20)
Mean number of times weighed:
16.
Proportion of mothers with cards who can explain it correctly (21)
Yes
(1)
No
(0)
NR
(9)
17.
Proportion who know name of their local CHW (22)
Yes
(1)
No
(0)
NR
(9)
18.
Proportion who have been visited by a CHW during the past three
months (23)
Yes
(1)
No
(0)
NR
(9)
Module 2: Assessing health needs; appendix 1.1
210
Cross-tabulations
Cross-tabs are generally not used in cluster samples because the sample
cannot be broken into subsamples for comparison of one subgroup to
another. That is, the statistics that are produced by cross-tabs cannot be
used. However, cross-tabs may still be useful in a qualitative sense. They
may give the manager an idea of possible relationships that could be
examined more closely in future investigations. If you are using random or
stratified samples, then cross-tabs are appropriate as one of the most
important types of analysis.
The proposed cross-tabs examine the distribution of an independent
variable (e.g., number of children) by a dependent variable (age) to see if
there is a correlation between the two variables. That is, does the number
of children vary according to the age of the mother? The rapid surveys
tend to include very few dependent variables. Age is the predominant one
in this example. Others that might be important and could be added include
sex, education, literacy, race, ethnic group, income level, and location.
1. Age of mother (6) by
Number of children (7)
Number of women who breast fed with colostrum (10)
Number of women who have their child’s growth chart at home (12)
Number of children registered for growth monitoring (13)
Number of children weighed at least once (15)
Number of mothers whose chart is correctly plotted (18)
Number of mothers who can explain the growth chart (21)
2. Community health worker’s visit (17) by
Number of children (7)
Number of women who breast fed with colostrum (10)
Number of children registered for growth monitoring (13)
Number of children weighed at least once (15)
Number of mothers whose chart is correctly plotted (18)
Number of mothers who can explain the growth chart (21)
Module 2: Assessing health needs; appendix 1.1
211
Appendix 1.2: Data entry and analysis
templates
The sample printouts that follow illustrate how survey data can be
entered into a preformatted spreadsheet that will automatically compute
most of the basic counts, averages, and frequency distributions that you will
need. The first spreadsheet (MINIGM. WK1) can be used to summarise
data for 30 clusters with up to 11 variables in addition to the descriptors.
The second (RAPIDANC.WK1) covers 14 variables, plus descriptors, and
includes multiple choice questions. It can be used to enter all 210 responses
from the 30 clusters.
This same format can be used for entering data manually. Simply use
several sheets of ruled paper, draw vertical lines to separate the columns,
label the variables along the top, and enter the data in each row.
The format and construction of these templates are identical; the only
difference is the number of variables and respondents. The MINIGM file
has been set up to summarize data for 30 clusters. The RAPIDANC file
has been set up for 210 respondents. Both can be enlarged or reduced
simply by inserting or deleting the appropriate number of rows. Variables
can be added or deleted as well, although this is a bit more complicated
since each variable will have its own coding structure.
The top border of both templates shows a summary of the variables and
their corresponding codes or abbreviations for easy reference. Those codes
or abbreviations are repeated in the row below. For example, in the
MINIGM spreadsheet Ch refers to variable 6: No. Children under age 2. In
the RAPIDANC spreadsheet the variables code number (9,12, etc.) is used
instead of abbreviations.
To enter data the interviewer simply needs to key in the precoded data
from a cluster or questionnaire into a row. For example, starting to the
right of "Quest." 1 in the MINIGM spreadsheet, enter the date under variable
4, then the cluster’s ID number in the next column (5), the total number of
children the respondents have under age 2 in the next column (6), and so
forth through item (17). Repeat this process until all data from all question
naires have been entered.
Many entries will simply be coded 1 for "Yes," 0 for "No," and 9 for Don t
Know/No" Response. Some multiple choice items may have additional
codes (see, for example, variables 9,10,11,13,15, and 17 in the RAPIDANC
spreadsheet). If an item is blank on the questionnaire, it should be left blank
in the spreadsheet. Do not enter a 0, as that is usually a negative response
and will be counted as such. Do not press the space bar, as that inserts an
Module 2: Assessing health needs; appendix 1.2
212
invisible apostrophe (’). In fact, do not enter anything, since the program
counts all non-blank cells when it does tabulations.
This program has no error-checking features, so it will be important to
verify the entries to make sure that they are correct. There are two simple
ways to do this: 1) enter the data twice in two separate files, print them out,
and compare the entries; and 2) use a two-person team to enter the data,
with the first reading out the data and checking what the second person
enters.
Module 2: Assessing health needs; appendix 1.2
213
MINI-SURVEY QUESTIONNAIRE, GROWTH MONITORING
16/January/1991
Study No. ____________
Prov._____________
Interviewer
(1)
(2)
(3)
ID ID No.
BSup Begin Supp Food
SH Shows card
Ch<2 Children under two
RGM Registered for GM
#Wt Times weighed
BF Breastfeeding baby
W Ever Weighed
WLQ # weights last qtr
SBF Age Stop Breastfeeding CH Growth chart at home
EXC Can explain chart
(5)
(4)
(6)
(7)
(8)
(9)
(10) (11) (12) (14) (15) (16)
ID Ch 2
Ques Date
BF SBF BSup RGM
W CH SH #Wt WLQ
101
1
1
24
6
1
1
1 24/April/1990
1
0
102
2
0
14
4
1
2 24/April/1990
0
0
103
1
1
16
7
0
1
9
3 24/April/1990
104
1
1
4
8
0
1
4 24/April/1990
9
105
1
1
12
9
1
1
0
5 24/April/1990
106
1
1
15
5
1
1
6 24/April/1990
0
107
1
1
18
7
1
1
1
0
7 24/April/1990
108
1
1
21
12
1
1
1
1
8 24/April/1990
3
1
109
2
22
0
2
1
0
1
1
2
1
9 24/April/1990
110
1
1
25
14
0
1
0
10 24/April/1990
111
1
1
32
13
1
1
1
1
3
1
11 24/April/1990
112
1
1
12
1
1
0
10
12 24/April/1990
113
2
1
14
1
1
1
1
4
8
1
13 26/April/1990
114
1
1
16
1
0
5
9
14 26/April/1990
1
1
18
1
1
0
115
9
15 26/April/1990
12
1
0
1
1
2
1
116
1
0
15
16 26/April/1990
16
1
1
0
117
1
1
13
17 26/April/1990
1
9
0
1
1
17
8
118
18 26/April/1990
0
1
22
9
1
1
1
119
19 27/Apri 1/1990
1
1
1
1
1
1
1
21
6
1
120
20 27/April/1990
0
1
1
13
11
121
1
1
21 27/Apri 1/1990
9
1
14
1
14
122
2
1
22 27/Apri 1/1990
1
1
0
1
16
6
123
1
23 27/Apri 1/1990
1
1
4
2
1
1
9
1
18
124
2
24 27/ApriI/1990
1
1
1
3
0
1
22
9
0
125
1
25 27/ApriI/1990
0
1
1
6
1
21
1
126
2
26 27/Apri!/1990
1
0
1
5
24
1
1
127
27 27/Apri!/1990
4
1
1
1
1
4
1
26
1
2
28 27/April/1990
128
1
0
12
1
22
1
29 27/April/1990
129
1
1
9
1
10
14
1
1
30 27/Apri 1/1990
130
9
Total
12
9
30
30
30
30
30
30
30
30
30
Module 2; Assessing health needs; appendix 1.2
(17)
EXC
1
1
0
1
1
1
1
0
1
9
214
Number
Average
Frequency Distributions:
1 Yes
0 No
9 UNK/NR
37
1.23
541
2.89
BF
26
4
0
26
2.89
256
111
RGM
25
5
0
w
26
4
0
CH
12
12
6
SH
9
3
0
10
1.11
EXC
7
2
0
PROBLEM HIGHLIGHTER: IF NO > 10 PROBLEM NOTED BELOW AS 1.
PROBLEM = 1:
0
0
0
1
0
0
EP
867%
13.3%
0%
RGM
w CH SH
83.3% 867% 40.0% 75.0%
16.7% 133% 40.0% 25.0%
0
0 20.0% 0.0%
EXC
77.8%
22.2%
0.0%
BF
1
BF
0
BF
9
RGM
1
RGM
0
RGM
9
Percentage distributions:
1 Yes
0 No
9 UNK/NR
Data Base Range Instructions:
W
1
w
0
w
CH
1
CH
0
CH
9
SH
1
SH
0
SH
9
9
GRAPH INFORMATION
Three graphs have been prepared for this spreadsheet. One is always active Press F10 to view it and
F10 again to return to the spreadsheet.
To view the other graphs press /.Graph,Name, (highlight name desired).
Graph Names:
% Brstfed
Percent children breast fed
%WEIGHED Percent of children ever weighed
REG GM
Percent of children registered for growth monitoring
EXC
1
EXC
0
EXC
9
Module 2: Assessing health needs; appendix 1.2
215
When all of the data have been entered, press F9 to calculate (or
recalculate) the totals, averages, and frequency distributions.
These are shown at the bottom of each spreadsheet, after the last
respondent’s questionnaire. The large spreadsheet (RAPIDANC) includes
a macro to move quickly to this area (press < Alt + F >).
There are several types of calculations shown, most of which are shown
in the same column as the data for a given variable. For example, the
computation of the average number of children under age two is directly
under the data entries for that variable in Column D.
Counts (totals of columns)
30 respondents to questions 5-12
12 respondents to question 14
37 children > 2 yrs
Averages (means)
1.23 children < 2 per respondent
Stop breast feeding at 18.03 months
Children weighted 2.89 times
Frequency and percentage distributions
26 women (86.7%) breast feeding
4 women (13.3%) not breast feeding
Problem highlighter
More than 10 respondents did not have a growth chart at home
The "problem highlighter" allows the manager to set a level above which
a particular response is considered a problem. In the MINIGM spreadsheet,
that level is set at 10 (cell F54). The level can be set to any number merely
by typing it in the cell. The program compares the number of "No"
responses in each column to 10 and places a 0 or 1 in the next row. The
0 indicates no problem (10 or fewer); the 1 indicates a problem (11 or more).
Three graphs are included in the MINIGM spreadsheet. Press F10 to
display the first. Instructions for switching to the other graphs are found
at cell A70.
The RAPIDANC spreadsheet is structured the same way, except that
multiple choice frequency distributions are placed at the bottom of the
spreadsheet because they require more room. In this example, variables 9,
10,11,13,15, and 17 are displayed. The excerpt illustrated here only shows
the first three of these distributions due to space limitations.
Module 2: Assessing health needs; appendix 1.2
216
At the very bottom of each spreadsheet is a block of "data base
instructions" that the Lotus 1-2-3 program needs to compute the frequency
and percentage distributions. These do not need to be printed for the report,
but they do need to be included in any copy that is made of these computer
files.
RAPID SURVEY DATA ENTRY AND TABULATION TEMPLATE FILE: RAPIDANC.WK1
Date. 16/January/1991
Press Alt + F = Go to FREQUENCY
ANTENATAL
CARE
DISTRIBUTIONS
Study No.
(1)
Prov.
(2)
Interviewer
(3)
5 ID No. (Clstr + Rspndnt)
12 Received TT last preg.
19 CHW visit last 3
6 Age of women
7 Received ANC last preg
8 No. times rec’d ANC
9 Month preg. before ANC
10 Place ANC received
11 Advised to get ANC
13 No. of vacc. received
14 Took iron pills
15 Outcome of pre gnancy
16 Where deliverec
17 Delivered by:
18 Name of C(4W
7
1
0
9
9
0
0
1
1
Quest.
1
2
3
4
5
6
7
8
Date (4)
24/Apr/90
24/Apr/90
24/Apr/90
24/Apr/90
24/Apr/90
24/Apr/90
24/Apr/90
24/Apr/90
5
101
102
103
104
105
106
107
201
6
23
24
25
26
27
28
30
35
207
208
209
210
Total:
27/Apr/90
27/Apr/90
27/Apr/90
27/Apr/90
210
3004
3005
3006
3007
30
1 2 1
1
1 2 1 1
30
30
1 2 1 1
28 9
1
30 210 97 98 210
VARIABLE NO.-
(6)
8
1
2
1
9 10
1 1
3
4
5
2
2
2 3
1 4
11 12
1 1
5 0
6 0
3 0
2 9
4 0
3 0
2 1
3 14 15 16 17
10 111
3
2 12
2 13
112
114
2 2
1 0 3
1
3
1 9 3 1 3
3 1
1 9 3 1 3
3 1
1 9 3 1 3
6 9 2 1 2 2
210 210 96 96 210 152 122
18
19
9
1
9
0
0
0
10
0
0
9
0
0
0
0
0
0
0
0
0
210
9
9
9
0
210
(8)
Number
295
3.07
Frequency Distributions — VARIABLE:
(7)
(12)
(14)
(16)
(18)
(19)
1 Yes
97
97
12
121
48
24
0 No
85
84
35
32
134
158
9 UNK/NR
28
29
49
0
28
26
Module 2: Assessing health needs; appendix 1.2
217
PROBLEM HIGHLIGHTER:
100
PROBLEM - 1;
0
Percentage Distributions:
1 Yes
ONo
9 UNK/NR
(7)
46.2%
405%
13.3%
PROBLEM IS NOTED BELOW AS L
1
1
1
1
1
(12)
(14)
12.5%
36.5%
51.0%
(16)
79.6%
20.4%
0.0%
(18)
22.9%
63.8%
13.3%
(19)
11.4%
752%
13.3%
(9) Months preg. prior ANC (10) Place where ANC received
(11) Advised to get ANC by:
1 3 months
49 50.0%
1 Hospital
50 23.8% 1 Physician, nurse 20 9.5%
2 4-6 months 26 26.5% 2 Health centre/ clinic 38 18.1% 2 Community
48 22.9%
nurse/ midwife
3 7-9 months 12 12.2% 3 Private hospital/clinic 47 22.4% 3 CHW/Volunteer 47 224%
9 UNK/NR
11 11.2% 4 Local TBA/healer
29 13.8% 4 TBA
21 10.0%
5 Other site of care
16 7.6% 5 Mother/relative
37 17.6%
9 UNK/NR
30 14.3% 6 Friend/neighbor 25 11.9%
7 Other
0 0.0%
9 UNK/NR
12 5.7%
(13) No. Vaccinations Rec’d (15) Pregnancy outcome
(17) Delivery attendant
1 One
61 63.5%
1 Live birth
104 49.5% 1 GHW
11 9.0%
2 Two
3 3.1% 2 Stillbirth
43 20.5% 2 TBA
35 28.7%
3 Three
10 10.4% 3 Abortion/miscarr,
44 21.0% 3 Unattended
35 28.7%
9 UNK/NR
22 22.9% 9 UNK/NR
19 9.0% 4 Private provider 15 123%
5 CHW
14 11.5%
6 CN/NMW
0 0.0%
12 9.8%
9 UNK/NR
Module 2: Assessing health needs; appendix 1.2
218
Adjusting the spreadsheets
Deleting and inserting rows
As noted above, it is very easy to expand or contract the spreadsheets
to fit the number of respondents in any given survey.
1) To DELETE rows: place the cursor on any data row except the first
and last. Press < / >, Worksheet, Delete, Row, (highlight the number
of rows to delete), <Enter>. All of the formulas will be adjusted
automatically. However, if you delete the first or last rows, there will
be an error, and the formulas will have to be re-entered.
2) To INSERT additional rows: place the cursor on any data row except
the first and last. Press < / >, Worksheet, Insert, Row, (highlight the
number of rows to enter), <Enter>. Next you must copy an already
formatted row into the blank spaces: </>, Copy, (highlight all of the
cells in the row to be copied), <Enter>, (place the cursor at the first
blank row, press the period/decimal point [.] and move the highlight
down to the last blank row), <Enter>. This will fill in the blank rows
and the formulas for totals, averages, and frequency distributions will
be adjusted automatically.
Deleting and inserting columns
It is slightly more complicated to delete, and especially to insert, new
columns of variables. That is because the codes and formulas will usually
have to be adjusted. It would be prudent to have the assistance of someone
who is familiar with Lotus 1-2-3 @ functions and formulas. Two easy ways
to make adjustments:
3) Instead of DELETING unwanted columns, just leave them blank or
erase (rather than delete) the portion of the column that contains
data and tabulations (</>, Range, Erase, [highlight area to be erased),
<Enter>).
4) Instead of INSERTING new columns, find one that has the same coding
structure as the one you want to insert (e.g., Yes = 1, No = 0, DK/NR
= 9), copy the portion of the column that contains data, tabulations,
and the database instructions to the first blank column on the
right of the spreadsheet: </>, Copy, (highlight range to be copied),
<Enter>, (move cursor to cell location), <Enter>). You will need to
change the variable name at the head of the column, e.g., EXC in
Column N of the MINIGM spreadsheet, and in the database instruc
tions at the bottom of the spreadsheet. For example, if the new variable
name is ORT, change EXC to ORT wherever it appears in the column.
Module 2: Assessing health needs; appendix 1.2
219
This is necessary so that the program can match the instructions with
the proper column.
Adapting the spreadsheets to other PHC topics
To customise the spreadsheet completely, it would be best to get someone
who is familiar with Lotus 1-2-3 or similar spreadsheets to work with you.
Basically, you will need to:
• change the summary of variables at the top of the spreadsheet;
• insert new variable names along the row above the database;
• copy, move, or insert the appropriate number and types of columns
for each variable;
• insert or delete rows to fit the number of expected respondents;
• adjust the formulas for counts, averages, and frequency distributions
at the bottom of the spreadsheet;
• set up frequency distributions for multiple choice questions; and
• adjust the data base instructions.
K'
Module 2: Assessing health needs; appendix 1.2
221
Appendix 1.3: Confidence interval
estimation template
Ralph Frerichs has developed a simple template that can be used to
compute confidence intervals for selected variables. An example is shown
on the next page.
This template would be used after the data have been entered and
tabulated to determine the standard error, the design effect, the intraclass
correlation, and three confidence intervals (90, 95, and 99 percent).
To use the template, select a variable to examine. In this example, the
variable is "the proportion of women who received TT vaccination during
their last pregnancy." You must first count the number of women in each
cluster who were interviewed and the number who responded "yes" or "no"
to the variable. Then simply enter those numbers in Column B (No. of
sampled women) and Column C (Observed). In the example, there were 7
women interviewed and 6 who answered "yes" in the first cluster. The
numbers were 7 and 6 in the second cluster, 7 and 5 in the third, and so
forth.
The only other data you need to enter is the total number of the
populations target group. In this case, 24,653 (entered in cell D45).
Press F9 and the program will make all of the calculations. The average
proportion who received TT is shown in the "Total" Column at the far right
column (cell G42) as 0.694, That is, 69.4 percent of the sampled women
received TT.
The confidence intervals are shown in the lower left corner of the page.
For example, we are 90 percent confident that the true proportion of
women who received TT lies somewhere between 61.3 and 77.4 percent.
Or, put another way, the proportion is 69.4 percent, plus or minus 8
percentage points.
This template can be easily adjusted to increase or decrease the number
of clusters. Simply delete or insert the appropriate number of rows in the
table. See the instructions in the previous section (Appendix H2) for more
details.
Module 2: Assessing health needs; appendix 1.3
222
Antenatal survey, Sisaket, Thailand
Proportion who receiver TT during last pregnancy
FILETT.WK1
No. of women who
received TT
B
A
Sequence
No. of
No. of cluster sampled
women
1
7
7
2
7
3
4
7
7
5
6
7
7
7
8
7
7
9
7
10
11
7
12
7
7
13
14
7
7
15
7
16
7
17
7
18
7
19
20
7
21
7
22
7
7
23
24
7
7
25
7
26
7
27
7
28
6
29
7
30
209
Total
Est. total women in cluster
Ave. no. women/cluster
Ave. no. clusters
Upper
Lower
c
Observed
D
Expected
6
6
5
6
7
6
7
7
1
2
5
6
7
7
3
7
4
5
3
4
4
2
1
4
7
4
4
5
3
7
145
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4 86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.86
4.16
4.86
145.00
24,653.
6.97
30
Confidence Intervals
95%
90%
0.774
0.790
0.597
0.613
99%
0.821
0567
Observed
minus
expected
squared
E
Proportion
with TT in
each cluster
F
0.857
1.308
0.857
1308
0.714
0.021
0.857
1.308
1000
4.595
0.857
1.308
1.000
4.595
1.000
4.595
0.143
14.872
0286
8.159
0.714
4.591
0.857
1.308
1.000
4.595
1.000
4.595
0.429
3.446
1.000
4 595
0.571
0.734
0.714
0.021
3.446
0.429
0.734
0.571
0734
0.571
0.286
8.159
14.872
0.143
0.734
0.571
1.000
4.595
0.734
0.571
0.734
0.571
0.021
0.714
0.500
1.352
1.000
4.595
0.694
102.088
STANDARD ERROR of estimated
sample proportion
for cluster sample
- 0.049
If simple random sample
= 0.032
DESIGN EFFECT
236
ESTIMATED INTRA-CLASS
CORRELATION
COEFFICIENT
0.23
Module 2: Assessing health needs; appendix 1.3
223
REFERENCES AND BIBLIOGRAPHY
• Bennett, Steve, Tony Woods, Winitha M. Liyanage, and Duane L. Smith. "A
simplified general method for'cluster sample surveys of health in developing
countries." World health statistics quarterly. 44 (3): 100,1991.
• David, Patricia H., Leila Bisharat, and Allan G. Hill. Measuring childhood mortality:
A guide for simple surveys. Amman, Jordan: UNICEF, Regional Office of the
Middle East and North Africa, 1990.
• Dean, A.G., J.A. Dean, A. H. Burton, and R.C. Dickers. EPI Info, Version 5: A word
processing, database and statistics system for epidemiology on microcomputers.
Atlanta: Centers for Disease Control, and Geneva: World Health Organization
1990.
• Frerichs, Ralph R., Jack Reynolds, and Melinda Wilson. "Family planning survey
and antenatal survey, Srisaket, Thailand." December, 1987 (unpublished paper,
URC/CHS); "Institutionalizing the use of rapid surveys for family planning
decision-making, an Operations Research Proposal," Gadja Mada University and
University Research Corporation, November 1989; and "Primary Health Care
Management Advancement Programme 1989-1992, a proposal of the Aga Khan
Health Network and PRICOR," November, 1989.
• Frerichs, Ralph R. and Tar Tar; K. "Computer-assisted rapid surveys in developing
countries." Public health reports. 104:14 - 23,1989.
• Graham, Wendy, William Brass, and Robert W. Snow "Estimating maternal
mortality: The sisterhood method." Studies in family planning. 20 (3): 125 - 135,
1989.
• Henderson, R.H. and T. Sunaresan. "Cluster sampling to assess immunization
coverage: A review of experience with a simplified method." Bulletin of the World
Health Organization, 60 (2): 253 - 260,1982.
• Lamptey P and P Piot. The handbookfor AIDS prevention in Africa. Family Health
International, 1990.
• Lemeshow, S. and D. Robinson. "Surveys to measure programme coverage and
impact: A review of the methodology used by the expanded programme on
immunization." World health statistics quarterly. 38: 65 - 75,1985.
• Smith, Gordon S. "Development of rapid epidemiological assessment methods to
evaluate health status and delivery of health services." International journal of
epidemiology. 18 (4 Supplement): S4,1989.
• Trussell, James and German Rodriguez. "A note on the sisterhood estimator of
maternal mortality," Studies in family planning, 21 (6): 344 - 346, November/December, 1990.
• United Nations, Manual X: Indirect techniques for demographic estimation.New
York, 1983.
Module 2: Assessing health needs; references
224
• United Nations, Step-by-stepguide to theestimation of child mortality. Department
of Economic and Social Affairs, 1990.
• World Health Organization. Diarrhoea morbidity, mortality and treatment prac
tices, household suruey manual. CDD/SER/86.2
• World Health Organization. Expanded programme on immunization, Trainingfor
mid-leuel managers: Coveragesuruey. WHO/EPI/MLM/COV/88, Revised 1988.
Module 2: Assessing health needs; references
225
Acronyms and abbreviations
AIDS
AKF
AKHN
AKHS
AKU
ARI
BCG
CHW
CMR
DPT
EPI
GM
IEC
IMR
KAP
MIS
MMR
MOH
NGO
OPV
ORS
ORT
PHC
PHC MAP
PNC
PRICOR
STD
TB
TBA
TT
UNICEF
URC
USAID
WHO
Acquired immune deficiency syndrome
Aga Khan Foundation
Aga Khan Health Network
Aga Khan Health Service
Aga Khan University
Acute respiratory infections
Bacillus of Calmette and Guerin (tuberculosis vaccine)
Community health worker
Child mortality rate
Diphtheria, pertussis and tetanus vaccines
Expanded Programme for Immunization
Growth monitoring
Information, education, communication
Infant mortality rate
Knowledge, attitudes, practice (behaviour)
Management information system
Maternal mortality rate
Ministry of health
Non-governmental organisations
Oral poliovirus vaccine
Oral rehydration salts
Oral rehydration therapy
Primary health care
Primary Health Care Management Advancement Programme
Peri-natal care
Primary Health Care Operations Research
Sexually-transmitted diseases
Tuberculosis
Traditional birth attendant
Tetanus toxoid
United Nations International Children’s and Education Fund
University Research Corporation
United States Agency for International Development
World Health Organization
Module 2: Assessing health needs; acronyms and abbreviations
226
Glossary
Attribute: A quality or characteristic of interest, such as age
Binomial: Refers to a variable or distribution that has only two possible
values, such as Yes/No, right/wrong, up/down.
Cluster: A group, usually within a specific geographic area.
Cluster sample: A sample of a population that is divided into a specified
number of groups. In this module the standard cluster sample consists of
30 clusters from which 7 or more respondents are selected for interview.
Community health worker (CHW): A person indigenous to the
community who provides basic preventive and curative health services to
members of the community. Includes village health workers, health guides,
and other terms
Community: A group of people having common organization or interest
or living in the same place under the same laws.
Coverage: The percent of a target group that has received a service or is
protected from a disease or health problem
Effectiveness: The degree to which desired outcomes are achieved
Effects: Changes in knowledge, skills, attitudes and behariours as a result
of a PHC programme
Efficiency: The degree to which desired outcomes are achieved without
wasting resources
Goals: The impact the PHC programme expects to have on health. Goal
statements specify the improvement desired, target group, amount of
change expected
Impacts: Changes in health status (mortality, morbidity, fertility, disability)
Indicator: An indirect measure of an event or condition. For example, a
baby’s weight-for-age is an indicator of the baby’s nutritional status.
Indicators: Indirect measures of a programme’s progress related to: inputs,
processes (outputs, effects, impacts); objectives; and goals.
Inputs: Resources (personnel, materials and equipment, information and
money)
Management: The art and science of getting things done through people.
Objectives: The output and/or effect that a programme hopes to achieve
Outcomes: Results of programme, including outputs, effects and impacts
Outputs: Products and services provided by a PHC programme
Effects: Changes in knowledge, skills, attitude and behaviour,
(including coverage) as a result of a PHC programme
Module 2: Assessing health needs; glossary
u
■Q
&
227
Impacts: Changes in health status, (mortality, morbidity, disability,
fertility) as a result of a PHC programme
Primary health care: Essential health care, accessible at affordable cost
to the community and the country, based on practical, scientifically sound
and socially acceptable methods. It includes at least eight components:
health education, proper nutrition, clean water and basic sanitation, mater
nal and child health care, immunization, control of common diseases and
injuries, prevention of local endemic diseases, essential drugs.
Processes: Activities or tasks carried out through programmes
Random sample: Selection of respondents in such a way that every
member of the population being studied has an equal chance of being
selected.
Respondent: The individual/s being asked or administered questions.
Sampling interval: In cluster sampling, this is the interval between one
cluster and the next The sampling interval is determined by dividing the
population of the area under study by the number of clusters required for
the survey.
Sampling interval: In cluster sampling, this is the interval between on
e cluster and the next. The sampling interval is determined by dividing the
population of the area under study by the number of cluster required for
the survey. For example, if the population of the study area is 45,000 and
the total number of clusters needed is 30, then the sampling interval is 1500
(45,000/30=1,500).
System: A set of discrete, but interdependent, components designed
to achieve one or more objectives.
Tabulate: To put data into a table or columns. To arrange systematically.
Target group: Specific groups of people designated to receive a PHC
service, such as children under age two years designated to receive
immunizations
Module 2: Assessing health needs; glossary
PHC MAP MANAGEMENT COMMITTEE
Dr. Ronald Wilson • Aga Khan Foundation, Switzerland (Co-Chair)
Dr. Jack Bryant • Aga Khan University, Pakistan (Co-Chair)
Dr. William Steeler • Secretariat of His Highness the Aga Khan, France (Co-Chair)
Dr. Jack Reynolds • Center for Human Services, USA (PHC MAP Director)
Dr. David Nicholas • Center for Human Services, USA
Dr. Duane Smith • Aga Khan Foundation, Switzerland
Dr. Pierre Claquin • Aga Khan Foundation, Switzerland
Mr. Aziz Currimbhoy • Aga Khan Health Service, Pakistan
Mr. Kabir Mitha • Aga Khan Health Service, India
Dr. Nizar Verjee • Aga Khan Health Service, Kenya
Ms. Khatidja Husein • Aga Khan University, Pakistan
Dr. Sadia Chowdhury • Aga Khan Community Health Programme, Bangladesh
Dr. Mizan Siddiqi • Aga Khan Community Health Programme, Bangladesh
Dr. Krasae Chanawongse • ASEAN Institute for Health Development, Thailand
Dr. Yawarat Porapakkham • ASEAN Institute for Health Development, Thailand
Dr. Jumroon Mikhanorn • Somboon Vacharotai Foundation, Thailand
Dr. Nirmala Murthy • Foundation for Research in Health Systems, India
PHC MAP TECHNICAL ADVISORY COMMITTEE
Dr. Nirmala Murthy • Foundation for Research in Health Systems, India (Chair)
Dr. Krasae Chanawongse • ASEAN Institute for Health Development, Thailand
Dr. Al Henn • African Medical and Research Foundation (AMREF), formerly of
the Harvard Institute for International Development
Dr. Siraj-ul Haque Mahmud • Ministry of Planning, Pakistan
Dr. Peter Tugwell • Faculty of Medicine, University of Ottawa, Canada
Dr. Dan Kaseje • Christian Medical Commission, Switzerland, formerly of the
University of Nairobi, Kenya
KEY PHC MAP STAFF AT THE CENTER FOR HUMAN SERVICES
Dr. Jack Reynolds (PHC MAP Director)
Dr. Paul Richardson
Dr. David Nicholas
Dr. Wayne Stinson
Ms. Maria Francisco
Dr. Neeraj Kak
Ms. Lori DiPrete Brown
Ms. Pam Homan
Dr. Lynne Miller Franco
Ms. Mary Millar
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